Home || Shrivan Kalp

1. Do you often experience pain in your back, neck, or joints?
Yes No

2. Does your pain get worse when sitting or standing for long periods?
Yes No

3. Does pain affect your sleep or daily activities?
Yes No

4. Do you feel stiffness after sitting for long time?
Yes No

5. Do you have trouble bending, lifting, or carrying objects?
Yes No

6. Do you feel muscle weakness or imbalance while walking?
Yes No

7. Does pain limit household chores?
Yes No

8. Do you avoid activities due to physical discomfort?
Yes No

9. Do you feel unsteady or lose balance while walking?
Yes No

10. Have you had falls or near-falls in last 6 months?
Yes No

11. Do you have difficulty using your hands?
Yes No

12. Do you get breathless on mild activity?
Yes No

13. Do you feel tired quickly during routine tasks?
Yes No

14. Can you comfortably walk for 6–10 minutes without stopping?
Yes No

Physiotherapy Screening