Does your pain travel or radiate down one leg? *

Yes

No

Does the pain extend below your knee? *

Yes

No

Do you experience numbness, tingling, or weakness in your leg or foot? *

Yes

No

Is your pain worse when sitting for long periods? *

Yes

No

On a scale of 0–10, how severe is your pain? *

1-3

4-6

7-9

10