Back Hyperextension Exercise Form Checklist
Complete this checklist before and after performing back hyperextension exercises to ensure safety, correct technique, and effective practice.
Participant Full Name
*
First Name
Last Name
Date of Exercise
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Are you currently experiencing any pain, injury, or medical condition that may affect your ability to perform back hyperextensions?
*
No
Yes (please describe below)
If you answered yes above, please describe your pain, injury, or medical condition.
Equipment and Environment Safety Check
*
Bench or mat is stable and in good condition
Area is clear of obstacles
Proper footwear is worn
No loose clothing or accessories
Step-by-Step Technique Assessment
*
Rows
Correct
Needs Improvement
Not Performed
Feet securely positioned
1
2
3
Hips aligned with pad
4
5
6
Back kept straight throughout
7
8
9
Controlled movement down and up
10
11
12
Avoids overextension at top
13
14
15
Proper breathing technique
16
17
18
Rate your perceived effort during the exercise
*
Very Easy
1
2
3
4
5
6
7
8
9
Very Hard
10
1 is Very Easy, 10 is Very Hard
Did you experience any pain or discomfort during the exercise?
*
No
Yes (please describe below)
If you experienced pain or discomfort, please describe the location and nature.
Additional Comments or Feedback
By signing below, I acknowledge that I have reviewed the safety checklist, understand the risks involved in back hyperextension exercises, and agree to perform the exercise at my own risk.
*
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