Lower Back Pain Assessment

Is the pain on one side, both sides, or centered in the lower back?

The pain is on the right side of my lower back.

The pain is on the left side of my lower back.

The pain is centred in the middle of my lower back.

Please select an option before proceeding.

Does the pain radiate to your legs or feet?

Yes, the pain radiates down to one or both of my legs.

Yes, the pain radiates to my feet, with tingling or numbness.

No, the pain does not radiate to my legs or feet.

Please select an option before proceeding.

Do you experience numbness, tingling, or weakness in your legs?

Yes, I experience tingling or numbness in my legs, especially when sitting or standing for long periods.

Yes, I feel weakness in my legs, making it hard to walk or stand for long.

No, I do not experience any numbness, tingling, or weakness in my legs.

Please select an option before proceeding.

Is the pain sharp, dull, or a persistent ache?

The pain is sharp, especially with sudden movements or certain positions.

The pain is dull and aching, mostly constant throughout the day.

The pain is a persistent ache that gets worse after prolonged sitting or standing.

Please select an option before proceeding.

Does the pain improve with movement or rest?

The pain improves with movement or light stretching.

The pain gets worse with movement but improves with rest.

The pain remains constant, regardless of movement or rest.

Please select an option before proceeding.

How long have you been experiencing this pain or issue?

Less than a week

1-4 weeks

Over a month

Other

How did the pain start?

Sudden

Gradual

Do you know the cause of pain?

Yes

How would you rate your pain on a scale of 1-10?

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Have you taken any medications or treatments for this pain?

Yes

Is this pain the first time you’ve experienced it, or have you had similar pain before?

Yes, this is the first time I’m experiencing this type of pain.

No, I’ve had this type of pain before, but it went away after a while.

No, I’ve had similar pain before, and it has been recurring.

Have you ever been involved in a road traffic accident (car, bike, or pedestrian)?

Yes, I’ve been in a road traffic accident before and sustained injuries.

Yes, but I did not experience significant injuries at the time.

No, I’ve never been in a road traffic accident.

Have you ever had any fractures or discitys in your body, particularly around the affected area?

Yes, I have had a fracture or discity in the area experiencing pain.

Yes, I’ve had a fracture or discity in another area of my body.

No, I’ve never had any fractures or discitys.

Have you undergone any surgeries in the past, especially related to the area experiencing pain?

Yes, I’ve had surgery in the affected area (e.g., hip, shoulder, back).

Yes, I’ve had surgeries elsewhere in my body but not in the affected area.

No, I have never had any surgeries.

Do you have any other medical conditions that might be related to the pain, such as arthritis, diabetes, or autoimmune disorders?

Yes, I have a medical condition (e.g., arthritis, diabetes, fibromyalgia) that may be related to the pain.

No, I don’t have any known medical conditions related to the pain.

I’m not sure, but I’ve been diagnosed with other health issues.

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Lower Back Pain Assessment

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