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What We Treat
Back Pain And Sciatica

Shoulder Pain

Foot and Ankle Pain

Arthritis

Chronic Pain

Fibromyalgia

Incontinence

Neurological Conditions

Pre/Post-Natal Pain

Post-Surgical Rehabilitation

TMJ Dysfunction

View More Conditions

Neck Pain

Hip and Knee Pain

Elbow, Wrist, and Hand Pain

Balance and Gait Disorders

Dizziness And Vertigo

Headaches and Migraines

Motor Vehicle Accident Injuries

Pelvic Pain

Pre-Surgical Physical Therapy

Sports Injuries

Work Injuries
How We Treat
Physical Therapy

Anodyne Therapy

Deep Tissue Laser Therapy

Electrical Stimulation

IASTM

Kinesio Taping

Myofascial Release

Telehealth Therapy

Therapeutic Massage Therapy

Vestibular Therapy

Biosway Therapy

Dry Needling

Fall Prevention

Joint Mobilization

Occupational Therapy

Manual Therapy

Spinal Mobilization

Therapeutic Exercise

Ultrasound Therapy
Patient Info
For Physician
Health Tips
Contact

About
What We Treat
Back Pain And Sciatica

Shoulder Pain

Foot and Ankle Pain

Arthritis

Chronic Pain

Fibromyalgia

Incontinence

Neurological Conditions

Pre/Post-Natal Pain

Post-Surgical Rehabilitation

TMJ Dysfunction

View More Conditions

Neck Pain

Hip and Knee Pain

Elbow, Wrist, and Hand Pain

Balance and Gait Disorders

Dizziness And Vertigo

Headaches and Migraines

Motor Vehicle Accident Injuries

Pelvic Pain

Pre-Surgical Physical Therapy

Sports Injuries

Work Injuries
How We Treat
Physical Therapy

Anodyne Therapy

Deep Tissue Laser Therapy

Electrical Stimulation

IASTM

Kinesio Taping

Myofascial Release

Telehealth Therapy

Therapeutic Massage Therapy

Vestibular Therapy

Biosway Therapy

Dry Needling

Fall Prevention

Joint Mobilization

Occupational Therapy

Manual Therapy

Spinal Mobilization

Therapeutic Exercise

Ultrasound Therapy
Patient Info
For Physician
Health Tips
Contact

Menu

Chesterton
Michigan City
Portage

About Us
What We Treat
How We Treat
Patient Info
FOR PHYSICIAN
Health Tips
Contact
Make A Payment
Request Appointment
Review Us

About Us
What We Treat
How We Treat
Patient Info
FOR PHYSICIAN
Health Tips
Contact
Make A Payment
Request Appointment
Review Us

Back Pain Self Screening Tool

1. Location of pain:

Lower back

Upper back

Neck

Radiating pain (down legs, arms, etc.)

2.Pain type:

Aching

Sharp

Burning

Numbness/tingling

3. Pain intensity (0-10):

Mild (0-3)

Moderate (4-6)

Severe (7-10)

4. Duration:

Acute (<6 weeks)

Subacute (6-12 weeks)

Chronic (>12 weeks)

5. Do you experience:

Pain when standing/sitting/lying down?

Pain when lifting/bending/twisting?

Pain when coughing/sneezing?

Numbness/weakness in legs/arms?

6. Triggers:

Heavy lifting

Poor posture

Stress/anxiety

Sleep quality

Others

7. Previous back injuries/surgeries?

Yes

No

8. Underlying medical conditions (e.g., diabetes, arthritis)?

Yes

No

9. Current medications?

Yes

No

10. Difficulty with:

Daily activities (e.g., dressing, bathing)

Work-related tasks

Leisure activities (e.g., sports, hobbies)

11. Impact on daily life (0-10):

Minimal (0-3)

Moderate (4-6)

Significant (7-10)

Loading …

Question 1 of 11

15356

Disclaimer: Remember, this self-screening tool is not a substitute for professional medical advice. If you’re concerned about your back pain, consult with a healthcare professional for an accurate diagnosis and treatment plan.

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CHESTERTON

425 Sand Creek Dr. N #C
Chesterton, IN 46304

P:

(219) 926-9779

MICHIGAN CITY

320 Dunes Plaza
Michigan City, IN 46360

P:

(219) 898-4360

PORTAGE

3190 Willowcreek Rd Suite A
Portage, IN 46368

P:

(219) 682-2990

What We Treat

Arthritis
Back Pain and Sciatica
Balance and Gait Disorders
Chronic Pain
Pelvic Pain
Dizziness And Vertigo

Elbow, Wrist, and Hand Pain
Pre-Surgical Physical Therapy
Pre/Post-Natal Pain
Motor Vehicle Accident
Neurological Conditions
Fibromyalgia

Foot and Ankle Pain
Headaches and Migraines
Hip and Knee Pain
Incontinence
Neck Pain
Post-Surgical Rehabilitation

Shoulder Pain
Sports Injuries
TMJ Dysfunction
Work Injuries
View More Conditions

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