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YOUR MESSAGE YOUR YOUR NAME *YOUR EMAIL *MESSAGEContact Us Seven-Day Progress Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. each afternoon to YOUR NAME *EMAIL *Confirm Email *Baseline for comparison - pain level and pain location:Baseline - pain level and pain locationBaseline - Pain Level (no pain to worst pain) *--- Select Choice ---no painmildmoderatesevereworst painBaseline - Pain location *--- Select Choice ---Centre of the lower backCentre of the lower back radiating to the buttock (left or right)Centre of the lower back radiating to the knee (left or right)Other locationDAY 1 (first day starting the exercises)Pain Level (no pain to worst pain) *--- Select Choice ---No painMildModerateSevereWorst painBaseline - Pain location *--- Select Choice ---Centre of the lower backCentre of the lower back radiating to the buttock (left or right)Centre of the lower back radiating to the knee (left or right)Other locationIn total how many times do you perform on day 1? (in the morning, noon, afternoon or night) *--- Select Choice ---OnceTwiceThree timesFour timesHow many sessions you completed each time? (a session includes = both semi push-up + cross-leg) *--- Select Choice ---1 session each time2 sessions each time3 sessions each time4 sessions each timeDAY 2Pain Level (no pain to worst pain) *--- Select Choice ---No painMildModerateSevereWorst painBaseline - Pain location *--- Select Choice ---Centre of the lower backCentre of the lower back radiating to the buttock (left or right)Centre of the lower back radiating to the knee (left or right)Other locationIn total how many times do you perform on day 2? (in the morning, noon, afternoon or night) *--- Select Choice ---OnceTwiceThree timesFour timesHow many sessions you completed each time? (a session includes = both semi push-up + cross-leg) *--- Select Choice ---1 session each time2 sessions each time3 sessions each time4 sessions each timeDAY 3Pain Level (no pain to worst pain) *--- Select Choice ---No painMildModerateSevereWorst painPain location *--- Select Choice ---Centre of the lower backCentre of the lower back radiating to the buttock (left or right)Centre of the lower back radiating to the knee (left or right)Other locationIn total how many times do you perform on day 3? (in the morning, noon, afternoon or night) *--- Select Choice ---OnceTwiceThree timesFour timesHow many sessions you completed each time? (a session includes = both semi push-up + cross-leg) *--- Select Choice ---1 session each time2 sessions each time3 sessions each time4 sessions each timeDAY 4Pain Level (no pain to worst pain) *--- Select Choice ---No painMildModerateSevereWorst painPain location *--- Select Choice ---Centre of the lower backCentre of the lower back radiating to the buttock (left or right)Centre of the lower back radiating to the knee (left or right)Other locationIn total how many times do you perform on day 4? (in the morning, noon, afternoon or night) *--- Select Choice ---OnceTwiceThree timesFour timesHow many sessions you completed each time? (a session includes = both semi push-up + cross-leg) *--- Select Choice ---1 session each time2 sessions each time3 sessions each time4 sessions each timeDAY 5Pain Level (no pain to worst pain) *--- Select Choice ---No painMildModerateSevereWorst painPain location *--- Select Choice ---Centre of the lower backCentre of the lower back radiating to the buttock (left or right)Centre of the lower back radiating to the knee (left or right)Other locationIn total how many times do you perform on day 5? (in the morning, noon, afternoon or night) *--- Select Choice ---OnceTwiceThree timesFour timesHow many sessions you completed each time? (a session includes = both semi push-up + cross-leg) *--- Select Choice ---1 session each time2 sessions each time3 sessions each time4 sessions each timeDAY 6Pain Level (no pain to worst pain) *--- Select Choice ---No painMildModerateSevereWorst painPain location *--- Select Choice ---Centre of the lower backCentre of the lower back radiating to the buttock (left or right)Centre of the lower back radiating to the knee (left or right)Other locationIn total how many times do you perform on day 6? (in the morning, noon, afternoon or night) *--- Select Choice ---OnceTwiceThree timesFour timesHow many sessions you completed each time? (a session includes = both semi push-up + cross-leg) *--- Select Choice ---1 session each time2 sessions each time3 sessions each time4 sessions each timeDAY 7Pain Level (no pain to worst pain) *--- Select Choice ---No painMildModerateSevereWorst painPain location (copy) *--- Select Choice ---Centre of the lower backCentre of the lower back radiating to the buttock (left or right)Centre of the lower back radiating to the knee (left or right)Other locationIn total how many times do you perform on day 7? (in the morning, noon, afternoon or night) *--- Select Choice ---OnceTwiceThree timesFour timesHow many sessions you completed each time? (a session includes = both semi push-up + cross-leg) *--- Select Choice ---1 session each time2 sessions each time3 sessions each time4 sessions each timeAny comments:Enter any comment regarding the experience of performing these exercises.Submit Form
