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How We Measure Progress

How We Measure Your Progress — Shift Spinal Health
Shift Spinal Health
5
clinical markers · The Shift Score

We measure your progress
with more than just pain scores

Most clinics track how much it hurts. We also track what your spine can actually do — using five specific markers that help us follow whether your function is genuinely improving.

The Shift Score is our own set of five clinical markers, built on established physical tests. We measure them at the start of your program and re-test every four weeks — so your progress is tracked against your own baseline, not guesswork.

Why pain scores alone aren't enough

Pain is a useful signal, but on its own it's an unreliable measure of progress. Two people can report the same pain score but have very different function — one rebuilding strength, the other managing symptoms while function stays poor.

The Shift Score helps close that gap. By also measuring what your spine can do — not just how it feels — we get a fuller picture of your recovery to guide the clinical decisions we make with you.

At your first appointment, we establish your baseline across all five markers. Every four weeks, we re-test them. The comparison against your own baseline is what informs your care.

About the Shift Score: it's our own clinical framework, built on established physical tests and a validated movement-confidence questionnaire. The individual tests are widely used in practice; the way we combine and score them is our own. It's a tool to track your progress and inform clinical decisions — not a separately validated diagnostic instrument, and never the only thing your clinician considers.
The five markers explained
1
Marker
Strength & endurance
Back extension hold
Our target: ~120 seconds

You lie face-down on a specialised bench with your upper body unsupported from the hips forward, and hold your body horizontal — to a consistent reference point — for as long as you can. We time it the same way each visit.

Why this matters for your recovery
The muscles along your spine, your glutes, and your hamstrings help keep load off your discs during everyday life — standing, walking, sitting at a desk. If these muscles tire quickly, your discs tend to absorb more of that load. Around 120 seconds is the reference point we use for endurance that supports the spine well. Many patients start well below this, and watching the number climb is one of the clearer signs your function is improving.
Week 4 reference: ~45 seconds Week 8 reference: ~90 seconds Week 12 reference: ~120 seconds
2
Marker
Movement quality & load tolerance
Hip hinge under load
Our target: clean pattern at ~40% bodyweight

You perform a Romanian Deadlift — a controlled hip-bending movement — while we assess your pattern against five specific criteria. We start with bodyweight using a dowel against your spine, then progress to load once the pattern is clean.

Why this matters for your recovery
Every time you bend to pick something up, you're loading either your hips and glutes or your spine. A hip-led movement distributes force through the posterior chain, where it's better tolerated. A spine-led movement sends more of that force through your discs. This marker shows us whether your body has learned the hip-led pattern and whether it holds under load — one of the more practical things we track.
Bodyweight: pattern being established Loaded: building toward target Clean pattern at ~40% bodyweight × 10
3
Marker
Movement confidence (self-reported)
Movement confidence
Our target: improvement from your baseline

We use a short, validated questionnaire that measures fear of movement and re-injury — at Shift we use the TSK-11 (Tampa Scale for Kinesiophobia). It's the one marker that reflects how you feel about moving, rather than a physical test.

Why this matters for your recovery
There's good evidence that fear of movement can slow recovery — people who are afraid to move tend to move less, and that can hold back the muscles that support the spine. Fear can also linger after the physical side has improved. We track this alongside the physical markers to make sure your confidence is keeping pace with your capacity. Because it's self-reported, it's never the deciding marker on its own — it's one input your clinician weighs alongside the others.
4
Marker
Nerve mobility
Neurodynamic clearance
Our target: full range, no nerve symptoms

You lie on your back while we slowly raise your straight leg, watching and asking whether any nerve-type symptoms — tingling, electric sensation, or pain travelling down the leg — are produced. We test both sides and note the angle.

Why this matters for your recovery
Your nerves need to slide and move freely as your body moves. When a nerve is compressed or irritated, this test can reproduce those travelling symptoms before full range is reached. A test that clears at discharge is a clinical sign the nerve is moving more freely than it was at the start. This applies to many presentations we see, whether or not you arrived with leg symptoms. Moving from a positive test at intake to a clear test by Week 12 is a meaningful, measurable change.
Positive — nerve symptoms reproduced Improving — angle increasing Cleared — full range, no symptoms
5
Marker
Lateral stability
Side bridge hold
Our target: ~60 seconds each side

You hold a side plank position — body in a straight line from ankle to shoulder, supported on your elbow — for as long as you can. We test both sides independently and note any difference between them.

Why this matters for your recovery
The muscles along the side of your trunk — your quadratus lumborum, obliques, and gluteus medius — help keep you stable side-to-side. When they're weak, the spine tends to take on load it's less suited to. The difference between sides is often as informative as the absolute time. A meaningful imbalance — even when one side looks acceptable — tells us something about how your spine is being loaded day to day.
Week 4 reference: ~20 seconds each side Week 8 reference: ~40 seconds each side Week 12 reference: ~60 seconds each side
When you'll be re-tested
First appointment
Your baseline
  • All five markers tested
  • Scores recorded in full
  • Results presented at your report of findings
  • This is your starting point — everything builds from here
Week 4
First progress review
  • All five markers re-tested
  • Compared directly to your baseline
  • You'll see how far you've moved
  • Care plan reviewed and adjusted
Week 8
Mid-program check
  • All five markers re-tested
  • Compared to Week 4 and baseline
  • Trajectory assessed — ahead, on track, or adjustments needed
  • Program refined if required
Week 12
Final review
  • All five markers re-tested against graduation criteria
  • Full comparison across the program
  • Discharge or next phase decided together
  • Protection plan established
Common questions
What if I can't do the tests at the start? ▼
That's completely fine — and very common. Many patients arrive unable to complete the back extension hold, the hip hinge at any meaningful load, or the side bridge for more than a few seconds. The markers are designed to meet you where you are. We document where you begin and track the change from there. The gap between where you start and where you finish is often the most motivating data in your whole program.
Do the tests hurt? ▼
Not in the way you might expect. The tests are performed within your current capacity — we're not pushing through pain to get a result. Some reproduction of symptoms during the neurodynamic test is a normal and expected part of how that test works — it's how we establish where your nerve is at. If anything feels more than mildly uncomfortable, we adjust. A modified side bridge (knees bent) is used when the full version is too demanding early in the program.
What does it mean if my scores don't improve? ▼
If your markers aren't moving the way we'd expect, we treat that as important clinical information — not a failure. We have an honest conversation about why, and we adjust the plan. It might be that decompression parameters need modifying, that load progressions need adjusting, or that something outside the clinic is interfering with recovery. The point of four-weekly reviews is to catch this early, at Week 4, rather than at Week 12.
Why do you measure movement confidence — that seems unusual ▼
It might seem unusual, but there's good evidence that how confident you feel about moving is one of the better predictors of long-term recovery — sometimes more so than the physical findings alone. People who are afraid to move tend to move less, which can hold back the muscles that support the spine. We use a validated questionnaire (the TSK-11) for this, and track it alongside the physical markers so we're addressing the whole picture, not just the structural side.
How is the Shift Score different from just asking me how I feel? ▼
Pain scores tell us how you feel on a given day — and they're influenced by sleep, stress, activity, and many factors that aren't about your spine specifically. The physical Shift Score markers measure what your spine can do, more independently of how you feel on the day. A patient who feels better but hasn't progressed on their hold times, movement pattern, or nerve clearance may not yet have made the functional gains that help prevent the problem returning. We use pain and function together — the Shift Score is one important part of how we make clinical decisions, alongside your clinician's judgement.
Why five markers — why not just one or two? ▼
Because spinal function isn't one-dimensional. A patient can build good posterior chain endurance while still having poor lateral stability. They can move well under load but still have an irritated nerve. They can clear every physical test but still be hesitant to move. The five markers together give a fuller picture than any single test. They're also chosen to be relevant across most of the spinal presentations we see, not just disc cases.

Ready to see your numbers?

Your first appointment establishes your Shift Score baseline. Everything builds from there — including a clear picture of where you're headed and what recovery could look like for you.

Book your first appointment

Shift Spinal Health · 101 Grange Rd, Allenby Gardens · 309 Unley Rd, Malvern

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