Try for free

Oregon WCD Form 2278L: Lumbar Range of Motion

This WCD worksheet records lumbar spine range of motion for Oregon closing examinations and other impairment-focused exams under Bulletin 239. The examiner takes inclinometer readings at T12 and the midsacrum to calculate true lumbar flexion, extension and lateral flexion, then runs the straight-leg raising check that tests whether the flexion measurement is valid. The completed form goes back with the examination report so the insurer or Division can rate impairment.

Who completes it

The examining physician completes every line, prints name and title, and signs with the exam date. Attending physicians, including chiropractic physicians, and medical arbiters perform these measurements; naturopathic physicians may not make impairment findings.

Submitting and payment

How to submit it
Return the form with the closing report to the insurer or self-insured employer within the 14-day window Bulletin 239 sets after the medically stationary exam.
Who pays
The insurer pays Oregon providers the lesser of the billed amount or the OAR 436-009-0040 physician fee schedule amount, and the worker cannot be billed for an accepted claim.

Good to know

  • WCD norms on the form are 60 degrees lumbar flexion, 25 degrees extension and 25 degrees lateral flexion to each side.
  • True lumbar flexion is invalid if the tightest straight-leg raise is not within 10 degrees of total motion at the midsacrum (sacral flexion plus extension).
  • A failed straight-leg raise cannot be the only reason for invalidating lumbar flexion, and any invalid finding needs a validity statement in the report.
  • Readings must repeat within 10 percent or 5 degrees, whichever is greater, across at least three measurements, with up to six attempts allowed.

Get the official form

Download the current version from the source each time; forms change without notice.

Spinal Range Of Motion

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

How does the straight-leg raising check work on Form 2278L?

With the worker supine, the examiner measures a passive straight-leg raise on each side with the inclinometer on the tibia, three times per leg. If the tightest raise is not equal to or within 10 degrees of the summed midsacral flexion and extension, the true lumbar flexion measurement is invalid.

Is Form 2278L the current lumbar form?

The version on WCD's site is stamped 440-2278L (4/24). Bulletin 239, reissued April 9, 2026, lists it among the attached impairment reporting forms and states that all forms other than the revised visual impairment form remain as previously published.