S.I.N.S a Key Concept in a Physical Therapy Evaluation
S.I.N.S. is an acronym for “Severity, Irritability, Nature, and Stage”


Clinical reasoning skills and the process to properly evaluate a patient comes from years of experience or learning from others that can share their experiences. The first weekend lecture of this residency was performed by physical therapist Rob Naber PT, OCS, SCS, ATC and we reviewed the importance of a thorough evaluation to determine the S.I.N.S. of a patient, which is necessary to properly dose the treatment.

Severity- Represents the intensity of symptoms and is based on the perception of symptoms by the patient and how much those symptoms affect their daily activity.

  • The severity is determined before a physical therapist sees the patient with the use of functional assessment questionnaires (FAQ). These allow for an objective assessment of the impact that the current condition has on the patients life.

Irritability- Refers to the activity that provokes the symptoms and how long it takes for those symptoms to subside.

  • Using a visual analog scale (VAS) the patient can give an objective rating for the intensity of their symptoms and determine if the symptoms are mechanical or chemical in nature.
    • Mechanical symptoms: are based on positions and subside rapidly with altered position
    • Chemical symptoms: can be increased by a position, but persist even after the position is improved.

Nature- Determining the nature of the condition in terms of biomechanics occurs during the evaluation process. The standard physical therapy evaluation process should be performed to determine the active ROM, passive ROM, and strength. There should also be consideration of a posture to relieve pain and to determine the forces that cause the symptoms to initially occur or that provoke the symptoms.

“This is the hypothesis for treatment and should guide treatment”

3 forces that cause tissue injury:


2 categories for the injury:


Stage- The stage is determined when the clinician is able to properly understand the patients functional limitations, symptoms, and the nature of the tissue injury.


  • S- Moderate = Lysholm Knee Scoring Sheet 40/100
  • I- Moderate = Pain is 4/10 with 50% mechanical and 50% chemical
  • N- Intolerant to tensile load (R knee AROM 0-90)
  • Hypothesis= Intolerant to tensile load on anterior aspect of R knee
  • Strategy= Stretching program
  • Tactics/techniques= Modalities for pain, anterior tissue mobilization, joint mobilization, sustained knee flexion stretch, and strengthening in new ROM.



Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s