Patients with chronic musculoskeletal conditions are often thought of as resistant to treatment. This is true for both conservative and non-conservative treatments, including pharmacological interventions. In settings where this is not the prevailing thought, then the amount of change expected as a result of conservative interventions is often small and seemingly insignificant, especially if improvements are not durable. In my practice, approximately two thirds of patients I work with have chronic musculoskeletal conditions. Join me as I discuss the why and how of a simple rule we use that helps signal significant improvement has occurred, the kind that often signals greater potential for recovery.