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Orthopedic Services

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.

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Orthopedic Services

How to Use This Self-Assessment

For each question, select the choice that best applies to you.

Neck and Back Pain Questions

  1. Do you have neck or back pain that limits you performing daily functional activities? (e.g.: dressing, bathing, toileting)
  2. Do you have neck or back pain that restricts you from performing any recreational activities? (e.g.: hiking, sports)
  3. Do you have neck or back pain that restricts you from performing any daily household activities? (e.g.: laundry, vacuuming, cleaning)
  4. Do you have pain at night that significantly interferes with your sleeping?
  5. Do you have any of the following symptoms in your arms or legs: pain, burning, shooting pain, ache/numbness, tingling?
  6. Have you noticed weakness in your arms or legs?
  7. Have you noticed significant loss of balance or difficulty walking?
  8. Do you have a weakness in the foot or “foot drop?”
  9. Have you experienced loss of bowel or bladder control?

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