442 South Main Street

Suite 12

Davidson, NC 28036

samantha@davidsonyogatherapy.com

 

Tel: 980-322-4518

Mon - Fri: 8:30am - 7pm

​​Saturday: 9-1

​Sunday: Closed

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How Bad is

Your Back Pain?

The following test is considered the ‘gold standard’ of back pain functional outcome tools. 

Oswestry Low Back Pain Disability Questionnaire

 
 
 
Instructions


If you suffer from back, hip, neck or shoulder pain, please answer by checking ONE box in each section for the statement which best applies to you. Consider your answers. Is your pain worse than you thought? What does it cost you to stay in pain? What would you get back if you could get relief or learn to better manage it?

 

Then, call for a free 30 minute consultation to see if the "Master Your Pain" program is a good fit for you. 

 

 
Section 1 - Pain intensity


__I have no pain at the moment
__The pain is very mild at the moment
__The pain is moderate at the moment
__The pain is fairly severe at the moment
__The pain is very severe at the moment
__The pain is the worst imaginable at the moment

 

Section 2 - Personal care (washing, dressing etc)

 

__I can look after myself normally without causing extra pain
__I can look after myself normally but it causes extra pain
__It is painful to look after myself and I am slow and careful
__I need some help but manage most of my personal care
__I need help every day in most aspects of self-care
__I do not get dressed, I wash with difficulty and stay in bed

 

Section 3 - Lifting

 

__I can lift heavy weights without extra pain
__I can lift heavy weights but it gives extra pain
__Pain prevents me from lifting heavy weights off the floor, but I can manage if they are conveniently placed eg. on a table
__Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positioned
__I can lift very light weights
__I cannot lift or carry anything at all

 

Section 4 - Walking*

 

__Pain does not prevent me walking any distance
__Pain prevents me from walking more than 1 mile
__Pain prevents me from walking more than 1/2 mile
__Pain prevents me from walking more than 100 yards
__I can only walk using a stick or crutches
__I am in bed most of the time

 

Section 5 - Sitting

 

__I can sit in any chair as long as I like
__I can only sit in my favorite chair as long as I like
__Pain prevents me sitting more than one hour
__Pain prevents me from sitting more than 30 minutes
__Pain prevents me from sitting more than 10 minutes
__Pain prevents me from sitting at all

 

Section 6 - Standing

 

__I can stand as long as I want without extra pain
__I can stand as long as I want but it gives me extra pain
__ Pain prevents me from standing for more than 1 hour
__Pain prevents me from standing for more than 30 minutes
__Pain prevents me from standing for more than 10 minutes
__Pain prevents me from standing at all

 

Section 7 - Sleeping

__My sleep is never disturbed by pain
__My sleep is occasionally disturbed by pain
__Because of pain I have less than 6 hours sleep
__Because of pain I have less than 4 hours sleep
__Because of pain I have less than 2 hours sleep
__Pain prevents me from sleeping at all

 

Section 8 - Sex life (if applicable)

 

__My sex life is normal and causes no extra pain
__My sex life is normal but causes some extra pain
__My sex life is nearly normal but is very painful
__My sex life is severely restricted by pain
__My sex life is nearly absent because of pain
__Pain prevents any sex life at all

 

Section 9 - Social life

 

__My social life is normal and gives me no extra pain
__My social life is normal but increases the degree of pain
__Pain has no significant effect on my social life apart from limiting my more energetic interests eg, sport
__Pain has restricted my social life and I do not go out as often
__Pain has restricted my social life to my home
__I have no social life because of pain

 

Section 10 - Traveling

 

__I can travel anywhere without pain

__I can travel anywhere but it gives me extra pain
__Pain is bad but I manage journeys over two hours
__Pain restricts me to journeys of less than one hour
__Pain restricts me to short necessary journeys under 30 minutes
__Pain prevents me from traveling except to receive treatment

References
1. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine 2000 Nov 15;25(22):2940-52; discussion 52.
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