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    Sports Physical Therapy Assessment Form

    Uploaded by

    Munazzah Ijaz

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Sports Physical Therapy Assessment Form

    Uploaded by

    Munazzah Ijaz
    346 views3 pages

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    346 views3 pages

    Sports Physical Therapy Assessment Form

    Uploaded by

    Munazzah Ijaz

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Physical Therapy (In-Patient)

    Sports Physical Therapy

    Department: _________________ Ward: ______ Bed: ______ Ph. No.__________________


    Patient Name: _______________________________________ Age/Sex: _______________
    Address: ___________________________________________________________________
    Diagnosis: _____________________________ DOA: ____________ DOD: _____________
    Marital Status: ____________________ Source of Referral: __________________________
    Subjective Assessment:

    Presenting Complaint: ______________________________________________________


    __________________________________________________________________________
    Position or Specialty in Sport: ________________________
    Previous Sports Injuries: _____________________________
    Current Injury Description: ___________________________
    Area of Injury: _______________________________________
    Type of Pain:
    Dull Sharp Radiating Throbbing Stinging Gnawing Shooting Cramping
    Pain Rating:
    0 1 2 3 4 5 6 7 8 9 10
    Pain Intensity:
    Mid Moderate Severe
    Range of Motion Assessment: ______________________________________________________
    Strength Assessment: _____________________________________________________________
    Functional Movement Assessment: __________________________________________________
    Special Tests Results Interpretation
    Physical Examination: Mark on the body-chart deformities or joint anomalies, back deformities or
    anomalies, oedema, shoulder subluxation etc.

    Capsular Pattern: ________________________________________________________________


    Short Term Goals:
    ________________________________________________________________________________
    ________________________________________________________________________________
    ________________________________________________________________________________
    ________________________________________________________________________________
    ________________________________________________________________________________

    Long Term Goals:


    ________________________________________________________________________________
    ________________________________________________________________________________
    ________________________________________________________________________________
    ________________________________________________________________________________
    ________________________________________________________________________________

    Physical Therapy Treatment:


    Modality: _______________________________________________________________________
    ________________________________________________________________________________
    ________________________________________________________________________________
    ROM: __________________________________________________________________________
    ________________________________________________________________________________
    ________________________________________________________________________________
    Strengthening: ___________________________________________________________________
    ________________________________________________________________________________
    Training (If Any): ________________________________________________________________
    ________________________________________________________________________________
    ________________________________________________________________________________
    Orthotic/Brace Recommendation: __________________________________________________
    ________________________________________________________________________________

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