How did your lower back pain begin

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  • Accident/Trauma
  • Woke Up With It One Day
  • Overuse
  • Slowly Got Worse Overtime

How long have you had it?

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  • one day to a week
  • one week to a month
  • one month to six months
  • over six months

Where is the pain?

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  • Centre Of Lower Back
  • Only On The Left
  • Only On The Right
  • Mid Back
  • Upper Back

Is the pain in one spot?

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  • Yes
  • No

Does the pain travel down your leg?

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  • Yes
  • No

How far does the pain travel down your leg?

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  • Thigh
  • Knee
  • Ankle
  • Foot

What time of the day is the pain the most intense?

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  • Morning
  • During The Day
  • Night Time

What time of the day is the pain the least intense?

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  • Morning
  • During The Day
  • Night Time

What position relieves the pain even if slightly?

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  • 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?

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  • 0
  • 1
  • 2
  • 3
  • More Than 3

What have you tried so far?

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  • Surgery
  • Physiotherapy
  • Corrective exercise
  • Nutrition/Lifestyle changes
  • Chiropractic adjustment
  • Medication/Pain killers

Have you had a diagnosis from a doctor/xray/mri?

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  • Yes
  • No

What was the diagnosis?

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  • Ruptured Disc
  • Fracture Of Vertebra
  • Spondylolisthesis
  • Lumbar Spinal Stenosis
  • Overuse
  • Muscular Imbalance