Form

Screening Questions

choose any that apply
Loss of bowel controlUnexplained weight lossNumbness between your legs and groinExtreme leg weakness

Back Extension Test

1. Lie on your stomach with your hands positioned at belly button level

2. Push up, straightening your arms as much as possible
Pass or fail?

✅ Pass: full press up with straight arms and hips stay on the ground🔴 Fail: unable to full straighten arms and/or hips come off ground

Back Flexion Test

1. Keeping your knees straight, bend over and touch your toes
Pass or fail?

✅ Pass: able to touch toes🔴 Fail: unable to touch toes

Back Rotation Test

1. Lie on your right side with your knees and hips bent
2. Place your right hand on top of your left thigh to keep your legs stable
3. Rotate your upper back toward the ground, reaching your left arm back as far as possible

4. Repeat on the other side
Pass or fail?

✅ Pass: able to touch top shoulder to ground and legs stay on ground (on both sides)🔴 Fail: unable to touch top shoulder to floor or keep legs flat on ground (on either side)

Back Side Bend Test

1. Lie on your back with your legs straight

2. Reach toward your right side as far as possible while keeping your shoulders down

3. Reach toward your left side as far as possible while keeping your shoulders down
Pass or fail?

✅ Pass: able to touch your knee on both sides (on both sides)🔴 Fail: unable to reach knee or shoulder comes off ground on both sides (on either side)

Hip Rotation Test

1. Sit on the floor with your hands behind you for support

2. Position your feet just outside hip-width apart, with your knees bent at 90 degrees
3. Rotate both legs to the right, allowing your knees to drop toward the floor
4. Rotate both legs to the left until your knees hit the floor
Pass or fail?

✅ Pass: able to get both knee to touch the ground at the same time (on both sides)🔴 Fail: unable to touch both knees to the ground at the same time (on either side)

Posterior Stability Test

1. Lie on your back and bend your right knee to 90 degrees

2. Keep your left leg straight and lifted slightly off the ground

3. Lift your hips off the ground, using only your right leg, lower back down

4. Perform 20 reps, repeat on the other side
Pass or fail?

✅ Pass: able to perform 20 full motion reps (on both sides)🔴 Fail: unable to perform 20 full motion reps (on either side)

Lateral Stability Test

1. Lay on your right side with your knees bent

2. Go into a lateral plank

3. Hold for 1 minute

4. Repeat on the other side
Pass or fail?

✅ Pass: able to hold for 1 minute with good form (on both sides)🔴 Fail: unable to hold for 1 minute or maintain good form (on either side)

Medial Stability Test

1. Lie on your left side with your leg on a box or chair

2. Lift your body off the floor into a side plank

4. The bottom leg should not be touching the ground

5. Hold for 30s, repeat on the other side
Pass or fail?

✅ Pass: able to hold for 30s with good form (on both sides)🔴 Fail: unable to hold for 30s with good form (on either side)

Extension Tolerance Test

1. Lie on your stomach

2. Place your hands near your stomach

3. Push up, straightening your arms as much as possible while keeping your hips on the ground

4. Repeat 30 times
Positive or negative?

🟢 Positive: pain or symptoms are less🟡 Stable: pain is unchanged🔴 Negative: symptoms worsen

Flexion Tolerance Test

1. Lie on your back

2. Bring both knees to your chest, hugging them tightly
3. Relax your arms slightly, then actively pull your knees back into your chest

4. Repeat this 30 times
Positive or negative?

🟢 Positive: pain or symptoms are less🟡 Stable: symptoms unchanged🔴 Negative: pain or symptoms worsen

Back Sensitivity Test

1. Place your right hand on the back of your right leg

2. Slide your right arm down the back of the leg

3. Repeat on the left side
Pass or fail?

🟢 Positive: this test causes symptoms🟡 Stable: symptoms unchanged🔴 Negative: symptoms decrease

Screening Questions