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Knee Rehabilitation Progress Tracking Chart

Patient Self-Monitoring Tool for Knee Condition Recovery

Orthopedics

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________
Date of Injury/Surgery: _________________
Diagnosis: _________________

Pain Level Tracking (Rate 0-10)

Date At Rest During Activity After Exercise

Range of Motion (ROM)

Flexion (Bending)

  • Target ROM: _____ degrees
  • Weekly Measurements:
    • Week 1: _____ degrees
    • Week 2: _____ degrees
    • Week 3: _____ degrees
    • Week 4: _____ degrees

Extension (Straightening)

  • Target ROM: _____ degrees
  • Weekly Measurements:
    • Week 1: _____ degrees
    • Week 2: _____ degrees
    • Week 3: _____ degrees
    • Week 4: _____ degrees

Strength Progress

Exercises (Rate perceived difficulty 1-5)

  1. Straight Leg Raises
  2. Quad Sets
  3. Hamstring Curls
  4. Wall Slides
Date Exercise 1 Exercise 2 Exercise 3 Exercise 4

Functional Milestones

  • Walking without assistive device
  • Climbing stairs
  • Squatting to 90 degrees
  • Running in straight line
  • Lateral movements

Notes

Record any concerns, changes, or observations:

Next Appointment

Date: _________________
Time: _________________

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