OSWESTRY LOW BACK PAIN QUESTIONNAIRE

Full Name/Participant’s Name:*

First NameLast Name

Email*

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This questionnaire has been designed to give your therapist information as to how your back pain has affected your ability to manage in every day life. Please answer every question by placing a mark in the one box that best describes your condition today. We realize you may feel that two of the statements may describe your condition, but please mark only the box which most closely describes your current condition.

Pain Intensity

I can tolerate the pain I have without having to use pain medication.The pain is bad but I can manage without having to take pain medication.Pain medication provides me complete relief from pain.Pain medication provides me with moderate relief from pain.Pain medication provides me with little relief from pain.Pain medication has no affect on my pain.

Personal Care (Washing, Dressing, etc.)

I can take care of myself normally without causing increased pain.I can take care of myself normally but it increases my pain.It is painful to take care of myself and I am slow and careful.I need help but I am able to manage most of my personal careI need help every day in most aspects of my care.I do not get dressed, wash with difficulty and stay in bed.

Lifting

I can lift heavy weights without increased pain.I can lift heavy weights but it causes increased pain.Pain prevents me from lifting heavy weights off the floor, but I can manage if the weights are conveniently positioned (ex. on a table).Pain prevents me from lifting heavy weights, but I can managelight to medium weights if they are conveniently positioned.I can lift only very light weights.I can not lift or carry anything at all.

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 from sitting for more than 1 hour.Pain prevents me from sitting for more than ½ hour.Pain prevents me from sitting for more than 10 minutes.Pain prevents me from sitting at all.

Standing

I can stand as long as I want without pain.I can stand as long as I want but increases my pain.Pain prevents me from standing more than 1 hour.Pain prevents me from standing more than ½ hour.Pain prevents me from standing more than 10 minutes.Pain prevents me from standing at all.