Lower Extremity Form

Lower Extremity Functional Scale 

We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your lower limb problem for which you are currently seeking attention. Please check an answer for each activity. 

Today, do you or would you have any difficulty at all with: 

Any of your usual Work, Household, or School Activities:
Your usual Hobbies, Recreational or Sporting Activities:
Getting Into or Out of the Bath:
Walking between Rooms:
Putting on your Shoes or Socks:
Squatting:
Lifting an Object, like a Bag of Groceries from the Floor:
Performing Light Activities Around Your Home:
Performing Heavy Activities Around Your Home:
Getting Into or Out of a Car:
Walking 2 Blocks:
Walking A Mile:
Going Up or Down 10 Stairs (about 1 flight of stairs):
Standing for 1 Hour:
Sitting for 1 Hour:
Running on Even Ground:
Running on Uneven Ground:
Making Sharp Turns While Running Fast:
Hopping:
Rolling over in Bed:

MDC (minimum detectable change) = 9 pts. 

Error +/- 5 Scale Points 

Thank you for taking the time to fill out this form.

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Office Hours

Our Regular Schedule

Arlington Chiropractic

Monday:

9:00 am-7:00 pm

Tuesday:

8:30 am-7:00 pm

Wednesday:

9:00 am-7:00 pm

Thursday:

9:00 am-7:00 pm

Friday:

8:00 am-5:00 pm

Saturday:

8:00 am-1:00 pm

Sunday:

Closed