Single-Leg Hip Thrust Exercise Assessment Form
Please complete the Single-Leg Hip Thrust Exercise Assessment Form to evaluate exercise performance and technique.
Which leg was assessed?
*
Left leg
Right leg
Rate the overall stability during the exercise.
*
1
2
3
4
5
How would you rate hip extension range of motion?
*
1
2
3
4
5
How well was the pelvis kept level throughout the movement?
*
Not at all level
1
2
3
4
Perfectly level
5
1 is Not at all level, 5 is Perfectly level
Rate the control during the upward and downward phases.
*
Poor control
1
2
3
4
Excellent control
5
1 is Poor control, 5 is Excellent control
Symmetry between left and right sides
*
Symmetrical
Slightly asymmetrical
Significantly asymmetrical
Check the appropriate description for each repetition:
*
Rows
Proper form
Loss of balance
Incomplete range
Rep 1
1
2
3
Rep 2
4
5
6
Rep 3
7
8
9
Rep 4
10
11
12
Rep 5
13
14
15
How difficult was the exercise to perform?
*
Very easy
1
2
3
4
Very difficult
5
1 is Very easy, 5 is Very difficult
Did you experience any discomfort during the exercise?
*
No discomfort
Mild discomfort
Moderate discomfort
Severe discomfort
Additional comments or observations
Submit Assessment
Should be Empty: