This is an example of what a personal limitations statement might look like:

Personal Limitations:  I have become very agitated. I can no longer pick up my infant daughter. When I wake up in the morning I have neck and back pain. I cant reach over my head or stretch my legs. There are times when I feel like Im being stabbed in the back. I am also having difficulty during sexual relations due to the pain in my neck and back.

This is an example of what a social limitations statement might look like:

Social Limitations: When I go to the movies or concerts I cant enjoy them because I cant sit for long periods of time without pain. I try to play touch football as I did prior to the accident, but I have difficulty due to my neck and back pain and limitations with my arm. I have a fear when driving in the car. Whenever I hear a horn or screeching brakes I am afraid Im going to get hit again.

This is an example of what a work limitations statement might look like:

Work Limitations:  I am an automobile mechanic. I cant lean over the car for a long period of time. When I use my right hand to hold tools for a long period of time I get pain that shoots up to my neck and down to my lower back. I have to stop from time to time and rest so its hard to finish repairs in a timely manner. I have also changed my job from a full time mechanic to a part time mechanic and a part time service writer reducing my pay.
Your Name
Personal Limitations
Social Limitations
Work Limitations