RANGE OF MOTION TESTING:
CERVICAL ROM (Circle your Approved Choice)
Flexion: _____ _____ _____ 45
Extension: _____ _____ _____ 45
Lateral Right: _____ _____ _____ 45
Lateral Left: _____ _____ _____ 45
Rotation Right: _____ _____ _____ 80
Rotation left: _____ _____ _____ 80
THORACOLUMBAR ROM (Circle your Approved Choice)
Flexion: _____ _____ _____ 90
Extension: _____ _____ _____ 30
Lateral Right: _____ _____ _____ 30
Lateral Left: _____ _____ _____ 30
Rotation Right: _____ _____ _____ 30
Rotation left: _____ _____ _____ 30
COMMENTS:
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COMPARATIVE MUSCLE TESTING:
CERVICAL CMT
Flexion: _____ _____
Extension: _____ _____
Lateral Right: _____ _____
Lateral Left: _____ _____
Rotation Right: _____ _____
Rotation Left: _____ _____
LUMBAR CMT
Flexion: _____ _____
Extension: _____ _____
KNEE CMT
RIGHT
Flexion: _____ _____
Extension: _____ _____
LEFT
Flexion: _____ _____
Extension: _____ _____
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