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OBJECTIVE
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Postural Findings
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Gait Analysis
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Task Analysis
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HIP
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Hip ROM - Active/Passive
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(L) Flexion 0-120
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(R) Flexion 0-120
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(L) Extension 0-20
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(R) Extension 0-20
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(L) Internal Rotation 0-45
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(R) Internal Rotation 0-45
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(L) External Rotation 0-45
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(R) External Rotation 0-45
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(L) Abduction 0-45
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(R) Abduction 0-45
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(L) Adduction 0-30
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(R) Adduction 0-30
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Reproduction of Pain/Symptoms
• • •
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Notes
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Hip Manual Muscle Testing (MMT)
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(L) Flexion
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(R) Flexion
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(L) Extension
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(R) Extension
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(L) Internal Rotation
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(R) Internal Rotation
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(L) External Rotation
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(R) External Rotation
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(L) Abduction
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(R) Abduction
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(L) Adduction
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(R) Adduction
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Reproduction of Pain/Symptoms
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Notes
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Hip Special Tests
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Tests Screening for Fracture
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Hip Muscle Length Tests
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Intra-articular Hip Pathology
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Piriformis Syndrome Tests
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Notes
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Hip Soft Tissue Findings
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Hip Soft Tissue: 1
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Finding(s)
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Hip Soft Tissue: 2
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Finding(s)
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Hip Soft Tissue: 3
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Finding(s)
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Notes
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Hip Joint Findings
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Joint
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Restriction(s)
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Joint
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Restriction(s)
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Notes
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KNEE
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Knee ROM - Active/Passive
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(L) Flexion 0-135
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(R) Flexion 0-135
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(L) Extension 0-10
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(R) Extension 0-10
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Reproduction of Pain/Symptoms
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Notes
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Knee Manual Muscle Testing (MMT)
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L Flexion
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R Flexion
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L Extension
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R Extension
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Reproduction of Pain/Symptoms
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Notes
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Knee Special Tests
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Valgus Stress Test (MCL)
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Varus Stress Test (LCL)
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ACL
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PCL
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Meniscus
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Patellofemoral Joint
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Iliotibial Band Syndrome
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Notes
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Knee Soft Tissue Findings
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Knee Soft Tissue: 1
• • •
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Finding(s)
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Knee Soft Tissue: 2
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Finding(s)
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Knee Soft Tissue: 3
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Finding(s)
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Notes
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Knee Joint Findings
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Joint: 1
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Restriction
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Joint: 2
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Restriction
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Joint: 3
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Restriction
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Notes
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ANKLE/FOOT
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Ankle/Foot ROM - Active/Passive
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(L) Dorsiflexion 0-20
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(R) Dorsiflexion 0-20
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(L) Plantarflexion /40
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(R) Plantarflexion /40
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(L) Inversion 0-35
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(R) Inversion 0-15
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(L) Eversion 0-15
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(R) Eversion 0-15
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(L) Great Toe Extension 0-70
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(R) Great Toe Extension 0-70
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(L) Great Toe Flexion 0-45
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(R) Great Toe Flexion 0-45
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Reproduction of Pain/Symptoms
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Notes
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Ankle/Foot Manual Muscle Testing
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L Dorsiflexion
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R Dorsiflexion
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L Plantarflexion
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R Plantarflexion
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L Inversion
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R Inversion
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L Eversion
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R Eversion
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Findings
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Ankle/Foot Special Tests
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R Knee to Wall Assessment
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L Knee to Wall Assessment
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R Figure 8 Girth Assessment
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L Figure 8 Girth Assessment
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Ankle Fracture Tests
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Ankle Ligament Integrity
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Achilles
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Tarsal Tunnel Impairments
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R Windlass Test
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L Windlass Test
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R Navicular Drop Test (6-8mm)
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L Navicular Drop Test (6-8mm)
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Findings
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Ankle/Foot Soft Tissue Findings
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Ankle/Foot Soft Tissue: 1
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Finding(s)
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Ankle/Foot Soft Tissue: 2
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Finding(s)
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Ankle/Foot Soft Tissue: 3
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Finding(s)
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Notes
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Ankle/Foot Joint Findings
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Joint: 1
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Restriction
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Joint: 2
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Restriction
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Joint: 3
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Restriction
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Notes
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Objective Treatment
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Manual Therapy
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Therapeutic Exercise
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Therapeutic Activity
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Gait Training
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Neuromuscular Re-Education
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