Self-Assessment: Hip & Knee Pain

Self-Assessment: Hip & Knee Joint Pain The following questions will help determine if you can benefit from therapeutic intervention to address your hip, knee or joint pain. For each question, select the choice that applies to you. Does your pain interfere with your quality of life? Yes No Do you have hip or knee pain that restricts you from performing any recreational activities? (e.g.: hiking, sports, cycling) Yes No Do you have hip or knee pain that restricts you from performing any daily household activities? (e.g.: laundry, vacuuming, cleaning) Yes No Do you have hip or knee pain that limits you performing daily functional activities? (e.g.: dressing, bathing, toileting, in/out of car) Yes No Do you have pain at night that significantly interferes with your sleeping? Yes No Do you have significant pain or difficulty with stairs or hills? Yes No Do you have difficulty walking or loss of balance? Yes No Orthopedic Services Self-Assessment: Hip & Knee Pain Self-Assessment: Neck & Back Pain