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Above & Beyond Physical Therapy has relocated from Phoenix to Glendale
Visit Our New Glendale Office
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Orthopedic Rehabilitation
Post-Surgical Rehabilitation
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Glendale
Queen Creek
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Take your first step toward recovery, your body will thank you.
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Queen Creek - 21321 E Ocotillo Rd, #122
Glendale - 18275 N 59th Ave, #152
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Spinal Cord Injury
Neurological Injury
Auto Accident Injury
Work Related Injury
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Tendinitis or Bursitis
Fracture or Dislocation
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Home
About Us
Meet Our Team
Conditions We Treat
Services
Orthopedic Rehabilitation
Post-Surgical Rehabilitation
Strength and Balance Therapy
Additional Therapies
Patient Education
Knee Surgery Guide
Back Pain Self-Assessment
Blog
Contact Us
Glendale
Queen Creek
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Take the First Step Toward Back Pain Relief Today
This short survey is designed to help you share how your back feels and how it affects your daily activities. Just choose the answers that best match your experience.
How would you describe your pain right now?
(Required)
I can tolerate it without pain medication
It’s bad, but I don’t need medication
Medication gives me complete relief
Medication gives me moderate relief
Medication gives me little relief
Medication doesn’t help at all
How much does pain affect your ability to take care of yourself (washing, dressing, etc.)?
(Required)
I take care of myself normally without pain
I take care of myself normally, but it increases my pain
It’s painful, and I have to move slowly and carefully
I need some help, but can manage most things
I need daily help for most activities
I can’t dress or wash myself and mostly stay in bed
How much does pain limit your ability to lift and carry objects?
(Required)
I can lift heavy weights without pain
I can lift heavy weights, but it causes pain
I can’t lift heavy weights off the floor, but I can if they’re on a table
I can’t lift heavy weights, but I can lift lighter ones if convenient
I can only lift very light objects
I can’t lift or carry anything at all
How much does pain affect your ability to walk?
(Required)
I can walk any distance without pain
I can walk more than 1 mile, but not further
I can walk more than ½ mile, but not further
I can walk more than ¼ mile, but not further
I can only walk using crutches or a cane
I spend most of my time in bed and must crawl to the toilet
How long can you sit without significant pain?
(Required)
I can sit in any chair as long as I want
I can sit in my favorite chair as long as I want
I can sit up to 1 hour
I can sit up to 30 minutes
I can sit only about 10 minutes
I can’t sit at all
How long can you stand without significant pain?
(Required)
As long as I want without pain
As long as I want, but pain increases
Up to 1 hour
Up to 30 minutes
Up to 10 minutes
Not at all
How much does pain affect your sleep?
(Required)
Pain doesn’t prevent me from sleeping
I sleep well only with medication
Even with medication, I sleep less than 6 hours
Even with medication, I sleep less than 4 hours
Even with medication, I sleep less than 2 hours
Pain prevents me from sleeping at all
How much does pain limit your social life?
(Required)
My social life is normal and pain-free
My social life is normal, but pain increases
Pain prevents me from doing energetic activities
Pain prevents me from going out often
Pain has restricted my social life to home
I hardly have any social life because of pain
How much does pain affect your ability to travel?
(Required)
I can travel anywhere without pain
I can travel anywhere, but pain increases
Pain restricts travel over 2 hours
Pain restricts travel over 1 hour
Pain restricts me to short necessary trips under 30 minutes
I can only travel to the doctor or therapist
How much does pain affect your work or homemaking activities?
(Required)
I can do all my usual activities without pain
I can do all activities, but pain increases
I can do most things, but not heavy tasks (lifting, vacuuming)
I can only do light duties
I can’t do even light duties
I can’t do any work or homemaking
Enter your name and email below to get instant access to your assessment results. You'll receive a customized report with tips and recommendations.
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