A free pain diary template and exercise log that patients fill in daily, with sample entries showing what to write.
✓One line a day, nothing more
✓Logs exercises by HEP number
✓Pain before and after exercise
Free · No sign-up · Saves in your browser
What's inside
Your Pain Scale
Daily Diary
Activities That Made Pain Better or Worse
Pain Medicines Taken
Questions for Your Physiotherapist
Preview · 5 sections
Pain and Exercise Diary
Name
Week starting
Physiotherapist
Next appointment
Pain area to rate
Clinic phone
Your Pain Scale
Pain scale chosen by your physiotherapistThe physiotherapist writes the scale, what its lowest and highest points mean, and which pain to rate.
Daily Diary
Day / Date
Exercises Done (numbers from your HEP)
Sets Done
Pain Before
Pain After
Notes (sleep, work, activity)
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Activities That Made Pain Better or Worse
Day
Activity
Better / Worse
How Long It Lasted
Pain Medicines Taken
Pain medicines takenOnly as prescribed by your doctor. Write what you took and when.
Questions for Your Physiotherapist
Questions for your physiotherapist
How to fill it in
1
Diary details
Week starting date, next appointment, the pain area to rate, and the clinic phone.
More guidance
Fill in the week starting date and the next appointment so the patient knows when the sheet is due back. Write the pain area to rate in the details table as well, where the patient will see it every time they open the page. Add the clinic phone number for questions that cannot wait until the visit.
2
Your Pain Scale
The physiotherapist names the scale, explains its ends, and says which pain to rate.
More guidance
Before handing the diary over, the physiotherapist writes the name of the pain scale they chose, what its lowest and highest points mean in plain words, and which pain to rate, such as the knee and not the back. Use the same scale as the clinic notes so diary and records match. Check the patient can use it by asking them to rate their pain right now.
3
Daily Diary
One row a day: exercises by HEP number, sets, pain before and after, a note.
More guidance
One row a day: the exercises done, by their number on the HEP sheet, how many sets, the pain just before starting and about half an hour after finishing, and a short note. Encourage honest blanks. A day with no exercises is useful information, and a diary filled in from memory on the morning of the appointment is not. Suggest a fixed time to fill it in, such as after dinner.
4
Activities That Made Pain Better or Worse
Anything outside the exercises that changed pain, and how long the change lasted.
More guidance
Here the patient notes things outside the exercises that changed their pain: a long bus journey, a festival with hours of cooking, a good night's sleep. Ask them to write how long the change lasted. Patterns across two or three weeks often tell you more than any single day.
5
Pain Medicines Taken
Any prescribed pain medicine taken and when, so ratings can be read fairly.
More guidance
Patients note any pain medicine they took and when, only as their doctor prescribed. This helps you read the ratings, since pain an hour after a tablet is not the same as pain without one. The diary gives no advice about medicines; questions about them go to the prescribing doctor.
6
Questions for Your Physiotherapist
Questions the patient wants to ask, written down as they come up.
More guidance
Leave space for questions as they come up during the week. Patients forget them in clinic, and the questions often reveal a misunderstanding about the exercises that you can fix in a minute.
Pain diary template and exercise log: filled sample
Fictional entries, initials only, showing the level of detail to aim for. Impression and summary sections are left for the treating clinician.
Diary details
Week starting: Monday 6 October. Next appointment: Saturday 11 October, 10 am. Pain area to rate: left knee.
Your Pain Scale
We use a 0 to 10 scale. 0 means no pain; 10 means the worst pain you can imagine. Rate your left knee pain only.
Daily Diary
Tue: exercises 1, 2, 3. Sets: 2, 2, 1. Pain before 3, after 4. 'Stopped exercise 3 early, knee tired after the market.'
Activities That Made Pain Better or Worse
Sat: stood cooking for about 4 hours for a family function. Worse. Lasted until Sunday afternoon.
Pain Medicines Taken
Thu: 1 tablet prescribed by Dr N., 9 pm, before sleeping.
Questions for Your Physiotherapist
Should I still do the exercises on days my knee looks swollen?
Pain diary or HEP sheet?
Pain and exercise diary
Home exercise programme sheet
Written by
The patient, one line a day
The physiotherapist
Tells you
What was done and how pain responded
What to do, how much, and when to stop
Changes
A new page each week
Only when the programme changes
In clinic
Read together at the start of the session
Checked and updated at the end
Used together
Logs exercises by their HEP numbers
Numbers each exercise so the diary can refer to it
Tips and mistakes to avoid
Do
Number exercises the same way on the HEP sheet and the diary, so patients can write '1, 2, 3'.
For patients who do not read comfortably, use ticks and a picture scale, or let a family member write the line.
Where your privacy policy allows, ask for a WhatsApp photo of the diary the evening before a session.
Start a new sheet each week and keep the old ones; four weeks together show trends.
Thank patients for completed diaries, including bad weeks, so a poor week does not feel like failure.
Avoid
Using a different pain scale in the diary from the one in the clinic notes.
Handing over the diary without explaining what to rate, so the patient mixes worst pain and average pain across days.
Asking for so much detail that the diary is abandoned after three days.
Collecting the diary and never discussing it with the patient.
Reading only the pain numbers and skipping the notes column, where the explanation for a bad day usually sits.
About this data sheet
A pain and exercise diary is a simple daily sheet the patient keeps between physiotherapy sessions: which exercises they did, how many sets, their pain before and after on the scale their physiotherapist chose, and notes on sleep, work and activity. This free pain diary template fills in online or prints as a PDF.
Alongside a new home exercise programme
When flare-ups seem linked to work, sleep or activity
Between widely spaced sessions for patients travelling in
Before progressing exercises, for a week of information
Read more
Ask a patient how the week went and you hear about the last two days, coloured by today. A short daily diary replaces that guess with a record you read together at the start of the session.
The physiotherapist fills in the pain scale and exercises first; the patient adds one line a day. The diary records what happened and leaves the interpretation to the physiotherapist. Physical therapy patients asked for an exercise log can use it too.
Questions
What is a pain diary template used for?+
It gives the patient a simple daily record of pain and activity between appointments, so the physiotherapist sees what happened rather than what was remembered. This one also logs home exercises and sets, with pain before and after.
Is there a filled sample of the pain diary?+
Yes. Each section in the guide above shows a fictional sample entry, such as one day's line with exercises, sets and pain before and after. The diary has no summary section; your physiotherapist reads the patterns with you in clinic.
How do I keep an exercise log for physiotherapy?+
Write one line a day: the exercises done (by HEP number), how many sets, pain before and after on the scale your physiotherapist gave you, and a short note. Fill it in at the same time each day and bring it to every visit.
Which pain scale should the diary use?+
The scale your physiotherapist chose for you, written at the top of the sheet. The diary does not choose one, so it stays consistent with your clinic's records.
How long should I keep a pain diary?+
As long as your physiotherapist asks, often until the next review. Even one or two weeks can show useful patterns.
Can a family member fill it in for me?+
Yes. Many patients find it easier when a son, daughter or grandchild writes the entry each evening. Make sure the pain ratings are your own.
Can I download the pain diary as a PDF?+
Yes. Fill it in on screen or print it blank, a new sheet each week. No sign-up is needed.
