CHINESE GENERAL HOSPITAL COLLEGES, INC.

286 Blumentritt Street, Sta. Cruz Manila, Philippines

Trunk Line No.: (02) 711-4141 Local 601 Telefax No.: (02) 711-0075

PHYSICAL THERAPY CLINICAL INTERNSHIP PROGRAM A.Y. 2022-2023

MONTHLY TREATMENT RECORD
(PATIENT LOAD)

AFFILIATION CENTER: MOBILITY AND RECOVERY PHYSICAL THERAPY CLINIC

MONTH: AUGUST 2023

Patient’s Name: E.C. Patient’s Name:

Age: 63 y/o Sex: M Age: Sex:

Type of document (IE/RE): IE Type of document (IE/RE):

Diagnosis/PT Impression: ACUTE ISCHEMIC Diagnosis/PT Impression:

STROKE (L) CVA MCA

PT MANAGEMENT: PT MANAGEMENT:

1. PREs of ® UE -> AP c assist. x 10 reps x 2

sets
a. SH flex, ext, abd using 2 lbs DB
b. SH ER, IR using Yellow TB
c. Elbow flex, FA pron/sup, wrist flex/ext
using 2 lbs DB
2. PREs of (L) UE -> AP x 10 reps x 2 sets
a. SH flex, ext, abd, ER, IR, Elbow flex, FA
pron/sup, wrist flex/ext using 4 lbs DB
3. Wall slides/Scapular Stabilization
towards ↑, ↓, side to side, and circular
motion c Scapular UR, DR, IR, and ER
manual resistance x 10 reps x 2 sets
a. Progression: Use ball c scapulae
assist. x 10 reps x 2 sets
4. Standing Wall push-ups x 10 reps x 2
sets
5. Standing YTW x 10 reps each x 2 sets
6. Cone Stacking using PNF pattern D1 and
D2 flex and ext. x 10 reps x 2 sets
7. Partial Squats c (B) Knee stabilization x
10 reps x 2 sets
8. STS using bad side c ® Knee stabilization,
good side and equal WB x 10 reps each
x 2 sets
9. Ball squeeze x 10 reps x 1 set
10. Bolts and Knots x 1 set
11. Fine motor Exercise using clothes pin
 CHINESE GENERAL HOSPITAL COLLEGES, INC.
286 Blumentritt Street, Sta. Cruz Manila, Philippines
Trunk Line No.: (02) 711-4141 Local 601 Telefax No.: (02) 711-0075

(opposition/reposition) x 5 reps x 2 sets

12. Heel raises x 10 reps x 2 sets
13. Marching in place x 1 min x 2 sets
14. Stepping 4-way toe taps x 10 reps x 2
sets
15. Heel to toe taps c obstacle x 10 reps x 2
sets
16. Walking inside the clinic c obstacles x 3
rounds x 1 set
17. GPS of UE and LE x 30 SH x 2 sets
18. Grip exercises using digiflex or
theraputty

HEP:

1. Observe Pt.’s posture during exercise/tx

2. Provide adequate rest and proper
breathing exercise in between exercise
3. Frequent monitoring of VS is
recommended

Noted by: HEAVEN LEIGH P. AGRIZ, PTRP

CLINICAL SUPERVISOR/STAFF
 CHINESE GENERAL HOSPITAL COLLEGES, INC.
286 Blumentritt Street, Sta. Cruz Manila, Philippines
Trunk Line No.: (02) 711-4141 Local 601 Telefax No.: (02) 711-0075

PHYSICAL THERAPY CLINICAL INTERNSHIP PROGRAM A.Y. 2022-2023

MONTHLY TREATMENT RECORD
(PATIENT LOAD)

AFFILIATION CENTER: MOBILITY AND RECOVERY PHYSICAL THERAPY CLINIC

MONTH: SEPTEMBER 2023

Patient’s Name: J.R. Patient’s Name: J.P.

Age: 26 y/o Sex: M Age: 16 y/o Sex: F

Type of document (IE/RE): IE Type of document (IE/RE): IE

Diagnosis/PT Impression: NECK STRAIN Diagnosis/PT Impression: CP Spastic

Quadriplegic
PT MANAGEMENT: PT MANAGEMENT:

1. Strain Counter Strain technique on (L) 1. GPS on ® shoulder flex, abd., sup., wrist
upper traps x 90 secs and MCP ext.; (B) hip flex, abd., ER,
2. HMP c TENS on (L) upper trapezius in ankle eversion, and PF x 30 SH x 3 reps
x 1 set
prone x 10’
2. AAROMEs on (B) hip flex and abd. and ®
3. Blading (release) on on (L) upper shoulder flex and abd. x 10 reps x 1 set
trapezius in prone x 5’ 3. Fine grasping activity using legos and
4. Relaxation technique on cervical area alphabet magnet on (B) UE x 5 reps
in supine x 3’ each x 1 set
5. Isometric Exercise on Capital Extension 4. RGR using cones towards D1-D2 flexion
using rolled towel x 7 SH x 10 reps in (B) UE x 4 reps x 1 set
5. Sitting tol. x 15 mins
6. Cupping on (B) upper trapezius x 5 mins
6. Pelvic bridge x 10 reps x 1 set
7. Cupping techniques (p 5 mins) c
AROMES on Cervical  AP x 10 reps
8. AROMEs → shoulder elevation, neck
flexion, neck extension, and lateral
flexion x 10 reps x 2 sets
9. Stretching → neck rotation and lateral
flexion x 30 SH x 3 reps x 1 set
10. Stretching on (B) pecs c Y & T position x
30 SH x 3 reps x 1 set
11. Scapular retraction using blue
Theratube x 7 SH x 10 reps x 1 set

Patient’s Name: A.M.

Age: 65 y/o Sex: M

Type of document (IE/RE): IE
 CHINESE GENERAL HOSPITAL COLLEGES, INC.
286 Blumentritt Street, Sta. Cruz Manila, Philippines
Trunk Line No.: (02) 711-4141 Local 601 Telefax No.: (02) 711-0075

Diagnosis/PT Impression: CVA

PT MANAGEMENT:

1. AAROMEs of (B) SH -> flex x 10 reps x 1

set
2. AAROMEs of (B) elbows -> flex x 10
reps x 1 set
3. AAROMEs of (B) wrists -> flex & ext. x
10 reps x 1 set
4. Peg Board Exercises by Screwing &
Unscrewing Alternately using (B) hands
x 1 set
5. Fine Movement Activities using ADL
Board x 2 sets
6. Prehension Exercise by Squeezing &
Rounding using theraputty (yellow) on
® hand x 10 reps x 3 sets
7. Squeeze Exercise using digiflex (green)
x 10 reps x 3 sets
8. STS x 10 reps x 2 sets
9. RGCR using PNF D1 flex & ext. Pattern
& D2 flex & ext. Pattern c cones x 8
reps x 2 sets
10. Gait Training on // c cone obstacles x 4
rounds
11. Ball Catch & Throw x 10 reps x 2 sets

Noted by: HEAVEN LEIGH P. AGRIZ, PTRP

CLINICAL SUPERVISOR/STAFF

PHYSICAL THERAPY CLINICAL INTERNSHIP PROGRAM A.Y. 2022-2023

 CHINESE GENERAL HOSPITAL COLLEGES, INC.
286 Blumentritt Street, Sta. Cruz Manila, Philippines
Trunk Line No.: (02) 711-4141 Local 601 Telefax No.: (02) 711-0075

MONTHLY TREATMENT RECORD

(PATIENT LOAD)

AFFILIATION CENTER: MOBILITY AND RECOVERY PHYSICAL THERAPY CLINIC

MONTH: OCTOBER 2023

Patient’s Name: P.E. Patient’s Name: N.M.

Age: Sex: M Age: Sex: M

Type of document (IE/RE): IE Type of document (IE/RE): IE

Diagnosis/PT Impression: (L) KNEE CARTILAGE Diagnosis/PT Impression: -

REPAIR

PT MANAGEMENT: PT MANAGEMENT:

ACTIVATIONS HIP ACTIVATIONS

1. Cryopush on (L) Knee - 15 mins 1. Frog Stretch x 30 SH x 3 sets
2. Patellar Mobilization AP - 50 reps 2. Piriformis Stretch x 30 SH 3 sets
3. Manual Resisted Hip ER, IR x 10 SH x 10
3. Wall slides - 30 reps (30 SH every 10th
reps x 2 sets
rep) 4. PPT x 10 SH x 10 Reps 2 sets
4. Functional Quads Sets c rolled bandage
x 8 SH x 10 reps x 2 sets CORE STABILITY + HIP STRENGTHENING
5. SL Knee Extension - 5 kg x 8 reps x 3 5. Drawing-in Maneuver + Weighted Hip
sets; 3rd set 7.5 kgs /side Bridge x 10 SH x 10 reps x 3 sets (1)
6. Prone Leg Curls - 20 kgs x 8 reps x 3 6. Drawing-in Maneuver + Clam shells; 90-
90 x 10 SH x 10 reps x 3 sets
sets
7. Drawing-in + Lat. Hip Bridge x 4 SH x 10
7. Planks x 60 SH x 3 sets reps x 2 sets
8. Side Planks x 30 SH x 3 sets
9. Miniband series (Black Miniband) x 10 ANKLE MOBILITY
reps x 3 sets 8. Straight Knee Calf Stretch x 30 SH x 3
10. Standing Hip Series (Purple Monster- reps
band or Cable Machine - 12.5 kgs) x 10 9. Bent Knee Calf Stretch x 30 SH x 3 reps
10. SL Straight Knee Standing x 10 sec
reps x 3 sets
lowering x 10 reps x 3 sets
11. SL Balance c Ball catching on Wobble
Board x 60 SH x 3 sets FOOT ARCH
11. Seated Medial Foot-arch raise x 10 SH x
STRENGTHENING 10 reps x 3 sets (Tib. Post. Activation)
12. SL Press c 30 kgs x 10 x 3 sets 12. Towel toe curls x 3 rounds
13. Towel Ankle Inversions x 3 rounds
13. Goblet Squats c 35 lbs DB x 10 reps x 3
sets
14. Hip Thrust c 60 kgs Olympic Bar x 6 reps
x 3 sets
 CHINESE GENERAL HOSPITAL COLLEGES, INC.
286 Blumentritt Street, Sta. Cruz Manila, Philippines
Trunk Line No.: (02) 711-4141 Local 601 Telefax No.: (02) 711-0075

15. SL Wall Squats x 6 SH x 8 reps x 2 sets

16. Forward step ups (Black Metal Stool) –
15 lbs KB - 10 reps x 3 sets
17. SL Calf Raises - 20 lbs KB x 10 reps x 3
sets

Uppers Day 1 (Push)

18. Bench Press – 40 kgs/10 reps, 60 kgs/8
reps, 60 kgs/8 reps
19. Seated Shoulder Press - 30/30 lbs DB x
12 reps x 3 sets
20. 1-arm Shoulder Press (split-stance) x 30
lbs DB x 10 reps x 3 sets

Uppers Day 2 (Pull)

21. Pull-ups (underhand) c Purple Monster-
bands x 8 reps x 3 sets
22. 1-arm row (landmine) c Olympic
bar+25 kgs Olympic Bar x 10 reps x 3
sets
23. Bent Over Flies c 30/30 lbs DB x 10 reps
x 3 sets

24. Bike x 10 mins (progress resistance as

tolerated)
25. Hamstring Stretch x 30 SH x 3 sets
26. Cryopush on (L) Knee x 20 mins

Patient’s Name: E.S. Patient’s Name: E.Z.

Age: Sex: M Age: 64 y/o Sex: M

Type of document (IE/RE): IE Type of document (IE/RE): IE

Diagnosis/PT Impression: ® ACL Diagnosis/PT Impression: (L) CVA

RECONSTRUCTION

PT MANAGEMENT: PT MANAGEMENT:

1. Pat Mob on ® Knee x 50 reps 1. Snow angels x 2 lbs DB x 10 reps x 3

2. Wall Slides x 10 reps x 3 sets sets
3. Quad Setting x 10 SH x 10 reps x 3 sets 2. STS on 20" Fitness Box x 10 reps x 4 sets
(10 lb kb on last 2 sets)
4. Hamstring Setting x 10 SH x 10 reps x 3
3. Seated Single Arm Rows c 15 kgs Cable
 CHINESE GENERAL HOSPITAL COLLEGES, INC.
286 Blumentritt Street, Sta. Cruz Manila, Philippines
Trunk Line No.: (02) 711-4141 Local 601 Telefax No.: (02) 711-0075

sets Machine x 8 reps x 3 sets

5. Gmed 90-90 c Black MB x 10 reps x 2 4. Shrugs 10/10 lbs DB x 10 reps x 3 sets
sets 5. Chest flies 5lbs DB x 8 reps x 3 sets
6. Calf raises c Wedge x 12 reps x 2 sets
6. Pelvic Bridge x 20 lbs DB x 10 reps x 3
7. YTW 1/1 lbs DB x 8 reps x 3 sets
sets 8. Push up on 20" Fitness Box c Black
7. Pelvic Tilts x 10 reps x 3 sets Monster-band x 6 reps x 4 sets (last set
8. Dead-bug taps x 10 reps x 3 sets 16" x 4 reps x 1 set)
9. Prone Leg Curls x 8KG AW x 10 reps x 3 9. SL Press 40 kgs x 8 reps x 4 sets
sets 10. Lateral Step-overs c 4 cones x 2 rounds
10. Isotonic Knee Extensions 90-45 x 8KG x 3 sets (contact guarding)
11. Walk-over markers c 5 markers x 2
AW x 3SH x 10 reps x 3 sets
rounds x 3 sets
11. Standing Hip Series c Black Band -> 12. Monster-walk c Green Monster-band x
Abd., Add., Ext. x 10 reps x 3 sets 40 steps x 3 sets
12. DL Wall Squats x 6SH x 10 reps x 2 sets 13. Diagonal Lunges in 1meter x 12 reps x 3
13. SL Wall Squats x 4SH x 10 reps x 2 sets sets
14. Step-up 12" Trapezoid Fitness Box x 10 14. SL Step up on Level 3 stepper x 8 reps x
reps x 2 sets 4 sets
15. HMP on (B) Shoulder x 10 mins
15. Calf Raises x 10 lbs KB x 10 reps x 3 sets
16. SL Balance x 30 sh x 3 sets
17. Bike x 10 mins
18. Cryopush on ® Knee x 15 mins

Patient’s Name: P.F.

Age: 31 y/o Sex: M

Type of document (IE/RE): IE

Diagnosis/PT Impression: (B) SHIN SPLINTS

PT MANAGEMENT:

1. Cryopush on ® Knee x 20 mins

2. Pelvic Tilts x 10 reps x 2 sets
3. Dead Bug taps c Vestibular ball x 10
reps x 3 sets
4. Gmed 90-90 x black and yellow x 4SH x
10 x 3 sets
 CHINESE GENERAL HOSPITAL COLLEGES, INC.
286 Blumentritt Street, Sta. Cruz Manila, Philippines
Trunk Line No.: (02) 711-4141 Local 601 Telefax No.: (02) 711-0075

5. Pelvic Bridging x 25 lbs DB c Ball b/w

legs x 10 x 3
6. Ankle strengthening c Gold TB towards
AP x 10 reps x 3 sets
7. Big Toe extension c Blue TB x 10 reps x
3 sets
8. Toe Raises x 10 kgs KB x 6SH x 10 reps x
3 sets
9. Towel Curls x 3 lbs Single DB x 3 rounds
x 3 sets
10. Eccentric-seated Calf Raises x 15 lbs
Medicine Ball x 10 reps x 3 sets (fast
up, slow down)
11. Eccentric-standing calf raises x 15 LBS
KB x 10 reps x 3 sets
12. 12. Miniband series x black above knee;
yellow below knee x 10 reps x 3 sets
13. Monster walks c Black MB x 10 reps x 3
sets
14. X-band walks c Black MB x 15 steps x 3
cycles
15. Banded Hip Flexion c Green MB x 10
reps x 3 sets
16. Banded split squats x 5/5 lbs DB x 10
reps x 3 sets
17. Trap bar RDL x 5/5 kgs Plate x 10 reps x
2 sets
18. Farmer's carry Heel-walks and Toe-
walks x 10/10 kgs Trap Bar x 10 steps x
3 cycles
19. Assisted Pogo jumps c Green Monster-
band x 20-30-35 secs
20. Wall-push c Running lunges x 10 secs x
3 sets
21. Stretch: Hip Flexors, Calf, Hamstrings,
ITB x 30 SH x 3 sets
22. Cryopush on ® Knee x 20 mins
 CHINESE GENERAL HOSPITAL COLLEGES, INC.
286 Blumentritt Street, Sta. Cruz Manila, Philippines
Trunk Line No.: (02) 711-4141 Local 601 Telefax No.: (02) 711-0075

Noted by: _____________________

CLINICAL SUPERVISOR/STAFF

PHYSICAL THERAPY CLINICAL INTERNSHIP PROGRAM A.Y. 2022-2023

MONTHLY TREATMENT RECORD
 CHINESE GENERAL HOSPITAL COLLEGES, INC.
286 Blumentritt Street, Sta. Cruz Manila, Philippines
Trunk Line No.: (02) 711-4141 Local 601 Telefax No.: (02) 711-0075

(PATIENT LOAD)

AFFILIATION CENTER: MOBILITY AND RECOVERY PHYSICAL THERAPY CLINIC

MONTH: NOVEMBER 2023

Patient’s Name: P.F. Patient’s Name: E.Z.

Age: 31 y/o Sex: M Age: 64 y/o Sex: M

Type of document (IE/RE): IE Type of document (IE/RE): IE

Diagnosis/PT Impression: Diagnosis/PT Impression: -

PT MANAGEMENT: PT MANAGEMENT:

1. Cryopush on ® Knee x 20 mins 1. Snow angels x 2 lbs DB x 10 reps x 3

2. Pelvic Tilts x 10 reps x 2 sets
3. Dead Bug taps c Vestibular ball x 10
reps x 3 sets
4. Gmed 90-90 x black and yellow x 4SH x
10 x 3 sets
5. Pelvic Bridging x 25 lbs DB c Ball b/w
legs x 10 x 3
6. Ankle strengthening c Gold TB towards
AP x 10 reps x 3 sets
7. Big Toe extension c Blue TB x 10 reps x
3 sets
8. Toe Raises x 10 kgs KB x 6SH x 10 reps x
3 sets
9. Towel Curls x 3 lbs Single DB x 3 rounds
x 3 sets
10. Eccentric-seated Calf Raises x 15 lbs
Medicine Ball x 10 reps x 3 sets (fast
up, slow down)
11. Eccentric-standing calf raises x 15 LBS
KB x 10 reps x 3 sets
12. 12. Miniband series x black above knee;
yellow below knee x 10 reps x 3 sets
13. Monster walks c Black MB x 10 reps x 3
sets
14. X-band walks c Black MB x 15 steps x 3
cycles
15. Banded Hip Flexion c Green MB x 10
sets
2. STS on 20" Fitness Box x 10 reps x 4 sets
(10 lb kb on last 2 sets)
3. Seated Single Arm Rows c 15 kgs Cable
Machine x 8 reps x 3 sets
4. Shrugs 10/10 lbs DB x 10 reps x 3 sets
5. Chest flies 5lbs DB x 8 reps x 3 sets
6. Calf raises c Wedge x 12 reps x 2 sets
7. YTW 1/1 lbs DB x 8 reps x 3 sets
8. Push up on 20" Fitness Box c Black
Monster-band x 6 reps x 4 sets (last set
16" x 4 reps x 1 set)
9. SL Press 40 kgs x 8 reps x 4 sets
10. Lateral Step-overs c 4 cones x 2 rounds
x 3 sets (contact guarding)
11. Walk-over markers c 5 markers x 2
rounds x 3 sets
12. Monster-walk c Green Monster-band x
40 steps x 3 sets
13. Diagonal Lunges in 1meter x 12 reps x 3
sets
14. SL Step up on Level 3 stepper x 8 reps x
4 sets
15. HMP on (B) Shoulder x 10 mins
 CHINESE GENERAL HOSPITAL COLLEGES, INC.
286 Blumentritt Street, Sta. Cruz Manila, Philippines
Trunk Line No.: (02) 711-4141 Local 601 Telefax No.: (02) 711-0075

reps x 3 sets
16. Banded split squats x 5/5 lbs DB x 10
reps x 3 sets
17. Trap bar RDL x 5/5 kgs Plate x 10 reps x
2 sets
18. Farmer's carry Heel-walks and Toe-
walks x 10/10 kgs Trap Bar x 10 steps x
3 cycles
19. Assisted Pogo jumps c Green Monster-
band x 20-30-35 secs
20. Wall-push c Running lunges x 10 secs x
3 sets
21. Stretch: Hip Flexors, Calf, Hamstrings,
ITB x 30 SH x 3 sets
22. Cryopush on ® Knee x 20 mins
23.
Patient’s Name: P.S. Patient’s Name: P.E.

Age: Sex: M Age: Sex: M

Type of document (IE/RE): IE Type of document (IE/RE): IE

Diagnosis/PT Impression: Diagnosis/PT Impression: (L) KNEE CARTILAGE

REPAIR
PT MANAGEMENT: PT MANAGEMENT:

PREPARATION & MOBILITY ACTIVATIONS

1. Cryopush on ® Knee x Mode 7 x 15
mins  elevated
2. FUP on ® Quads x 10 mins  elevated
3. Patellar mobilization  AP-ML
direction x 30-40 oscillation
4. Wall slides x 10 reps x 3 sets (30 SH per
reps, until 120 degrees knee flexion
only)
STRENGTHENING
5. NMES of (R) Quads x 10 mins - Quad
Sets  (L) Quads
6. NMES of (R) Hamstrings x Knee bent x
10 mins - Hams Sets  (L) Hamstrings
7. Hip series - abduction, adduction,
extension c 8 KG AW on (L) then 2KG
1. Cryopush on (L) Knee - 15 mins
Patellar Mobilization AP - 50 reps
2. Wall slides - 30 reps (30 SH every 10th
rep)
3. Functional Quads Sets c rolled bandage
x 8 SH x 10 reps x 2 sets
4. SL Knee Extension - 5 kg x 8 reps x 3
sets; 3rd set 7.5 kgs /side
5. Prone Leg Curls - 20 kgs x 8 reps x 3 sets
6. Planks x 60 SH x 3 sets
7. Side Planks x 30 SH x 3 sets
8. Miniband series (Black Miniband) x 10
reps x 3 sets
9. Standing Hip Series (Purple Monster-
band or Cable Machine - 12.5 kgs) x 10
reps x 3 sets
 CHINESE GENERAL HOSPITAL COLLEGES, INC.
286 Blumentritt Street, Sta. Cruz Manila, Philippines
Trunk Line No.: (02) 711-4141 Local 601 Telefax No.: (02) 711-0075

AW on (R) x 10 reps x 3 sets 10. SL Balance c Ball catching on Wobble

8. Prone Hamstrings curls on (L) x 10 reps Board x 60 SH x 3 sets
x 3 sets c (L) AW 8 kgs then ® 2 kgs AW
9. Gmed 90-90 x Black MB x 10 reps x 2 STRENGTHENING
sets 11. SL Press c 30 kgs x 10 x 3 sets
10. Pelvic bridging x 20 lbs DB x 10 reps x 3 12. Goblet Squats c 35 lbs DB x 10 reps x 3
sets sets
11. DL Wall Squats x 4 SH x 8 reps x 2 sets 13. Hip Thrust c 60 kgs Olympic Bar x 6 reps
12. Weight shifting on (R) x forward x 8 SH x 3 sets
x 10 reps x 2 sets 14. SL Wall Squats x 6 SH x 8 reps x 2 sets
13. Step ups Level 3 stepper x 10 reps x 2 15. Forward step ups (Black Metal Stool) –
sets 15 lbs KB - 10 reps x 3 sets
14. Gait training c 6 cones x 2 rounds x 3 16. SL Calf Raises - 20 lbs KB x 10 reps x 3
sets sets
15. Calf raises on wedge x 10 reps x 3 sets
16. Balance Training  SL on Rolled towel Uppers Day 1 (Push)
x 20 SH x 2 sets 17. Bench Press – 40 kgs/10 reps, 60 kgs/8
reps, 60 kgs/8 reps
POST-WORKOUT: 18. Seated Shoulder Press - 30/30 lbs DB x
17. Stretch (L) Hamstrings x 30 SH x 3 sets 12 reps x 3 sets
18. Cryopush on ® Knee x Mode 7 x 15 19. 1-arm Shoulder Press (split-stance) x 30
mins  elevated, then Ice pack on (L) lbs DB x 10 reps x 3 sets
Knee x 15 mins
Uppers Day 2 (Pull)
20. Pull-ups (underhand) c Purple Monster-
bands x 8 reps x 3 sets
21. 1-arm row (landmine) c Olympic bar+25
kgs Olympic Bar x 10 reps x 3 sets
22. Bent Over Flies c 30/30 lbs DB x 10 reps
x 3 sets

23. Bike x 10 mins (progress resistance as

tolerated)
24. Hamstring Stretch x 30 SH x 3 sets
25. Cryopush on (L) Knee x 20 mins

Patient’s Name: T.A. Patient’s Name: D.A.

Age: Sex: M Age: Sex: M

Type of document (IE/RE): IE Type of document (IE/RE): IE

Diagnosis/PT Impression: ® SUPRASPINATUS Diagnosis/PT Impression: ® BANKART LESION 2°

 CHINESE GENERAL HOSPITAL COLLEGES, INC.
286 Blumentritt Street, Sta. Cruz Manila, Philippines
Trunk Line No.: (02) 711-4141 Local 601 Telefax No.: (02) 711-0075
STRAIN C IMPINGEMENT SYNDROME
PT MANAGEMENT:
MOBILITY:
1. Wand exercises towards (B) shoulder
flexion x 10 reps x 1 set
2. Wand Exercises towards (B) shoulder
abduction; adduction x 10 reps x 1 set
3. Thoracic Extension c roll behind upper
back x 10 reps x 1 set
ACTIVATION:
1. Chin tucks x 10 SH x 10 reps x 1 set
2. Scapular squeeze x 10 SH x 10 reps x 1
set
3. ® Supraspinatus isometrics x 10 SH x 10
reps x 1 set
4. ® shoulder abduction isometrics (initial
range, ~15 degrees) c yellow monster
band x 10 SH x 8 reps x 3 sets
5. ® shoulder ER isometrics (full range) x
10 SH x 8 reps x 3 sets
STRENGTHENING:
1. (B) Banded rows c Red Monster-band x
10 reps x 3 sets
2. (B) Banded face pulls c Red Monster-
band x 10 reps x 3 sets
3. (B) Y raises c 3lbs DB x 8 reps x 3 sets
4. ® Ball exercise towards clockwise &
counterclockwise x 10 reps x 3
sets/side
STRETCHING:
1. Pecs corner stretch x 30 SH x 2 sets
COOLDOWN:
2. Ice on (R) Shoulder x 15 mins
NON-CONTACT TRAUMATIC SHOULDER
DISLOCATION
PT MANAGEMENT:
WARM-UP
Head & Neck Strengthening Exercises
1. Chin Tucks x 10 seconds hold x 10
reps x 3 sets
2. Static Neck Extensions x 10 seconds
hold x 10 reps x 3 sets
ROTATOR CUFF ACTIVATION EXERCISE
1. Supraspinatus Activations x 10 seconds
hold x 10 reps x 3 sets
2. Infraspinatus Activations x 10 seconds
hold x 10 reps x 3 sets
3. Teres Minor Activations x 10 seconds
hold x 10 reps x 3 sets
4. Subscapularis Activations x 10 seconds
hold x 10 reps x 3 sets
EXERCISE PROPER
THORACIC (TORSO) STRENGTHENING EXERCISE
1. Dumbbell Thoracic Extensions x 12 reps x 3
sets
SCAPULAR STABILIZATION EXERCISE
1. Bent-over Dumbbell Rows x 10 seconds
hold x 10 reps x 3 sets
2. Dumbbell Scaptions x 12 reps x 3 sets
3. Push-up Plus x 10 seconds hold x 10
reps x 3 sets
Alternatively: Dumbbell Punch-outs x 10
seconds hold x 10 reps x 3 sets
4. Dumbbell Plate Prone Snow Angels x 12
reps x 3 sets
5. Prone I-Y-W Shoulder Raises x 10 reps x
3 sets
6. Bent-over Dumbbell “I” “Y” “W”
Shoulder Raise x 12 reps x 3 sets
SHOULDER EXTERNAL ROTATORS
 CHINESE GENERAL HOSPITAL COLLEGES, INC.
286 Blumentritt Street, Sta. Cruz Manila, Philippines
Trunk Line No.: (02) 711-4141 Local 601 Telefax No.: (02) 711-0075

STRENGTHING
1. Bent-over Dumbbell Face-pulls x 10
seconds hold x 10 reps x 3 sets
2. Side-lying Dumbbell External Rotations
x 12 reps x 3 sets
3. Single-arm Cable Row to External
Rotation Shoulder Press x 10 reps x 3
sets
4. Mini-band Shoulder External Rotations
to Overhead Press x 12 reps x 3 sets

MIDDLE DELTOID STRENGTHENING

1. Dumbbell Shoulder Lateral Raises x 12
reps x 3 sets

REAR DELTOID STRENGTHENING

1. Dumbbell Shoulder Posterolateral
Raises x 12 reps x 3 sets

Noted by: _____________________

CLINICAL SUPERVISOR/STAFF