Self Assessment

Instructions:  Test each motion (1-2 reps each), one side at a time. Compare motions on the left, right, and center when possible.  Give yourself a score of 0-100 for each movement.  Don’t just concentrate on pain but also the ease of movement when comparing to the opposite side & center when possible.  Make sure you are doing them the same on each side.  There is a tendency to compensate when there is a restriction. Minimal differences score between 10-30, moderate differences 31-69, significant differences between 70-100.  An example of scoring would be comparing your right arm raise to your left.  If the left is 70% worse than the right, either because of pain or limits in movement, then score it a 70.  We also want to find out which movements feel good.  Those would be scored a zero.

Bio Data


Turn to the side

Look down

Look up towards the ceiling


(With elbow straight)

Forward Raise

Side Raise

Backward Raise

(With elbow bent)

Forward Raise

Side Raise

Backward Raise

Reach Behind Head

Reach Behind Back

Trunk (area between shoulders & hips)

With Trunk Straight, Do a Twist

Lean Forward & Do a Twist

Lean Back & Do a Twist


(You can lean back – knee kept straight)
Forward Leg Raise foot straight up
Forward Leg Raise foot rotated inward
Forward Leg Raise foot rotated outward

Total number of scores

between 10-30:
between 31 – 69:
between 31 – 69: