Premier Institute Affiliated with Govt.

College University,

Faisalabad

Synopsis of Doctor of Physical Therapy.

TITLE:

PREVALENCE OF PLANTAR FASCIITIS IN OVER WEIGHT

NURSES.

Date of Admission: 14-05-2021

Date of Initiation: 14-12-2020

Probable Research Duration: 06 Months

PERSONAL:

Name of Student: Sheheryar Masih

Roll #: 53424

SUPERVISORY COMMITTEE:

1. Supervisor: Dr. Nadia

2. Member: Dr. Nadia
3. Member: Dr. Farah
4. Member: Dr. Mateen
5. Member: Dr. Awais
 Signature

FORWARDED BY SUPERVISORY COMMITTEE:

1. Supervisor: Dr. Nadia

2. Member: Dr. Nadia
3. Member: Dr. Farah
4. Member: Dr. Mateen
5. Member: Dr. Awais

Recommended and forwarded by Chairman Board of Studies

of Department of Doctor of Physical Therapy.

(Chairman)
Plantar Fasciitis:

INTRODUCTION:

Planter fasciitis is a progressive degenerative condition affecting the thick band of

tissue that covers the bones on the bottom of the foot (planter fascia), and been
associated with heel pain, falls, poor quality of life and disability. Plantar fasciitis
(PF) is a common and debilitating pathology whose chief complaint is acute
plantar heel pain. This pathology affects between 1 and 2 million Americans each
year. Approximately one percent of U.S adults reported a diagnosis of plantar
fasciitis in the year and more than three quarters of them reported having plantar
fasciitis pain in the previous month. The prevalence of plantar fasciitis was lowest
in those aged 18-44 and highest in those aged 45-64 Females were 2.5 times more
likely to report plantar fasciitis than males. (Van, 2016).

Planter Fascia is the deep fascia or aponeurosis sole of the foot. It arises from the
calcaneum posteriorly dividing into bands which further divides to enclose tendons
Plantar fasciitis is an inflammatory condition that causes degeneration close to the
site of origin of the plantar fascia as the medial tuberosity of the calcaneous. The
exact mechanism is unknown and thought to be multifactorial. Micro tears occur
due to repetitive trauma and overuse along with cycles of tearing and healing
which results in the release of various chemical mediators and thus leading to
myxoid degeneration and weakness of the fascia as well as pain. (Ferri, 2020).

Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the
heel. The pain is usually worse with the first few steps after awakening, although it
can also be triggered by long periods of standing or when you get up after sitting.
The pain is usually worse after exercise, not during it.

Your plantar fascia is in the shape of a bowstring, supporting the arch of foot and
absorbing shock when you walk. If tension and stress on this bowstring become
too great, small tears can occur in the fascia. Repeated stretching and tearing can
irritate or inflame the fascia, although the cause remains unclear in many cases of
plantar fasciitis. (Vahdatpour, 2016).

While the causes of Plantar Fasciitis aren’t entirely clear, some risk factors that are
associated with the condition include; Prolonged standing or walking for extended
periods can put unnecessary stain of the Plantar fascia. Obesity - For obvious
reasons, being overweight puts extra pressure on the heel and requires more
support from plantar fascia. The paradox is that, people who are overweight are
more likely to have heel pain, but their heel pain keeps them from exercising.
Excessive exercise - Each step that you take causes your planter fascia to expand
and contract. Running a mile would force this tissue to expand and contract
thousands of times. If you don’t give the tissue sufficient time to rest and recover,
it can lead to significant strain and irritation. Not enough exercise conversely
keeping the foot inactive for prolonged period of time can cause the plantar fascia
to lose its flexibility. Moderate amount of exercise can help to keep the tissues
limber and strong. Other risk factors include: Tight Achilles/ Achilles tendonitis,
high arches of the feet and flat feet. (Franchini, 2018).

The plantar fascia originates from the posteromedial cancaneal tuberosity and
inserts into each metatarsal head to form the longitudinal arch of the foot. Plantar
fasciitis is a biomechanical overuse condition resulting in degenerative changes at
its attachment to the calcaneus. Histologic examination of samples taken from
patients undergoing planter fascia release surgery shows myxoid degeneration with
fragmentation and degeneration of the planter fascia and bone marrow vascular
ectasia. These findings support that the condition is a degenerative fasciosis
without inflammation, not a fasciitis. Therefore, plantar fasciopathy is a more
accurate descriptor.

Plantar fasciitis can be diagnoses clinically by findings from the patient history and
physical examination. The patient will have sharp pain in the anteromedical aspect
of the heal.

Pain will begin with ambulation after a period of inactivity, then will improve or
resolves as the activity progresses. However, the pain will return at the end of the
day. The classic presentation is pain with the first step of the morning. Paresthesia
is uncommon. The patient imaging tests: X-ray, MRI (AskMayoExpert, 2019).

Plantar fasciitis can be treated by stretching and strengthening exercises or using

special devices may relieve symptoms. They include: Physical Therapy, A physical
therapist can show you a series of exercises to stretch the plantar fascia and
Achilles tendon and to strengthen lower leg muscles. A therapist might also teach
you to apply athletic taping to support the bottom of your foot. Night splint, Your
physical therapist or doctor might recommend that you wear a splint that stretched
your calf and the arch of your foot while you sleep. This holds the plantar fascia
and Achilles tendon in a lengthened position overnight to promote stretching.
Orthotics, Your doctor might prescribe off-the-shelf or custom-fitted arch supports
(orthotics) to help distribute pressure to your feet more evenly.

Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium
(Aleve) may ease the pain and inflammation caused by plantar fasciitis. Surgical or
other procedures. Injections, Injecting steroid medication into the tender area can
provide temporary pain relief. Multiple shots aren’t recommended because they
can weaken your plantar fascia and possibly cause it to rupture. Using ultrasound
imaging, platelet-rich plasma obtained from the patient’s own blood can be
injected to promote tissue healing. Extracorporeal shock wave therapy, in this
procedure, sound waves are directed at the area of the heel pain to stimulate
healing. It’s usually used for chronic plantar fasciitis that hasn’t responded to
more-conservative treatments. Some studies show promising results, but it hasn’t
been shown to be consistently effective. Ultrasonic tissue repair, this minimally
invasive technology was developed in part by Mayo Clinic doctors. It uses
ultrasound imaging to guide a needlelike probe into the damaged plantar fascia
tissue. Using Ultrasound energy, the probe tip vibrates rapidly to break up the
damaged tissue, which is then suctioned out. Surgery, Few people need surgery to
detach the plantar fascia from the heel bone. It is generally an option only when the
pain is severe and other treatments have failed. It can be done as an open procedure
or through a small incision with local anesthesia.

LITERATURE REVIEW:

Luffy Lindsey and Grosel, John MD (2018) described that a 53-year-old lady
presented to the podiatrist with a 1-year history of heel pain in the right foot that
has worsened in the last 2 months. This is the first time she has been seen for this
complaint. She reports that the pain has been intermittent for the past year but more
consistent and bothersome in the past 2 months. She describes the pain as sharp
and burning. The pain worsens when she rises from a seated position or during the
first few steps in the morning. She has attempted with ice and ibuprofen with
minimal relief. She has a history of gout in the left first metatarsophalangeal joint.
The patient has tenders to palpation along the medial band of the plantar fascia and
at its orgin on the medical calcaneal tubericle, as well as mild edema in this region.
She has tightness in the posterior calf and gastrocnemius equines contracture.

Bilateral anterior-posterior and lateral radiographs revealed a calcaneal

enthesophyte at the origin of the plantar fascia on the right foot. In-office
ultrasound was performed and the plantar fascia was grossly thickened at its
insertion. The patient was diagnosed with plantar fascia. She was fitted for custom
orthotics and given stretching instructions. However, her pain was only improved
by 50% with orthotics and stretching, so night splint therapy was added to her
treatment plan. By her second follow-up, 6 weeks after presentation she returned
pain-free. (Luffy Lindsey and Grosel, 2018)

In 2005 Rathleff and Molgaard studied the plantar fasciitis. The aim of this study
was to investigate the effectiveness of shoe inserts and plantar fascia-specific
stretching vs shoe inserts and high-load strength training in patients with plantar
fasciitis. Forty-eight patients with ultrasonography-verified plantar fasciitis was
randomized to shoe inserts and daily plantar-specific stretching (the stretchgroup)
or shoe inserts and high-load progressive strength training (the strength group)
performed every second day. High-load strength training consisted of unilateral
heel raises with a towel inserted under the toes. Primary outcome was the foot
function index (FFI) at 3 months. Additional follow-ups were performed at 1, 6
and 12 months. At the primary endpoint, at 3 months, the strength group had a FFI
that was 29 points lower compared with the stretch group. At 1,6 and 12 months,
there were no difference between groups. At 12 months, the FFI was 22 points in
the strength group and 16 points in the stretch group. There were no differences in
any of the secondary outcomes. A simple progressive exercise protocol, performed
every second day, resulted in superior self-reported outcome after 3 months
compared with plantar-specific stretching. High-load strength training may aid in a
quick reduction in pain and improvements in function. (Molgaard, 2005)

In 2006 Digiovanni and Nowoczenski introduced a study on Plantar fascia-specific

stretching exercise improved outcomes in patients with chronic plantar fasciitis.
This study includes 82 patients with chronic proximal plantar fasciitis for duration
of more than ten months completed a randomized, prospective clinical trial. The
patients received instructions for either a plantar fascia-stretching protocol or an
Achilles tendon-stretching protocol and were evaluated after with weeks.
Substantial differences were noted in favor of the group managed with the plantar
fascia-stretching program. The goal of this two- year follow-up study was to
evaluate long-term outcomes of the plantar fascia-stretching protocol in patients
with chronic planar fasciitis.

Phase one of the clinical trial concluded at eight weeks. At the eight-week-follow-
up evaluation, all patients were instructed in the plantar fascia-stretching protocol.
At the two-year follow-up evaluation, a questionnaire consisting of pain, function
and satisfaction with treatment was mailed to the eighty-two subjects who had
completed to initial clinical trial. Data were analyzed with use of a mixed-model
analysis of covariance for each outcome of interest.

Complete data set was obtained from 6 patients. The two-year-follow-up results
showed marked improvement for all patients after implementation of the plantar
fascia stretching exercises, with an especially high rate of improvement for those in
the original group treated with the Achilles-tendon-stretching program. In contrast
to the eight-week results, the two –year results showed no significant differences
between the groups with regard to the worst pain or pain with first steps in the
morning. Descriptive analysis of the data showed that 92% (sixty-one) of the sixty-
six patients reported total satisfaction or satisfaction with minor reservation. Fifty-
one patients (77%) reported no limitation in recreational activities. And sixty-two
(94%) reported a decrease in pain. Only sixteen of the sixty-six patients reported
the need to seek treatment by a clinician.

This study supports the use of tissue-specific plantar fascia-stretching protocol as

the key component of treatment for chronic plantar fasciitis. Long-term benefits of
the stretch include a marked decrease in pain functional limitations and a high rate
of satisfaction. This approach can provide the health-care practitioner with an
effective, inexpensive and straightforward treatment protocol. (Nowoczenski,
2006)

In 2019 Sung and Chung introduced a study Plantar fasciitis in physicians and
nurses. They described that Physicians and nurses in Taiwan have heavily
workload and long working hours which may contribute to plantar fasciitis.
However, this issue is unclear, and therefore they conducted this study in delineate
it. They conducted a nationwide population-based study by identifying 26,024
physicians and 127,455 nurses and an identical number of subjects for comparison
(general population) via the National Health Insurance Research Database. The
risk of plantar fasciitis between 2006 and 2012 was compared between physicians
and general population, between nurses and general population, and between
physicians and nurses. They also compared the risk of plantar fasciitis of 8.14%
and 13.11% during the 7-year period, respectively. The risk plantar fascia was
lower among physicians (odd ratio [OR]: 0.660; 95% confidence interval [CI]:
0.622-0.699) but higher among nurses (OR: 1.035; 95% CI;1.011-1.059)
compared with that in the general population, Nurses also had a higher risk than
the physicians after age and sex (adjusted odds ration [AOR]: 1.541; 95% CI:
1.399-1.701). Physician subspecialties of orthopedics and physical medicine and
rehabilitation showed a higher risk. Female physicians had a higher risk of plantar
fasciitis than male physicians. This study showed that nurses, physicians had a
higher risk of plantar fasciitis. Improvement of the occupational environment and
health promotion are suggested for these populations. (Chung, 2019)

Sullivan and Burns in 2014 introduced a study Musculoskeletal and activity-related

factors associated with plantar heel pain they described that Despite the prevalence
and impact of plantar heel pain , its etiology remains poorly understood, and there
is no consensus regarding optimum management. The identification of
musculoskeletal factors related to the presence of plantar heel pain could lead to
the development of better targeted intervention strategies and potentially improve
clinical outcomes. The aim of this study was to investigate relationships between a
number of musculoskeletal and activity-related measures and plantar heel pain.

In total, 202 people with plantar heel pain and 70 asymptomatic control
participants were compared on a variety of musculoskeletal and activity-related
measures, including body mass index (BMI), foot and ankle muscle strength, calf
endurance, ankle and first metatarsophalangeal (MTP) joint range of motion, foot
alignment, occupational standing time, exercise level, and generalized
hypermobility. Following a comparison of groups for parity of age, analyses of
covariance were perform to detect difference between the 2 groups of any of the
variable measures.

The plantar heel pain group displayed a higher BMI, reduced ankle dorsiflexion
range of motion, reduced ankle evertor and toe flexor strength, and an altered
inversion/eversion strength ratio. There were no difference between groups for foot
alignment, dorsiflexor or inverter strength, ankle inversion or eversion range of
motion, first MTP joint extension range of motion, generalized hypermobility,
occupational standing time, or exercise level. Plantar heel pain is associated with
higher BMI and reductions in some foot and ankle strength and flexibility
measures. Although these factors could be wither casual or consequential, they are
all potentially modifiable and could be targeted in the management of plantar heel
pain. (Burns, 2014)

Van Leeuwen and Rogers in 2015 studied Higher body mass index in associated
with plantar fasiitis. In which 51 included studies (1 prospective, 46 case-control
and 4 cross sectional studies) evaluated a total of 104 variables. Pooling was
possible for 12 variables. Higher body mass index (BMI) (BMI>27, OR CI 2.93 to
5.62)) in patients with PF was the only significant clinical association, and its
effects was the strongest in the non-athletic subgroup. In people with PF compared
to controls, pooled imaging data demonstrated a significantly thicker,
hypoechogenic plantar fascia with increased vascular signal and perifascial fluid
collection. In addition, people with PF were more likely to have a thicker loaded
and unloaded heel fat pat, and bone findings, including a subcalcaneal spur and
increased Tc-99 uptake. No significant difference was found in the extension of the
first metatarsophalangeal joint. We found a consistent clinical association between
higher BMI and plantar fasciopathy. This association may differ between athletic
and non-athletic subgroups. While consistent evidence supports a range of bone
and soft tissue abnormalities, there is lack of evidence for the dogma of clinical
and mechanical measures of foot and ankle function. Clinicians can use this
information in shared decision-making. (Rogers, 2015)

In 2017 Barned and Sullivan performed a study on Clinical and Functional

Characteristics of People with Chronic and Recent-Onset Plantar Heel Pain. A total
of 71 people with plantar heel pain for longer than 12 months and 4 people with
plantar heel pain for less than 6 months were recruited from the general public.

Functional characteristics of participants in both heel pain groups were assessed

with a variety of clinical measured and the Foot Health Status Questionnaire.
Clinical measures included body mass index, foot and ankle muscle strength using
hand-held dynamometry. As well as ankle and first metatarsophalangeal joint
range of motion. The Foot Health Status Questionnaire was used to collect self-
reported measures of foot pain severity, foot function and physical activity.
Univariate analysis of variance was performed to detect differences between the 2
groups for each of the variables measured.

The chronic heel pain group exhibited reduced ankle dorsiflexor and toe flexor
strength yet better self reported foot function. There was no difference between
groups for body mass index, ankle and first metatarsophalangeal joint range of
motion, inversion strength, eversion strength, self endurance, self reported foot
pain, and physical activity. Chronic plantar heel pain is associated with selected
weakness of foot and ankle muscle groups but less affected foot function compared
with heel pain of recent onset. Those with chronic symptoms may moderate or
make adaptations to their daily activities, or simply accept their condition, enabling
more effective coping. Strength deficits, although possibly a cause or consequence
of chronic symptoms, suggest a need to include resistance exercise in the
management of plantar heel pain. (Sullivan, 2017)

Joseph N and Danial DO studied in 2015. High Prevalence of Obesity and Female
Gender Among Patients With Plantar Fasciitis. The link between increased body
weight and hindfoot complaints is largely based on correlation to single foot
pathology. We retrospectively reviewed 6879 patients with plantar fasciitis (PF).
We compared age, gender, and body mass index among these groups. Patients with
PF diagnosis were neither statistically older nor more obese. However, they were
statistically more female. Given the overall high prevalence of obesity in the study
population, we feel these data support the link between obesity and multiple foot
pathology. (DO, 2015)

Sharma Pallavi and Sharma Yamini researched in 2020. The purpose of this
research is to check whether there is any co-relation between the footwear and the
foot alignment (foot position) for example there is decreased dorsiflexion of foot in
females wearing high heels as compared to females wearing flat foot wears and
whether it makes people prone to develop plantar fasciitis or not. Methodology:
100 subjects were taken for the trial, the study included a total 100 girls from
Galgotias University out of which 2 groups were made of 50-50, that is, 50 girls
who were regular heel users and 50 girls who wear flat foot wear. Subjects were
tested in department’s lab room. The subjects were informed to sit upright on
plinth with their one leg crossed over the other to make figure of four and the
subjects were informed to look straight. Then manual plantar fascia stretch test was
performed by grasping and stabilizing the heel with one hand and dorsiflexing the
ankle and toes together with the other hand of the researcher, which in turn
stretched the plantar fascia of the foot. Then the subjects were asked if there was
any pain experienced or not at the heel or in the sole of the foot while the test was
performed. Next step was to perform the windlass test with the subject maintaining
the same sitting position and then coming in standing position. Results and
conclusion: The result showed that out of total sample 20% subjects felt the plantar
fascia stretch. 7% subjects with positive windlass test, 27% of population in
sample was prone to develop plantar fasciitis out of which 19% of the subjects
were those who wear high heels. The 7& population who has position windlass test
were the females who were wearing heels. (Yamini, 2020)

In 2015, by Reda Goweda and Enas Alfalogy a cross-sectional study was

conducted on 270 patients with heel pain attending five randomly selected primary
health care centers. An interview questionnaire was structured to recognize the
socio-demographic data, medical history of the heel pain and independent risk
factors for plantar fasciitis. Diagnosis was based on history and clinical
examination. The prevalence of plantar fasciitis among 270 patients was 57.8%. 88
(56.4%) of them were males. 104 (66.7%) were obese, 91 (58.3%) were wearing
inappropriate shoes and 140 (89.7%) had sedentary lifestyle. Logistic regression
showed that sedentary lifestyle is the most significant variable associated
independently to Plantar fasciitis (OR = 38.371; 95% CI: 5.411-272.110 p 0.000).
Conclusion: Plantar Fasciitis is very common in primary health care settings,
Obesity, sedentary lifestyle, wearing inappropriate shoes; frequent running and ling
standing were shown to be risk factors. (Alfalogy, 2015)

Investigation conducted by Yan and Chuan in 2015 of the morbidity and

influencing infactors of plantar fasciitis in nurses. Objective to investigate the
morbidity and influencing infactors of plantar fasciitis in nurses. Methods: the
clinical nursing staff of 829 people were included in this series. 71 people of them
conform to the standard of the plantar fasciitis. According to the proportion of 1:1,
71 nurses without plantar fasciitis were included in the control group. The
thickness and hardness index of the plantar fascia were detected by ultrasound
elastically. The survey contents including age, the average working hours every
day (h), the average standing time in working day (h), body weight, body mass
index (BMI), number of night shifts, average walking time everyday (min) and the
average weekly running time (hours) were conducted. The single factor and multi-
factor regression method were used to analyze the influence factors of the onset of
plantar fascia. Results 71 cases of 829 nurses were with plantar fascia, and the
incidence was 8.56% . The thickness in observation group was (3.86±0.53) mm,
which was significantly smaller than (2.67±0.39) mm of the control group
(P<0.05) Hardness index was 2.01±0.23, lower than 3.83±0.70 in control group
(t=14.09, P<0.05). Single factor analysis results showed that the average standing
time in working day, weight, BMI, average walking time every day, the average
weekly running time were different between the two groups (P<0.05). The
regression equation: the plantar fascia hardness index=25.34 + 4.78 × the average
standing time in working day + 3.45 × weight + 1.22 × BMI. The equation of the
ability to explain the plantar fascia hardness index reached 72.2%, and had a good
effectiveness. Conclusions: Body weight and BMI, prolonged standing work may
induce the nurse plantar fasciitis and they were independent risk factors. (Chuan,
2015)

MATERIALS AND METHODS:

Study Design:

Descriptive Study

Data Collection Instruments:

Structured Proforma

Duration of Study:

3 Months

Instruments:

Visual analogue scale and epitool.

Sample Size:
50 nurses.

Sampling Technique:

Consecutive Technique

Sample Collection:

Criteria for Sample collection are as following:

Inclusive criteria:

 Nurses with age range from 25 to 35 years.

 Nurses with high BMI.
 Nurses suffering from plantar fascitiis.

Exclusive Criteria:

Patient evaluated by Physiotherapist and orthopedics were only included.

Data Collection:

All the patients fulfill the inclusive criteria, were evaluated by physiotherapist
orthopedics. During this period after taking permission from authority this gross
motor functional classification system (gmfcs) was used to assess gross motor
function. Manual ability classification system for bimanual performance.

Data Analysis Procedure:

Appropriate statistical data analysis technique by using SPSS (statistical package

for the social science) version 20.

Conclusion:

This study showed that nurses with high BMI had a higher risk of plantar fasciitis.
Improvement of the occupational environment and health promotion are suggested
for these populations.
REFERENCES:

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mass index is associated with plantar fascipathy/’plantar fasciitis’;
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 Ferri FF. Planar fasciitis. In ferri’s clinic Advisor 2020 Elsevier; 2020.
http://www.clinicalkey.com. Accessed sept 2, 2019.
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 PFPS Plantar Fasciitis Pain/Disability Scale

MALE or FEMALE Dx: Today’s date: _______

Date of Birth Ethnicity: _____________ Onset of pain:___________

1. VAS: Rate your pain on a scale of 1 to 100. ÷ 8.3 = score of

2. How many days a week does pain affect your mobility? (1-7)

3. Is the pain on the surface or deep? Surface = 1, Deep = 3

Pain Description
4. Where is your pain located? 0 = Toes, 1 = Ball of foot, 2 = Mid sole, 3 = Bottom of
Heel

5. In the past 6 weeks how often have you had pain?

0 = Every other week 1 = Once a week 2 = Once a day 3 = Many times a
day

6. How often since the onset of pain, have you been pain free?
0 = weeks, 1 = days, 2 = hours, 3 = minutes

7. How long does the pain last?

0 = only when I over exert, 1 = pain lasts for less than one hour, 2 = pain lasts for
one to two hours, 3 = pain lasts for more than two hours

8. In the past 6 weeks what time of day is your pain the worst? (Note this
specifically for diagnosis of different problems).
0 = Always the same,
1 = Only in the afternoon,
2 = Both day & night,
3 = Only when you first get up
9. In the past 6 weeks does the pain make it hard to get to sleep?
0 = Never, 1 = Some nights, 2 = most nights, 3 = every night

10. In the past 6 weeks, how often does your pain awaken you?
0 = Never, 1 = Some nights, 2 = most nights, 3 = every night

11. How difficult is it to cope with your pain?

0 = Easy to deal with, 1 = Inconvenient, 2 = Troublesome, 3 = Almost impossible
12. How much does the pain interfere with your athletics or with weight-bearing activities
such as walking?
 0 = never, 1 = occasionally, 2 = frequently, 3 = always
Mobility/Function
13. When you awake, how many minutes must elapse before you can walk comfortably?
0 = No time, 1 = less than 10 minutes, 2 = 11 to 30 minutes, 3 = it takes over 30
minutes until I can walk comfortably

14. Is it more comfortable to walk on your toes than

walk flat footed?
0 = No, 3 = Yes

15. Please check the columns below that describe how much your pain affects you in
different conditions.
(If you are unable to perform such a task list check “Severe.”
Activity 0 = Not at all 1 = Very little 2 = Moderate 3 = Severe
Walking in the
Morning
Standing up on
your toes
Driving
Climbing Stairs
Descending Stairs
Reaching up
Bending over
Walking bare foot
Standing after watching a
movie
Riding a bike
Running a short distance

16. How often do you take medication for your pain?

0 = Less than once a week, 1 = Several times per week, 2 = Once
Daily, 3 = More than once every day, since the injury

17. Describe the medications’ affect on your pain.

0 = It always stops the pain, 1 = Decreases the pain, 2 = Usually
takes the pain away, 3 = Little or no affect on the pain

18. How does the pain affect you emotionally?

0 = No affect, 1 = It causes anxiety, 2 = The pain worries me daily,
3 = It makes me consider giving up my recreational activities

19. Rate the limitations that your pain/injury affects your daily life style.
0 = Does not limit your lifestyle, 1 = some activities avoided (i.e.
riding in car or sitting in stadium for hours), 3 = You avoid all
activity due to injury
Total Score Date