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Subjective History
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Objective
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Treadmill settings:
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Speed (mph)
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Pace (min/mile)
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Treadmill Incline (%)
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Current cadence (steps/min)
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Shoe Brand
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Type of shoe
• • •
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Orthotics?
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Posterior View
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LEFT Pelvic tilt
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RIGHT pelvic tilt
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LEFT knee separation
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RIGHT knee separation
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LEFT Knee joint center alignment
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RIGHT knee joint center alignment
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LEFT foot - COM (MS)
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RIGHT foot - COM (MS)
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LEFT foot pronation
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RIGHT foot pronation
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Trunk rotation
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Trunk side bend
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Foot position (TO)
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Forefoot position
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Lumbar lordosis/anterior pelvic tilt
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Sagittal View
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Initial contact
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LEFT Heel - COM
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RIGHT heel - COM
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LEFT foot inclination
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RIGHT foot inclination
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LEFT knee flexion
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RIGHT knee flexion
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Mid-stance
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LEFT knee flexion
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RIGHT knee flexion
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LEFT ankle DF
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RIGHT ankle DF
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Toe-off
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LEFT hip extension (TO)
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RIGHT hip extension (TO)
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Vertical displacement
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Forward trunk flexion
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Additional comments:
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MMTs
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LEFT calf strength
/
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RIGHT calf strength
/
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Analysis
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Exercises
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Recommended cadence (steps/min)
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Cadence retraining instruction
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Plan
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