Part A : Are you at risk ?

1. How often are you uncomfortably aware of any part of your body?

   Never   Sometimes   Often
   Specify area/areas

   Neck	Shoulder	Upper back	Lower back
   Forearm	Elbow	Wrist	Hip & Buttocks
   Knee	Calf	Ankle	Foot

2. On an average how many hours a day, do you spend seated at work?

   Sit less than 3 hrs
   Sit 3-6 hrs
   Sit more than 8 hrs
   

3. How many times do you exercise in a week?

   Every day
   3-4 times a week
   Rarely/ Never
   

4. Are able to work a whole day without fatigue?

   Yes, 8 hrs/ day
   2-6 hours /day
   Yes, less than 2 hrs / day
   

5. Do you have stiffness in any joint?

   Never
   Sometimes
   Yes, after sitting for more than 30 minutes
   Specify area/areas

   Neck	Shoulder	Upper back	Lower back
   Forearm	Elbow	Wrist	Hip & Buttocks
   Knee	Calf	Ankle	Foot

6. Does any of your joints creak?

   Never
   Yes, but no discomfort or pain
   Yes, with discomfort and/or pain
   Specify area/areas

   Neck	Shoulder	Lower back
   Wrist	Knee	Ankle

7. Do you experience a catch in any part of your body?

   Never Sometimes Often
   Specify area/areas

   Neck	Shoulder	Upper back	Lower back
   Forearm	Elbow	Wrist	Hip & Buttocks
   Knee	Calf	Ankle	Foot

8. Do you have trouble climbing up or down stairs?

   Never Sometimes Often

9. Do you get swelling in any of your joints ?

   Never Sometimes Often
   Specify area/ areas

   Elbow

   Wrist

   Knee

   Ankle

10. How often have you experienced pain episodes, on average, during the past three months?
    Never Sometimes Often
    Specify area/ areas

    Neck	Shoulder	Upper back	Lower back
    Forearm	Elbow	Wrist	Hip & Buttocks
    Knee	Calf	Ankle	Foot

Part B: Test yourself

Attempt to perform the activity as described and answer the following questions as accurately as possible

• Test 1

  

  • Sit up with your back straight in a chair.

  • Move your head up as far as you can.

  • Bend head forward to try touch chin to chest

  • Turn your head to the left as far as you can

  • Turn your head to the right as far as you can

  
  

  Choose the answer most applicable
  

  The movements were smooth and I didn’t have any pain or restriction
  

  I felt some amount of restriction
  

  • Stretching back
  • Bending head down
  • Turning head sideways Left Right

  I felt pain and couldn’t complete the activity

  • Stretching back Left Right
  • Bending head down Left Right
  • Turning head sideways Left Right
• 
  
  

  Test 2

  

  • Lie down on your back, bend your knees at 90 degrees with your feet on the floor.

  • Lift both arms perpendicular to the floor.

  • Slowly lower your right arm straight over your head to the floor as far as you can, without arching your back off the ground

  • Repeat with your left arm

    
    
    

  Choose the answer most applicable
  

  Could complete activity without any pain or restriction
  

  I felt some amount of restriction
  

  • 0-45 deg Left Right
  • 45-90 deg Left Right
  • 90-180 deg Left Right

  I felt pain and couldn’t complete the activity

  • 0-45 deg Left Right
  • 45-90 deg Left Right
  • 90-180 deg Left Right
• 
  
  

  Test 3

  

  • Stand up and raise your left arm straight above your head.

  • Bend your left elbow and bring your palm behind your back.

  • Fold your right arm and bring your hand behind your back, palm facing outwards.

  • Now reach down with your left hand while reaching up with your right.

  • Try to bring the fingers of both hands together

  • Have a friend measure the distance between your fingertips.

  • Now switch arms to test your opposite shoulder.

  Choose the answer most applicable
  

  My fingers could touch each other
  

  My fingers could not touch
  

  With Left Arm Up With Right Arm Up

  My fingers were more than 2" apart

  With Left Arm Up With Right Arm Up
• 
  
  

  Test 4

  

  • Start with your arm raised in front of you with your palm facing down.

  • Use your other hand to pull the wrist towards you.

  
  
  

  Choose the statement most applicable
  

  I was able to get 90 deg without pulling
  

  I was able to get 90 deg with pulling
  

  Left Right

  I couldn’t complete because of pain

  Left Right
• 
  
  

  Test 5

  

  • Start with your arm raised in front of you with your palm facing up.

  • Use your other hand to pull the wrist towards you.

  
  
  

  Choose the statement most applicable
  

  I was able to get 90 deg without pulling
  

  I was able to get 90 deg with pulling
  

  Left Right

  I couldn’t complete because of pain

  Left Right
• 
  
  

  Test 6

  

  • Stand straight, feet together

  • Lift your hands and keep them parallel to each other, palms facing each other

  • Move them as far back as possible

  
  
  

  Choose the statement most applicable
  

  Could stretch back with shoulder blade in line with heel and front of hip in line with toes
  

  Can do it, but felt pain
  

  Specify region of pain
  Neck Shoulder blades Upper Back Middle Back Lower Back From buttocks to knee From Knee to Ankle

  I couldn’t complete because of pain
• 
  
  

  Test 7

  

  • Stand straight, feet together

  • Lift hands above head

  • Bend down to touch your feet without bending knees

  
  
  

  Choose the statement most applicable
  

  Can touch toes without pain
  

  Can do it, but felt pain
  

  Specify how far your hands reached
  Below Knee Above Knee

  I couldn’t complete because of pain
• 
  
  

  Test 8

  

  • Lie comfortably on the floor

  • Lift one leg to the ceiling

  • Keep the other leg parallel to the floor without raising heels. This is very important

  • Repeat with other leg

  
  
  

  Choose the statement most applicable
  

  Could lift leg up 90 degree without any pain or restriction
  

  I felt some amount of restriction
  

  Specify
  Lower Back Hips & Buttocks Back of Thigh Calf

  I couldn't lift because I felt pain and restriction

  Specify
  Lower Back Hips & Buttocks Back of Thigh Calf
• 
  
  

  Test 9

  

  • Stand with your back flat against a wall

  • Set your feet about shoulder-width apart and then about 2 ft out from the wall

  • Slide your back down the wall, bending your legs to get 90 degree angle

  • Your knees should be directly above your ankles, but no more forward

  • Stand up slowly, while leaning against the wall

  
  
  

  Choose the statement most applicable
  

  Could complete activity
  

  Could not squat low enough to get 90 deg at knees
  

  Had pain while squatting
  

  Specify
  Upper Thigh Back of Thigh Around Knee Joint Inside Knee Joint
• 
  
  

  Test 10

  

  • Face the wall. Kneel on one knee with other knee about four inches from the wall

  • Move the knee forward, to touch the wall without shifting sideways

  • Keep heel in contact with the floor throughout

  • Repeat on opposite knee

  
  
  

  Choose the statement most applicable
  

  Knee could touch wall without any problem
  

  Knee could touch the wall, but felt restriction in ankle
  

  Left Right

  Could not complete because of pain & restriction in ankle

  Left Right
• 
  
  

  Test 11

  

  • Stand straight with hands on the side

  • Lift one leg up and try to balance your body for 10 seconds

  • Repeat with other leg

  
  
  

  Choose the statement most applicable
  

  I could keep balance for more than 10 sec
  

  I could not balance for 10 sec
  

  Left Right

  Ankle had a roll and moved back and forth

  Left Right