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Physio Review
Patient Assessment - Page 1 (Edit)
Date *
Patient Name *
PR No
Age / Gender *
F
M
T
Contact No
Reference
Address
Sasi Nagar
Occupation Type *
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Government
Non-Government
Senior Citizen
Others
Designation
Nature of Work
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Active
Desktop
Field
Travel
House Holder
others
Vitals
HEIGHT
WEIGHT
BP
PR
TEMP
SPO2
Other Health Issues & Treatment History
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History of Present Complaints
Revision surgery - L4 L5 - May 18th 2026 - SIMS hospital, SRM Chennai 1st surgery done on 2011 - Same spot Catch in Calf and great toe - Right leg, Swelling at times
Onset
Sudden
Insidious
Gradual
Treatment Taken
Revision surgery - L4 L5 - May 18th 2026 - CIMS hospital, SRM Chennai
Investigation Details
Not Taken
Done , Not Produced
Attached with Case Sheet
Current Physiotherapy Episode
1
2
>3
Previous Session Details
Physio in Marthandam - Basics, as suggested by Surgeon
Update
Present Complaints
Right leg - Ankle Swelling at times; Numbness in the foot and Distal calf Advised to avoid bending, lifting weights, sitting on the floor, two wheeler ride, long travel in car Catchy feeling in Right great toe, base of the fore foot, distal 1/3rd of the calf Pain - low back in sitting Catchy feeling in foot - In sitting
Symptoms
Constant
Intermittent
Worsening Factors
Relieving Factors
Pain Chart Notes
21-45
Pain Scale
Worst
Same
Better
VAS
At Worst
At Best
Pain Type
Nociceptive
Neuropathic
Nociplastic
Skin Colour
Scar
Adherent
Non-Adherent
No Scar
Swelling
Soft Fluctuating
Leathery
Tough
Dry
Tened
Hard
Boggy
Spongy
Thick
8 to 24 Hours of Injury
Tenderness
Grade I
Grade II
Grade III
Grade IV
Remarks
Update
Edit - Page 3
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Patient Management
Edit - Page 3
ROM
AROM
Movement
Side
Part
Plane
Available Range
Pain Starts
Action
Select
Left
Right
Select
Neck
Wrist
Shoulder
Elbow
Spine
Hip
Knee
Ankle
Select
Sagittal
Frontal
Transverse
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PROM
Movement
Side
Part
Plane
Available Range
Pain Starts
Action
Select
Left
Right
Select
Neck
Wrist
Shoulder
Elbow
Spine
Hip
Knee
Ankle
Select
Sagittal
Frontal
Transverse
-
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End Feel
Soft
Firm
Hard
Empty
MMT
-
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Special Tests
Special Test 1
Special Test 2
Remarks
Patient is in fear of movement - Still having numbness - Needs education - Believing surgeon's advice as a bible words FOCUS: Spine mobility - Loaded mobility - Progressive loading - Multi planar workouts
Diagnosis
Patient Goals & Concerns
Physiotherapy Goals
Short Term Goals
Long Term Goals
Action
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Further Referral (if needed)
No
Physiotherapist Details
Assessed Physio Name
IAP Membership No.
Treatment In-Charge Name
IAP Membership No.
Update
Electrotherapy
Modality
Site
Details
Date
Remarks
Action
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Supportive Techniques
Technique
Details
Date
Remarks
Action
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Corrective Exercises
S.No
Exercise
Sets
Reps
Time
Date
Remarks
Action
1
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2
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3
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4
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5
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6
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Date
Remarks
3 sessions per week x 4 weeks followed by review based sessions Rs.800 per session
Update
