Self-Assessment: Neck & Back Pain

Self-Assessment: Neck & Back Pain

The following questions will help you learn if you can benefit from therapeutic intervention to address your neck or back pain. For each question, select the choice that best applies to you.

Do you have neck or back pain that limits you performing daily functional activities? (e.g.: dressing, bathing, toileting) Yes
No Do you have neck or back pain that restricts you from performing any recreational activities? (e.g.: hiking, sports) Yes
No Do you have neck or back pain that restricts you from performing any daily household activities? (e.g.: laundry, vacuuming, cleaning) Yes
No Do you have pain at night that significantly interferes with your sleeping? Yes
No Do you have any of the following symptoms in your arms or legs: pain, burning, shooting pain, ache/numbness, tingling? Yes
No Have you noticed weakness in your arms or legs? Yes
No Have you noticed significant loss of balance or difficulty walking? Yes
No Do you have a weakness in the foot or "foot drop?" Yes
No Have you experienced loss of bowel or bladder control? Yes
No