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