What is the nature of pain?
Acute
Chronic
Acute on chronic
What is the intensity of the pain?
Rest
Aggravating factors can peak pain to
Where is the pain located?
Left side of lower back
Right side of low back
More on one side that changes between side
Bilaterally
Are there any neurological signs associated?
No
Yes
Aggravating factors?
Bending forward
Bending backwards
Sitting for long periods
Standing for long periods
Sitting
Putting socks and shoes on
Gym exercises
Other
Easing factors?
Heat
Rest
Stretching
Movement
Massage cream
Medications
When is the pain worse?
Mornings
Throughout the day
Night time
Any red flags?
No
Yes
Past medical history
Auto-immune conditions
Diabetes mellitus
Hypertension
7th of June 2023
Mr Seth Matthews
10 Bosisto Street
RICHMOND 3121
Dear Dr Bob Myers,
Re. Mr Seth Matthews of 10 Bosisto Street RICHMOND. DOB 04/12/1998.
Thank you for refering Seth to 4 Life Physiotherapy for opinion and management of lower bac pain.
Subjective:
Yours Sincerly,
Haydn Matthews
Physiotherapist
Subjective Storage Objectt for Development: