Obviously, we don’t have a crystal ball to know exactly how many visits a patient will require to get better.  Each person is unique and there are many variables. So how do we approach treatment?

What is the Rule of 50%?

Cox practitioners are taught to treat patients using the rule of 50%.  For every 50% a patient improves, I cut the treatment frequency in half.  For example, if I am treating a patient 3 days per week, I cut back to 2x per week.  If I am treating them 1x per week, I let them go 2 weeks before follow-up. 

How do we determine 50% improvement?

I typically use a combination of pain scales and exam findings to determine if a patient is 50% improved.  On a 10-point pain scale, if a patient’s pain has dropped from a 6 to a 3, then they are 50% improved. Maybe their ability to bend forward has doubled or ability to sit has increased.  It is not an exact science.  Sometimes I just ask the patient to estimate how much improvement they feel from when we started. 

How long before I can expect 50% improvement?

In most cases I would like to see at least 50% improvement within 1 month of care.  If the patient has not achieved this, then I re-evaluate them. I must ask myself several questions. Has the patient been compliant?  Are they keeping their appointments?  Are they doing their exercise?  If so, do I need to change the treatment?  Should I do some imaging, or should I possibly refer them out? 

Can I expect 50% improvement if I have chronic pain?

With chronic pain patients, we hope to achieve 50% improvement within 90 days.  Medicine teaches that if a procedure can provide 30% relief, then it is a good outcome and worth doing.  Most chronic pain sufferers realize that they are dealing with management of their pain vs curing their pain. 


Treating by the rule of 50% gives us structure. It helps keep me on track and it helps the patient understand where they are in the course of treatment. 

I talk with patients a lot about managing their conditions vs curing them.  They may be pain free for periods of time but statistically it is a matter of when their pain will return, not if it will return.  It is just the nature of back pain.

Overland Chiropractic Blogs

Does losing weight really improve your back pain?

Does losing weight really improve your back pain?

Does losing weight really improve your back pain? For years I have heard people comment that if they could only lose weight, their back would feel better. There is very little research to support this belief. A review of the literature was published in May 2022,...

Manual therapy for back pain vs Staying active on your own?

Manual therapy for back pain vs Staying active on your own?

Is it less expensive to have Manual therapy for back pain vs Staying active on your own? Have you ever heard that your back pain will get better on it’s own? Maybe it will and maybe it won’t. Some people just don’t want to go to the doctor. Others don’t go because...

5 Tips To Manage Holiday Stress

5 Tips To Manage Holiday Stress

Pay attention to your budget   Tightening your budget can help alleviate additional financial stress. Pay with cash or debit card. Personally, this helps me to stay on track. It is more painful to watch the cash leave your hands. Then you do not have the added stress...




11791 W 112th Street #101
Overland Park, KS 66210



Office Hours

M-W: 8am – 6pm Th: 1pm – 6pm F: 8am – 12pm S-S: 9Closed