Primary outcome measures are as follows : Quadruple Numerical Pain Rating Scale ( for back ) , the Roland-Morris Disability Questionnaire , the number of muscles grade 4 or lower on manual muscle testing , and the number of spinal fixations detected by motion palpation and vertebral challenge at intake ( B1 ) , 2 weeks later before treatment began and orthotic use was initiated ( B2 ) and before each subsequent treatment at approximately days 3 , 10 , 17 , and 24 after B2 .