Welcome to your QUIZ - Do You Need Physical Therapy? Where is your problem? Back Neck Shoulder Knee Other None How long has this been going on? Days Weeks Months More than a year None Pain intensity (0–10) 1 2 3 4 5 6 7 8 9 10 None How did the problem start? Trauma Spontaneous Chronic Worsening (progressive) pain Which factor increases the symptoms? (You can choose more than one answer.) Sitting Stand Prone position (face down) Supine position (face up) Walk Lift weights Play sports Other Describe your pain. Sharp/stinging pain Dull pain Constant pain Burning pain (stinging) Pain that radiates (e.g., down the leg or arm) Rigidity Tingling (sensation of pins and needles) Numbness (altered perception) Other What activities are you unable to do because of the problem? Work Sleep through the night Play sports Daily activities Guide Other Warning signals (select if present) Recent trauma or suspected fracture Numbness in the genital area / loss of sphincter control Progressive weakness in the legs or arms Sudden fever with severe pain Chest pain or difficulty breathing Clear signs of post-injury inflammation (swelling/redness/pain/heat/difficulty moving) Nobody Time's up
