Performance Optimization Assessment Client Name* First Last Client Email* Client Height (IN)* Are you struggling with pain or a potential injury you’d like to discuss with our doctor? Yes No If yes (please indicate area) Anatomical ProfileFoot* Low Neutral High Tibial Shape* Valgus Neutral Varus Tibial Direction* Internal Neutral External Knee* Valgus Neutral Varus Hip* Anteversion Neutral Retroversion Range of Motion ProfileWalk on heels* 0 Points / Pain Extremely Low Low Within Normal Limits Walk on toes* 0 Points / Pain Extremely Low Low Within Normal Limits Bend and try to touch toes* 0 Points / Pain Extremely Low Low Within Normal Limits Pull big toe back* 0 Points / Pain Extremely Low Low Within Normal Limits Fundamental Running Movement ProfileSquat TestSquat Test* 0 Points / Pain Two Faults One Fault No Faults SL Squat TestRight Leg* 0 Points / Pain Two Faults One Fault No Faults Left Leg* 0 Points / Pain Two Faults One Fault No Faults In-Line Lunge TestRight Leg* 0 Points / Pain Two Faults One Fault No Faults Left Leg* 0 Points / Pain Two Faults One Fault No Faults Balance Test (eyes closed) (if they leave area, fault)Right Leg* 0 Points / Pain Less than 30 Seconds Between 30 and 60 Seconds 60 Seconds Left Leg* 0 Points / Pain Less than 30 Seconds Between 30 and 60 Seconds 60 Seconds Hop Test 1 (hop 20 times in 20 seconds in square)Right Leg* 0 Points / Pain Two Faults One Fault No Faults Left Leg* 0 Points / Pain Two Faults One Fault No Faults Hop Test 2 (single leg hop for distance)Right Leg* 0 Points / Pain 25% height or less or loss of balance in attempt Between 25% and 50% height Greater than 50% height Left Leg* 0 Points / Pain 25% height or less or loss of balance in attempt Between 25% and 50% height Greater than 50% height
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