OQ Welcome to your OQ Please describe the nature of your orthopedic problem and all symptoms: (broken bones, neck, back, arm, shoulder, knee, ankle, leg, foot) What was the date of your first symptoms? Date of most recent symptoms? Do you have any current pain? Please select your answer Yes No How long does the pain last? What methods do you use to alleviate or manage your symptoms? (Rest, medication, orthopedic equipment, etc.) Realize that you will not likely have access to ice, resting for long periods of time, or prescription pain medication- how can you manage your symptoms on the course? Is your pain debilitating? Please select your answer Yes No If yes, what do you need to feel better? Would activities like carrying a heavy backpack, climbing, paddling, etc. cause old injuries to become painful? Please select your answer Yes No If yes, how? For how long? How likely is it that your injury would cause you to leave the course? Check only one of the answers below. Please select your answer 0% -Not a concern 25% -Would hurt but could finish 75% -Rest needed & might leave 100% Very Likely Do you have any restrictions on your level of activity? Please select your answer Yes No What impact do your symptoms have on your level of activity? Please be specific. What is your range of motion? Please select your answer Full Partial Limited None Please describe your concerns towards engaging in activities involving sustained repetitive motion, (i.e. paddling, rowing, prolonged hiking up/downhill on uneven terrain, etc.)? Describe any limitations to bear and lift weight? If you have had surgery: When was it performed? What surgery was performed? Did you undergo physical therapy? Please select your answer Yes No If yes, for how long? If you have not had surgery? Was surgery advised? Please select your answer Yes No Do you have plans for future surgery? Please select your answer Yes No Do you have a brace that you can bring with you? Please select your answer Yes No If so please plan to bring one. If not, consider getting a brace. For land courses, also consider bringing trekking poles which can greatly aid in reducing knee and ankle (re)injuries. Describe your plan to adequately prepare for your course?(Include any prescribed physical therapy plans and exercises) Time's up
