Back pain can be tricky. Most people who’ve dealt with it know it isn’t fun, and there isn’t a single agreed-upon cause. Some point to weak glutes, others to tight hip flexors or hamstrings, and the reasons can vary from person to person.
In my years as a personal trainer and strength coach, I’ve worked with hundreds of athletes and clients dealing with low back pain. It’s a common part of the profession. I’ve built skills within my scope to help them, and I can assess rather than diagnose, aiming to create a plan that addresses what’s going on.
Often, addressing low back issues can be straightforward: identify movements that hurt or worsen symptoms, avoid those movements, and find others that allow for training without pain.
Dr. Stuart McGill is a cornerstone of spine research. He’s co-authored many studies and written influential books on low-back pain, including Ultimate Back Fitness & Performance (now in its sixth edition) and Low Back Disorders. His work has shaped much of how professionals approach back health.
When it comes to practical guidance, McGill’s book Back Mechanic stands out for breaking down a full method—from spinal hygiene and assessment to corrective exercises and strength training. It’s a thorough resource, though you can start with the core ideas and build from there.
McGill also has a practical set of core movements he often recommends for people with low back issues: the Curl-Up (not a full sit-up), the Side Bridge or Plank, and the Bird-Dog. Even after you master those, progress gradually and add appropriate challenges.
A note on trends: overemphasizing avoiding spinal flexion can backfire. Some people become flexion-intolerant and then develop extension-based back pain because they’ve lost the ability to move their spine into pain-free flexion. For example, Dr. Ryan DeBell has discussed his own history—he trained himself toward spinal neutral, avoided flexion, and eventually found that extension-based movements started to hurt as well.
As a coach, my job is to build confidence and work with the client on what tends to work—start with movements that don’t hurt and go from there.
McGill’s go-to starting moves for a low-back client are the Curl-Up, the Side Bridge (or Plank), and the Bird-Dog. Even when these are mastered, I tend to keep them in for a few weeks and gradually increase the challenge.
Take the Bird-Dog with resistance bands (to add kinesthetic feedback and engagement in the anterior core and glutes). Another option is Bird-Dog off a bench, which reduces stability demands and forces slower, more controlled movement.
Moving the spine should be encouraged when it’s pain-free. In assessments, I’ll often find that a person’s spine doesn’t move as it should, either because of a faulty pattern or because they were coached to avoid flexion. A toe-touch test can reveal this: when bending to touch the toes, there should be a smooth, natural curve in the spine. If the lower back remains flat or there’s little movement, that’s a red flag to address.
The Segmental Cat-Cow drill is one I’ve used more with low-back clients. The idea is to slow the movement down and move the spine segment by segment. Many people can round and arch their back, but they may move well only in one region (like the thoracic spine) and not in others (often the lumbar). Coaching the movement point by point helps people learn to move their spine slowly and with control. Give this drill a try with your clients: it doesn’t require more than a few passes per set, and a total of a few sets can be very educational. It helps people understand that moving the spine is allowed when it’s pain-free and sets them up for long-term spine health.
These drills are starting points. I also use unloaded rotational and spinal flexion/extension movements, as well as loaded exercises like tempo deadlifts, various hip and lower-back dissociation movements, and a range of single-leg work to build overall strength.
Bottom line: you should combine motor-control work with lifting heavy stuff. Pain science is complex, and there isn’t one simple reason for back pain. While some practitioners reference glute activation as a factor, it’s often an oversimplification. Glute training can aid proprioception and sensor mapping in the lower back area, but it isn’t a universal cure. The real takeaway is to balance movement and strength, progress gradually, and respect that the spine benefits from a broad set of healthy movements.
