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Program Treatment Flow Sheet — Shoulder Level 1
SOR Physical Therapy
Patient & Session Information
Treatment Exercises & Repeat-Visit Columns8 Visit Columns (Frozen Left Column)
Treatment(Frozen) | Protocol Ref | Visit 1 | Visit 2 | Visit 3 | Visit 4 | Visit 5 | Visit 6 | Visit 7 | Visit 8 |
|---|---|---|---|---|---|---|---|---|---|
1.Shoulder PROM | |||||||||
2.Band Forward Rz | |||||||||
3.Foam Rollout Lat | |||||||||
4.Foam Rollout | |||||||||
5.ITY Band | |||||||||
6.SL Ext Rot | |||||||||
7.SL Abduction | |||||||||
8.Cane Flex | |||||||||
9.Cane Abduction | |||||||||
10.Cane Chest Press | |||||||||
11.S/L Ext Rot | |||||||||
12.Lawn Mower | |||||||||
13.Biceps Curl | |||||||||
14.Wall Push Off | |||||||||
15.Overhead Lift | |||||||||
16.Lat Pull Down | |||||||||
17.Low Rows | |||||||||
18.High Rows | |||||||||
19.Band Biceps Curl | |||||||||
20.Overhead Peg Bd | |||||||||
21.UBE | |||||||||
22. | |||||||||
23. | |||||||||
24. |
Standard Notations:# = lbs (e.g. 1x20-3#)red = red resistance bandSL vs S/L = specific exercise protocol distinctions1x = 1 pass completion (Overhead Peg Bd)
24 Rows Total(21 Standard + 3 Custom)
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