Prevelance of low back pain among office

workers
 Name:

 Age

 Gender

 Occupation

 Height

 Weight
 BMI

 Do you have low back pain: yes No

 Duration of work

 < 6 hours
 4 - 6 hours
 > 8 hours
 Onset of Pain :
 Sudden
 Gradual
 Severity of pain :
 Mild
 Moderate
  Severe
 Duration of pain :
 < 1 month
 2 - 3 months
 4 – 6 months
 > 6 months
 Does your Pain radiate to leg :

Yes No

 History of fall :

Yes No

 Regular medications:
 Steroids
 Supplements
 None