Sports Fitness and Wellness Clinic

By Rajesh Sawant- CSCS

Strength & Conditioning Coach

Musculoskeletal Screening Assessment Form

Player Details
Name
Age

Injury / Illness History

Date Diagnosis Notes
NA
Current Injuries
NA
Current Illnesses

NA
Past Injuries

NA
Past Illnesses

Past Medical History

NA
Medical Conditions
NA
Current Medications
Past Surgery NA
Allergies: NA

Testing Results

Shoulder Left Right Goal

Internal Rotation at 90 Abduction in supine >90

External Rotation at 90 Abduction in supine >90

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Lower Limb Left / Flex Right / Goal
Extn

Hamstring Length at 90/90 > 170

Iliopsoas Muscle Length < 5
Rectus Femoris Muscle length > 80
Hip Internal Rotation prone > > > 30
Hip External Rotation prone > > > 45

DF Lunge Test > 10 cms

Postural Assessment

Head Neutral Forward

Left Neutral Elevated / Depressed Neutral / Rounded
Right Neutral Elevated / Depressed Neutral / Rounded
Shoulders
Thoracic Spine Neutral Flattened / Kyphosis Scoliosis
Lumbar Spine Neutral Increased / Decreased Lordosis
Pelvis Neutral Anterior / Posterior tilt Left / Right / Raised / Lowered
Left Neutral Varus / Valgus KNOCK KNEES
Right Neutral Varus / Valgus
Knees
Left Medial Arch = Flat / High /Norm Neutral/ hyperpronated
Right Medial Arch = Flat / High /Norm Neutral/ hyperpronated
Foot

Bicep Relax
Bicep Flex
Chest
Waist
Hip
Thigh
Calf

Tricep SS Bicep SSP ABs Thigh Calf

Vertical Jump Speed 20 m Speed 40 m 2.4 km Agility

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