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Yes |
No |
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1. |
Do you experience RECURRENT back pain of any intensity, even the most mild aches? |
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2. |
Do you have to AVOID ANY SPECIFIC PHYSICAL ACTIVITY because of back pain? |
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3. |
Do you take pain medication occasionally (MONTHLY) for back pain? |
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4. |
Do you have a very busy lifestyle and find you're TOO BUSY to sometimes take care of
yourself? |
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5. |
Do you EXERCISE LESS THAN 3 TIMES A WEEK (30 minutes minimum)? |
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6. |
Are you OVERWEIGHT (by 30 pounds), or eat ANY of the following foods DAILY; those with
ultra-high sugar content (such as carbonated sugar pop, sweets), deep fried or fried fast
food, or hydrogenated and processed foods like potato chips? |
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7. |
Does you job require a lot of BENDING, LIFTING, or prolonged SITTING WITHOUT BREAKS (at
least every twenty minutes)? |
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8. |
Do you care for children under the age of three, shovel, vacuum, do yard work, major
home or car repairs DAILY? |
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9. |
Do you have DISCOMFORT SLEEPING, or have mild PAIN IN THE MORNING after sleeping that
goes away after short while? |
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10. |
Are you unemployed, divorced and single and financially stressed, do not receive
regular affection such as loving words and hugs weekly, hardly have any social life, or
feel depressed frequently? |
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Results |
