ASSESSMENT

Welcome!  We can't wait to learn all about you so we can design a program that will alleviate your back pain.  Watch each video then answer each of the questions relating to that video.  When you are done just hit submit and we will be back in touch 

Watch each video to see how to perform the stretch.  Read the instructions before performing each stretch. Answer all the questions as completely and with as much detail as possible.  The more information you provide, the more we will have to use when creating your personalized program.

Did you feel any discomfort from this exercise?

Balance test

The following Tests are done in a standing Position

1: STANDING BALANCE TEST

Instructions:
Watch video and stand on each leg as demonstrated in the video.  Aim to stand on each leg for 20 seconds

Do you feel any discomfort when standing on your right leg?
Were you able to maintain balance for 20 seconds when standing on your right leg?
Did you feel any discomfort from this exercise?
Do you feel any discomfort when standing on your left leg?
Were you able to maintain balance 20 seconds when standing on your left leg?

2: QUADRICEPS STRETCH

Instructions:
You will be instructed to try to reach your ankle and pull your thigh backward.  Try to keep knees together and avoid letting your back arch as best as possible. You will feel your standing leg working, and that is ok as long as there is no pain. If you cannot reach your ankle then please use a towel for assistance as demonstrated in the video

Can you stand on your left leg reach your right ankle, pull your leg backward and feel the stretch in the front of your right thigh?
Can you stand on your left leg and perform this stretch without holding on?
Did you need to use a towel to reach your right ankle?
Did you need to use a towel to reach your left ankle?
Do you feel any discomfort in your low back when standing on your right leg leg?
Did you need to use a towel to reach your right ankle?
Do you feel any discomfort in your low back when standing on your left leg?
Can you stand on your right leg reach your left ankle, pull your left leg backward and feel the stretch in the front of your left thigh?
Can you stand on your right leg and perform this stretch without holding on?
Did you feel any discomfort from this exercise?

3: Standing/Posture tesT

Instructions:
This exercise is done standing against the wall. If you feel your back is arching when you perform this exercise, roll up a thin hand towel and place it in the small of your back, making sure it doesn’t slip to the floor.

Does your head comfortably touch the wall when standing in this position with eyes looking forward?
Did you feel any discomfort from this exercise?

4: U-Test

Instructions:
This exercise is done standing against the wall. If you feel your back is arching when you perform this exercise, roll up a thin hand towel and place it in the small of your back, making sure it doesn’t slip to the floor.

Does your right upper arm touch the wall?
Does your left upper arm touch the wall?
Does your right forearm touch the wall?
Does your left forearm touch the wall
Do your shoulders elevate when performing this exercise?
Are you able to hold the towel in place when performing this stretch?
Do you experience any pain when performing this exercise?
Did you feel any discomfort from this exercise?

5: Internal/External rotation

Instructions:
This exercise is done standing against the wall. If you feel your back is arching when you perform this exercise, roll up a thin hand towel and place it in the small of your back, making sure it doesn’t slip to the floor.

Do your shoulders elevate when arms are rotated down and hands are approaching the wall?
Does your back arch (lose pressure or drop the towel) when arms are rotated down and hands are approaching the wall?
Do your hands touch the wall when hands are down?
Does your back arch (lose pressure or drop the towel) when arms are rotated toward the ceiling?
Do you hands touch the wall when hands are up, finger tips pointing to the ceiling?
Did you feel any discomfort from this exercise?

6: Overhead squat

Instructions:
This is a more difficult exercise.  If you find that it causes you discomfort, do not perform this exercise and note it in the comments.

Can you perform this exercise without pain?
Do you knees stay in line with your toes?
Can you keep your arms in line with your ears when you perform this exercise?
Do you feel you are leaning forward when performing this exercise?
When you perform this exercise, does it cause knee pain?
When you perform this exercise, does it cause back pain?
Can you lift your arms overhead and keep your elbows next to your ears?
Can you straighten your arms?
Does your back arch when performing this exercise?
Does your head move forward when performing this exercise?
Did you feel any discomfort from this exercise?

7: Snow angel

Instructions:
This exercise is done standing against the wall with a rolled up hand towel in the small of your back

Do your shoulder tend to elevate when performing this exercise?
Does this exercise cause shoulder discomfort?
When your arms are parallel to the ground, are they straight?
Do your shoulders roll forward when performing this exercise?
How high can you lift your arms without arching your back, elevating your shoulder, causing pain or rolling your shoulders forward?
Did you feel any discomfort from this exercise?

8: hip flexor stretch