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How We Measure Progress

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.
Two versions, one system: the Shift Score comes in a lower-back (lumbar) set and a neck (cervical) set, each with its own five markers. Your clinician uses the set that matches the region driving your problem. Both are shown below.
The five markers — lower back (lumbar)
1
Marker
Strength & endurance
Back extension endurance
Our target: 30 clean reps to neutral

You lie face-down on a specialised bench with your upper body unsupported from the hips forward, and perform slow, controlled extensions up to a neutral reference point. We count how many clean reps you complete, up to 30, and record it as a score out of 30 (for example, 12/30) 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. Thirty clean reps to neutral is the benchmark we work toward for endurance that supports the spine well. Many patients start with just a handful, and watching the count climb is one of the clearer signs your function is improving.
Early: a handful of clean reps Building: more reps, better control Target: 30/30 to neutral
2
Marker
Strength, objectively measured
Posterior chain strength
Our target: measurable strength gains from your baseline

We measure the strength of your posterior chain — the hips, glutes and back-of-thigh muscles that take load off your spine — on a VALD dynamometer, a precise force-measuring device. It gives an objective strength number, relative to your body weight, that we can track exactly the same way each visit.

Why this matters for your recovery
Your hips, glutes and posterior chain are built to take load that would otherwise fall on your discs. Measuring their strength objectively, rather than by eye, lets us prove it is genuinely improving, not just feeling better. A stronger posterior chain is one of the most practical protections against your problem returning.
Baseline strength recorded Building: strength climbing Target: strong, balanced, protective
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: clears on both sides

You sit on the edge of the bench and we take you through the slump test: you slump forward, we add a chin-to-chest position, then straighten each knee in turn, watching whether any nerve-type symptoms (tingling, an electric sensation, or pain travelling down the leg) are produced. We test both sides and note the response.

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 — symptoms reproduced Improving — less easily provoked Cleared — negative both sides
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
The five markers — neck (cervical)
1
Marker
Strength, objectively measured
Deep neck flexor strength
Our target: measurable strength gains from your baseline

You perform a controlled deep-neck-flexor effort, a gentle precise nod, while we measure the force on a VALD dynamometer. It gives an objective strength number for the deep muscles at the front of your neck, tracked the same way each visit.

Why this matters for your recovery
These deep muscles are the neck’s postural foundation — they steady your head and take load off the joints and discs. Rebuilding their strength is one of the clearest early signs the neck is regaining control, and measuring it objectively lets us prove it, not just take your word for how it feels.
Baseline strength recordedBuilding: strength climbingTarget: strong, steady deep flexors
2
Marker
Strength, objectively measured
Neck extensor strength
Our target: measurable strength gains from your baseline

We measure the strength of the muscles at the back of your neck, the extensors that hold your head up against gravity, on a VALD dynamometer, a precise force-measuring device. It gives an objective strength number we can track exactly.

Why this matters for your recovery
Together with the deep neck flexors (marker one), the extensors hold your head steady all day. Measuring their strength objectively shows it is genuinely building, not just feeling better, so your neck can hold up through a normal day rather than tiring and aching.
Baseline strength recordedBuilding: strength climbingTarget: strong, balanced neck
3
Marker
Postural endurance
Shoulder-blade endurance
Our target: hold the set position beyond ~30 seconds

Face-down, you set your shoulder blades and hold a low-shoulder-blade position (a “Y” hold), or we assess the quality of a wall-slide. We time how long you keep the shoulder blade properly set.

Why this matters for your recovery
The shoulder blade is the neck’s foundation. When the muscles that steady it fatigue, the neck takes on load it is less suited to. Endurance here supports the whole neck-and-shoulder system and is a common limiter we work to improve.
Early: hard to set the bladeBuilding: holding longerTarget: set and hold beyond ~30s
4
Marker
Movement confidence (self-reported)
Movement confidence
Our target: improvement from your baseline

We use the same short, validated questionnaire as the lower-back program — the TSK-11 (Tampa Scale for Kinesiophobia) — which measures fear of movement and re-injury. It is the one marker that reflects how you feel about moving, rather than a physical test, and it applies to the neck just as it does to the back.

Why this matters for your recovery
There is good evidence that fear of movement can slow recovery — people who are wary of moving tend to move less, and that can hold back the muscles that support the neck. We track this alongside the physical markers so your confidence keeps pace with your capacity. Because it is self-reported, it is never the deciding marker on its own.
5
Marker
Movement & nerve mobility
Rotation & nerve mobility
Our target: full, symmetrical, pain-free rotation

We check how far and how evenly your neck turns to each side, and how your arm nerves tolerate a gentle tension test (the upper limb tension test). We compare both sides and note any restriction or asymmetry.

Why this matters for your recovery
Free, symmetrical neck movement and calm arm nerves are signs the neck is moving and loading well. Moving from restricted or one-sided at the start to full and comfortable by the end is a meaningful, measurable change — and it often tracks with the travelling symptoms settling.
Early: restricted or asymmetricalImproving: range increasingTarget: full, symmetrical, pain-free
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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