Subjective Examination – The Recovery Lab

Subjective ExaminationSName *FirstLastAgeDateBody Chart

Areas Relevant To The Region

Intensity Of Pain

	No Pain	Mild Pain	Moderate Pain	Severe Pain	Very Severe Pain	Worst Possible Possible
Select Pain Intensity	Select Pain Intensity No Pain	Select Pain Intensity Mild Pain	Select Pain Intensity Moderate Pain	Select Pain Intensity Severe Pain	Select Pain Intensity Very Severe Pain	Select Pain Intensity Worst Possible Possible

Is The Pain Deep Down Or Is it On The Surface?

Deep Pain
Superficial Pain

Constant Or Intermittent Symptoms

Constant Pain
Intermittent – Pains Starts Suddenly

Can You Feel the Pain In Any Other Area Of The Body?Temporomandibular Joint

Yawning = Depression Of Mandible
Chewing – Elevation/Depression of mandible
Talking – Elevation/Depression Of Mandible

Shoulder

Tucking Shirt In = Hand Behind Back
Fastening Bra – Hand Behind Back
Lying On Shoulder – Joint Compression
Reaching Up – Flexion

Elbow

Eating – Flexion/Extension
Carrying = Distraction
Gripping – Flexion/Extension
Lying On Elbow – Compression

Forearm/Wrist/Hand

Turning Key – Pronation/Supination
Typing/Writing – Sustained Extension
Gripping – Extension
Power Gripping – Extension
Leaning On Hand – Compression

Hip

Squat – Flexion
Walking – Flexion/Extension
Stairs – Flexion/Extension
Side Lying With Painful Hip Uppermost = Adduction And Medial Rotation

Knee

Squat – Flexion
Walking – Flexion/Extension
Stairs – Flexion/Extension

Foot And Ankle

Walking – Dorsiflexion/Plantarflexion, Inversion/Eversion
Running – Dorsiflexion/Plantarflexion, Inversion/Eversion

Cervical Spine

Reversing The Car – Rotation
Sitting Reading/Writing – Sustained Flexion

Thoracic Spine

Reversing The Car – Rotation
Deep Breath – Extension

Lumbar Spine

Sitting – Flexion
Standing/walking – Extension
Lifting – Flexion

Sacroiliac Joint

Turning Over In The Bed – Nutation/Counternutation of sacrum
Getting Out Of Bed – Nutation/Counternutation of sacrum
Walking – Nutation/Counternutation of sacrum
Standing On One Leg – Downward Shear

Muscular Tissue

Contraction Of Muscle
Passive Stretch Of Muscle

Nervous Tissue

Passive Stretch Or Compression Of Nervous Tissue

Headaches

Has The Patient Experienced Symptoms Of Spinal Cord Compression?

Yes
No

If Yes? Give DescriptionHas The Patient Ever Experienced Symptoms Of Cauda Equina Compression?

Yes
No

If Yes? Give Description