44 year old Omar Tawashij recently migrated to Australia from his home country Sudan. Omar presents with a lower back injury sustained due to an accident in his early twenties, when he fell off his bike onto a hard surface. Since then, he has sought treatment for the pain which has enabled him to continue with his daily duties. He was a transport officer for several years which required him to stand on his feet for long periods of time. Remedial massage techniques are applied to treatments provided twice a week. Home exercises have been provided in the treatment plan to help with strengthening and pain management. After the first sessions, Omar reported a slight improvement in the pain however in the last 2 months he admits that he is not performing his home exercises. He is distracted with the disappointment of being unable to secure a full time job to help with the living expenses of his family and appears emotionally and physically stressed. Omar missed a few sessions and had to be reminded of his appointment times. During his last treatment he reported a worsening of pain and general apathy to treatment and motivation to home exercises