Name:Injury Date:Attach Doctor Note(s) Here
Injury Log
Write a brief description of your injury, as you understand it. Include how it happened, the technical name for the injury, and what the plan of action for treatment/rehabilitation is. As you have your injury evaluated over time (take this with you to doctor/trainer visits), revise your plan as needed. This must be completed daily, along with written assignments, in order to earn daily points.
Keep a daily log of how the injury is feeling (pain scale, mobility scale) as well as including all treatments, stretches, and exercises performed each day.
Date:
Before treatments, stretches, and exercises:
Pain level0 1 2 3 4 5 ( 0 = no pain, 5 = extreme pain)
Specific location of pain:
Mobility/flexibility0 1 2 3 4 5 ( 0 = no lack of mobility, 5 = immobile)
After treatments, stretches, and/or exercises:
Pain level0 1 2 3 4 5 ( 0 = no pain, 5 = extreme pain)
Specific location of pain:
Mobility/flexibility 0 1 2 3 4 5 ( 0 = no lack of mobility, 5 = immobile)
Treatments, stretches, and/or exercises performed:
Date:
Before treatments, stretches, and exercises:
Pain level0 1 2 3 4 5 ( 0 = no pain, 5 = extreme pain)
Specific location of pain:
Mobility/flexibility 0 1 2 3 4 5 ( 0 = no lack of mobility, 5 = immobile)
After treatments, stretches, and/or exercises:
Pain level0 1 2 3 4 5 ( 0 = no pain, 5 = extreme pain)
Specific location of pain:
Mobility/flexibility 0 1 2 3 4 5 ( 0 = no lack of mobility, 5 = immobile)
Treatments, stretches, and/or exercises performed:
Date:
Before treatments, stretches, and exercises:
Pain level0 1 2 3 4 5 ( 0 = no pain, 5 = extreme pain)
Specific location of pain:
Mobility/flexibility 0 1 2 3 4 5 ( 0 = no lack of mobility, 5 = immobile)
After treatments, stretches, and/or exercises:
Pain level0 1 2 3 4 5 ( 0 = no pain, 5 = extreme pain)
Specific location of pain:
Mobility/flexibility 0 1 2 3 4 5 ( 0 = no lack of mobility, 5 = immobile)
Treatments, stretches, and/or exercises performed:
Date:
Before treatments, stretches, and exercises:
Pain level0 1 2 3 4 5 ( 0 = no pain, 5 = extreme pain)
Specific location of pain:
Mobility/flexibility 0 1 2 3 4 5 ( 0 = no lack of mobility, 5 = immobile)
After treatments, stretches, and/or exercises:
Pain level0 1 2 3 4 5 ( 0 = no pain, 5 = extreme pain)
Specific location of pain:
Mobility/flexibility 0 1 2 3 4 5 ( 0 = no lack of mobility, 5 = immobile)
Treatments, stretches, and/or exercises performed:
Date:
Before treatments, stretches, and exercises:
Pain level0 1 2 3 4 5 ( 0 = no pain, 5 = extreme pain)
Specific location of pain:
Mobility/flexibility 0 1 2 3 4 5 ( 0 = no lack of mobility, 5 = immobile)
After treatments, stretches, and/or exercises:
Pain level0 1 2 3 4 5 ( 0 = no pain, 5 = extreme pain)
Specific location of pain:
Mobility/flexibility 0 1 2 3 4 5 ( 0 = no lack of mobility, 5 = immobile)
Treatments, stretches, and/or exercises performed:
Date:
Before treatments, stretches, and exercises:
Pain level0 1 2 3 4 5 ( 0 = no pain, 5 = extreme pain)
Specific location of pain:
Mobility/flexibility 0 1 2 3 4 5 ( 0 = no lack of mobility, 5 = immobile)
After treatments, stretches, and/or exercises:
Pain level0 1 2 3 4 5 ( 0 = no pain, 5 = extreme pain)
Specific location of pain:
Mobility/flexibility 0 1 2 3 4 5 ( 0 = no lack of mobility, 5 = immobile)
Treatments, stretches, and/or exercises performed:
Date:
Before treatments, stretches, and exercises:
Pain level0 1 2 3 4 5 ( 0 = no pain, 5 = extreme pain)
Specific location of pain:
Mobility/flexibility 0 1 2 3 4 5 ( 0 = no lack of mobility, 5 = immobile)
After treatments, stretches, and/or exercises:
Pain level0 1 2 3 4 5 ( 0 = no pain, 5 = extreme pain)
Specific location of pain:
Mobility/flexibility 0 1 2 3 4 5 ( 0 = no lack of mobility, 5 = immobile)
Treatments, stretches, and/or exercises performed: