How To Confidently Treat Back Pain Patients Without Using Your Hands

Where do you start with a complex back pain patient if you can’t use your hands?

Do you feel confident that you could ease their pain in the first couple of sessions?

Do you feel confident in what exercises they would need and how they would progress?
Not 100% sure?

I’ll be honest with you…

Neither did I 10 years ago.

Especially with nerve root or facet joint type pain presentations.

They can be tricky to treat in the clinic let alone online… and not being able to use your hands.

I’d get overwhelmed

Stuck and panic!

That was until I took a step back.

I looked at things differently.

The patient first, pain second.

That’s how Joby has been able to structure his assessments in a simple way that both him and his patient understand.

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It’s how his patients are progressing in every session.

Building resilience and stopping their pain experience from returning…

…without needing to use his hands.

You see, you can make big differences to peoples lives…without having to perform mobilizations or even using your hands.

Let’s say you have a patient in front of you on a telehealth session.

They get pain on extension based movements…and you notice when they extend., this brings the pain experience in their lower back region…

To simplify the movement of extension…
what might not be doing its job that may be putting more pressure on the low back or the facet joint for example?

Extend your lumbar spine in standing…

The weight in your foot reacts and your weight travels forwards…

This is to manage your base of support and keep you balanced.

Is this happening?

If it’s not happening then you’re not using hip extension to achieve this movement and are using your low back a lot.


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That completely depends on the person’s story, their injury history… and their current movement


I’ll let you in on something…

It’s not (or very rarely) weak glutes.

Another thing you may notice is when the patients lean back, they may not elevate their ribcage…

Try it for yourself

…don’t allow your ribcage to elevate as you extend your lumbar spine…

…versus exaggerating your ribcage elevation and notice when you reach end rage extension.

You’ll reach end range pretty quickly with a rib cage that doesn’t elevate.

A ribcage that doesn’t elevate will have implications for the pelvis also.

With this type of patient, we may choose to help the ribcage to elevate…

This would also help the abdominals to decelerate the forward momentum of the pelvis as the spine extends…

…and very often then we’ll eliminate that low back ‘pinch’ very quickly.

Click here to read my previous blog on how I use this with rugby players.

Keep it simple.

The more simple your keep things,

The less overwhelmed you’ll become when it comes to treating ticky patients online.

Your confidence will increase for you and the patient in front of you.

Listen, if you own a private practice… now is the time for action

Enough waiting and seeing if your patients will show up.

It’s time to do something about it and guarantee that they WILL show up.

And today, I have something that will help you do just that.

I’ve got a brand new Telehealth Webinar packed full of value…

It shows you how to get predictable consistent results confidently with online appointments without needing to use hands-on.

It’s completely FREE and you’ll be able to claim your spot by clicking here.

Nothing for sale.

Just pure value.

Thes 3 core elements that I’m going to teach you could recession proof your clinic

Don’t believe me?

Go see for yourself and claim your FREE sport right here.

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Download a Free ‘ebook’ copy of the 8-Step ‘World Cup’ Treatment Plan that helped my private patients achieve full recovery and made me a ‘go-to’ physio for complex cases…

About The Author

Dave O'Sullivan

Dave O’Sullivan, Chartered Physiotherapist with a master’s in Strength and Conditioning, worked as a sports physio for the Wallabies Rugby Union team (2023 World Cup), England Rugby Union (2019 World Cup) and England Rugby League (2017 World Cup). He built a leading clinic in Huddersfield, UK, and developed a unique step-by-step approach with his own sporting and non sporting patients.

Dave now teaches his methods globally and has helped over 1,000 physiotherapists and other health professionals, giving them confidence and clarity to help patients who have failed traditional approaches.