Male Questionnaire
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This section covers problems with your neck and back.


Do you have pain between your shoulder blades?
  • No / don't know
  • Yes, some
  • Yes, significant


Have you ever had a herniated disc ("slipped disc")?
  • No / don't know
  • Probably
  • Yes, one minor episode
  • Yes, several minor or one major episode
  • Yes, several major episodes


Have you suffered injury to your spinal cord?
  • No / don't know
  • Minor - there was some pain
  • Moderate - there was a lot of pain
  • Serious, including temporary loss of motor control
  • Severe, including permanent paralysis


Do you suffer from lower back pain that is not caused by a known injury?
  • No / rarely / I was injured / don't know
  • Past minor problem, now resolved
  • Past major problem, now resolved
  • Yes, there is some pain
  • Yes, serious / a lot of pain


Do you have a painful or stiff neck?
  • Don't know
  • No
  • Yes, it is due to a physical injury
  • Yes, I woke up with it a few days ago
  • Yes, for quite a while, not from physical injury*
* more questions will be asked later