20 Questions to Diagnose Back Problems

Print on Demand

A number of things can cause back trouble. This simple questionnaire can help provide important clues to what’s at the root of your back problem. Answer as many questions as you can and take a copy of this section to your doctor when your back needs medical attention.

1.  Do you have a history of back problems?

2.  What is the major complaint?

3.  When did the pain, stiffness, or symptoms begin?

4.  Did it begin gradually or suddenly?

5.  Were you sick in any way when it began?

6.  Do these symptoms disturb or prevent sleep (awaken you with pain)?

7.  Is this the first experience of this kind?

8.  Is the pain unrelenting?

9.  Is the pain intermittent?

10. Is the pain sharp, dull, burning, aching, cramping, or shooting?

11. What do you suspect the problem was caused by? Check all that apply.

– Injury.

– Overweight.

– Poor posture.

– Stress/tension.

– Menstruation.

– Illness.

– Pregnancy.

– Overexertion.

– Other. Explain.

12. When does the problem annoy you the most? Check all that apply.

– At work.

– When lifting.

– When in bed.

– When bending.

– When stressed.

– When fatigued.

– When coughing or sneezing.

– When sitting.

– When standing.

– When driving.

– When carrying.

– In the morning.

– In the afternoon.

– In the evening.

– Other. Explain.

13. Does the pain radiate or move in a particular direction? If yes, explain.

14. Do you experience muscle spasms?

15. Do you sleep on a soft mattress or a hard one?

16. Have you been under nervous or emotional strain lately?

17. Is there any redness, tenderness, or swelling?

18. Is there a daily pattern to the pain?

19. What helps relieve the pain? Check all that apply.

– Heat.

– Ice packs.

– Exercise.

– Bed rest.

– Hot baths.

– Muscle relaxants.

– Massage.

– Brace.

– Walking.

– Painkillers.

– Nothing.

– Haven’t tried anything.

20. Are there any other factors that the doctor should be aware of?

This website is not meant to substitute for expert medical advice or treatment. Follow your doctor’s or health care provider’s advice if it differs from what is given in this guide.


The American Institute for Preventive Medicine (AIPM) is not responsible for the availability or content of external sites, nor does AIPM endorse them. Also, it is the responsibility of the user to examine the copyright and licensing restrictions of external pages and to secure all necessary permission.


The content on this website is proprietary. You may not modify, copy, reproduce, republish, upload, post, transmit, or distribute, in any manner, the material on the website without the written permission of AIPM.