A kitchen chair, a phone propped against the kettle, and a physiotherapist on the screen watching you bend forward. That is what back pain treatment looks like for a growing number of people, and the evidence says it is not a compromise.
What back pain usually is
Most back pain is not caused by damage that a scan can find. The 2018 Lancet series on low back pain put it plainly: for the great majority of people no specific structure can be identified as the cause, and that is normal rather than a failure of investigation. Pain in the lower back is usually a mix of sensitive tissues, muscles that have tightened to protect the area, poor sleep, stress and reduced movement, and those factors feed each other.
This matters because it changes what treatment is for. If nothing is broken, nothing needs fixing. What needs to change is how the back is moving and loading, and how confident the person is in using it.
What the evidence says works
The guidance is unusually consistent across countries.
The NICE guideline on low back pain and sciatica (NG59), which Irish practice follows closely, was updated again in July 2026. Its core has not moved: give people tailored information, encourage them to carry on with normal activities, and treat with exercise. Manual therapy such as hands-on mobilisation is only recommended as part of a package that includes exercise, never on its own. Routine scans are not recommended for back pain without other concerning features, because they rarely change treatment and often show age-related findings that worry people without being the cause of their pain.
A Cochrane review published in 2021 pooled 249 trials with 24,486 participants and found that exercise reduces chronic low back pain by about 15 points on a 100-point scale compared with no treatment or usual care, which the authors judged clinically meaningful, with a smaller improvement in function. The certainty of the evidence was moderate. The review compared many kinds of exercise against no treatment and usual care, and the finding that holds across them is that exercising beat not exercising. What matters is a suitable amount of something you can keep doing.
Bed rest is no longer advised for back pain. Staying active, within what the pain allows, shortens episodes.
For acute back pain the natural course is encouraging. A 2012 systematic review in the Canadian Medical Association Journal found that most people with a new episode improve substantially within six weeks, though pain often does not disappear completely. The Lancet series notes that recurrence is common, which is the reason a good physiotherapist treats the next episode as well as this one.
Why that means the treatment lives at home
Look at what the evidence puts first: information, staying active, and exercise. None of those happen in a clinic. They happen in your kitchen, on your commute, at your desk and on the floor of your living room, every day, between appointments.
The physiotherapist's job is to work out what is driving your particular pain, choose the right movements and the right dose for where you are now, teach you to do them well, and change the plan as you improve. That part needs a physiotherapist. The repetition does not. A 30 minute appointment every week or two is the planning meeting; the treatment is the other 13 days.
Seen that way, the question of video versus in person is mostly a question of whether the planning meeting works on a screen. The research says it does. The American Physical Therapy Association's 2024 clinical practice guideline on telerehabilitation found video care at least equivalent to in-person care for patient satisfaction, with better attendance and adherence. A 2024 systematic review in the Journal of Physiotherapy found satisfaction with real-time video physiotherapy comparable to in person, and attendance and exercise adherence similar or better. An earlier meta-analysis of real-time video physiotherapy for musculoskeletal conditions found outcomes for pain and function comparable to face-to-face care.
The honest limit: a physiotherapist cannot put hands on you through a screen. For back pain that is less of a loss than it sounds, since the guidelines put hands-on treatment in a supporting role at most, and a physiotherapist can see a great deal from how you stand, bend, sit and walk. Where an in-person examination is needed, a good online physiotherapist says so.
What a video session for back pain involves
The first session is mostly conversation. The physiotherapist asks how the pain started, what makes it better and worse, how it is affecting sleep, work and activity, what you have tried, and about your general health. Part of that conversation is a check for anything in your history that means a doctor should see you first; if there is, you will be told, and sent in the right direction.
Then they watch you move. Standing, bending, turning, sitting down and getting up, walking a few steps. A phone at waist height on a shelf or a chair, with a couple of metres of floor space, is enough.
From there you get an explanation of what they think is going on, in plain words, and a plan: a small number of movements chosen for you, how often and how hard to do them, what to expect over the coming weeks, and what to do if a flare comes. Follow-up sessions check progress, correct technique and move the plan on.
When video is not the right first step
Some back pain should be seen by a doctor before a physiotherapist, and some needs urgent care. If your pain followed an accident or a fall, if you are generally unwell, or if you have symptoms that are new to you and worrying, see your GP first. The HSE's back pain page describes when to seek urgent help, and a physiotherapist will run through the same questions at the start of your session.
Back pain in Ireland
Public physiotherapy exists, but the wait for an initial assessment is often long. For back pain, which responds best to early advice and movement, months are the wrong length of time to wait.
Private physiotherapy in Ireland typically costs between EUR 50 and EUR 75 a session in person. Many health insurance plans refund part of the cost of physiotherapy with a CORU-registered physiotherapist, and physiotherapy fees can count as a qualifying health expense for tax relief. Check your own policy and the Revenue guidance, because the rules vary by plan.
Because sessions are by video, it works the same from Dublin, Cork, Limerick, Galway or anywhere else in the country.
How Book a Physio fits
Book a Physio connects you with CORU-registered physiotherapists for 30 minute video sessions at a fixed price.