How did your lower back pain begin
Choose an Answer
- Accident/Trauma
- Woke Up With It One Day
- Overuse
- Slowly Got Worse Overtime
How long have you had it?
Choose an Answer
- one day to a week
- one week to a month
- one month to six months
- over six months
Where is the pain?
Choose an Answer
- Centre Of Lower Back
- Only On The Left
- Only On The Right
- Mid Back
- Upper Back
Is the pain in one spot?
Choose an Answer
- Yes
- No
Does the pain travel down your leg?
Choose an Answer
- Yes
- No
How far does the pain travel down your leg?
Choose an Answer
- Thigh
- Knee
- Ankle
- Foot
What time of the day is the pain the most intense?
Choose an Answer
- Morning
- During The Day
- Night Time
What time of the day is the pain the least intense?
Choose an Answer
- Morning
- During The Day
- Night Time
What position relieves the pain even if slightly?
Choose an Answer
- Standing Up Straight
- Lying On The Left
- Lying On The Right
- Rounding Your Back/Pulling Your Knees In
- Moving About
- Lying Still
How many pain relievers do you take a day to be able to cope with the pain?
Choose an Answer
- 0
- 1
- 2
- 3
- More Than 3
What have you tried so far?
Choose an Answer
- Surgery
- Physiotherapy
- Corrective exercise
- Nutrition/Lifestyle changes
- Chiropractic adjustment
- Medication/Pain killers
Have you had a diagnosis from a doctor/xray/mri?
Choose an Answer
- Yes
- No
What was the diagnosis?
Choose an Answer
- Ruptured Disc
- Fracture Of Vertebra
- Spondylolisthesis
- Lumbar Spinal Stenosis
- Overuse
- Muscular Imbalance
