Low back pain (LBP) is a topic that often stirs debate, but it isn’t as mysterious as some make it seem. The idea that “everything and nothing causes LBP” reflects how tricky it can be to pin down a single cause or solution. If you asked ten doctors or therapists about the same patient, you’d likely get ten different opinions on the root cause and the best plan. Some point to delayed activation of the transverse abdominis, others blame posture or tight hamstrings. Often the blame falls on tight hamstrings, and that’s usually a simplification. LBP rarely has one sole cause. There are even jokey notions about coffee or other odd culprits, but there’s little evidence for such easy explanations. The bottom line: what helps one person may not help another.
There’s no one-size-fits-all answer, and it’s a mistake to lump all LBP together as if the same approach works for everyone. There’s no single right way to treat it, and assuming all LBP should be treated the same is a big error. We don’t expect everyone reading this to be clinicians or physical therapists, and personal trainers aren’t typically diagnosing. If you’re a trainer who diagnoses, you should stop. Instead, rely on qualified health and fitness professionals you trust. Still, trainers can be the first to notice faulty movement, weakness, and imbalances, and they can play a valuable role in helping clients with LBP.
Here’s a concise look at what has helped me with LBP.
1) Rest is not the answer
Rest is overused as a default. Sometimes a little rest is appropriate, but most people do better with movement and gradual progression. It’s fine to teach a neutral spine as a starting point, but over time people need to move through different positions. Movement is corrective, and while rest has its place, stagnation tends to worsen things. The body is meant to move and adapt to safe, appropriate challenges.
2) Move, but move well
Movement quality comes from three factors: structure, coaching/technique, and programming. People are unique, and anatomy matters—hip shape, shoulder mobility, and other factors can influence how you move. The body tends to use the path of least resistance, but efficient movement isn’t always best movement. Curb the exercise to the lifter, not the lifter to the exercise. If someone lacks hip flexion, for example, a conventional deadlift may not be ideal. Coaching and programming should reflect the lifter’s abilities and limitations, not force the same lift on everyone.
3) Finding a pain-free neutral ROM is important
A practical approach is to find a pain-free range of motion (ROM) and help the person own it. Start from a comfortable position, then assess how flexion or extension affects pain. Some people tolerate flexion well; others don’t. The goal is to minimize painful movements and teach how to sit, stand, and move in ways that protect the spine. Build spinal endurance and strength through well-timed drills, and gradually expand ROM as symptoms allow. Everyday life will involve some spinal movement, so the plan should prepare the person to handle it safely.
4) Don’t treat people like patients
Deadlifts and other hip-hinge movements can be valuable for many with LBP when taught properly and progressed thoughtfully. A deadlift doesn’t automatically harm the spine; it can build resilience. If needed, use accessible tools like kettlebells, trap bars, or offset loading to suit mobility and comfort. The focus is on finding a training plan that creates progress and expands usable movement, rather than labeling someone as permanently damaged.
Bottom line: LBP has many possible causes—tightness, weakness, poor kinesthetic awareness, or other factors. There isn’t a single root cause or a universal fix. But there are solid, reliable ideas that help: move with good technique, load gradually and smartly, and slowly widen the range of safe movement. I hope this offers a useful starting point.
