Low back pain (LBP) is a topic people often treat as controversial, but the reality is there isn’t a single right answer for assessment, diagnosis, or treatment. The last few years have amplified debates about what’s best, but there isn’t one universal solution.
LBP is complex and can have many supposed causes, which is why you can get ten different opinions from ten different clinicians about the root problem and the best plan. Some point to delayed firing of the transverse abdominis, others to posture or tight hamstrings. In truth, there’s rarely a single culprit. “Tight hamstrings” gets blamed far too often, and the same logic is applied to other issues. Sometimes it’s not possible to pin LBP to one cause. There are even days when explanations feel far-fetched, and still others that aren’t supported by evidence. The key point is there is no one-size-fits-all approach.
As a fitness professional, I don’t diagnose. If you’re diagnosing as a trainer or coach, you should stop and defer to qualified health professionals. That said, trainers are often the first point of contact in spotting faulty movement, weakness, and imbalances, and we can play a vital role in helping people move better and build resilience.
Here’s a concise look at what has helped me with LBP:
1) Rest is not the answer
Many advise rest as the main remedy, but prolonged rest or being told to simply “live with” low back pain is usually counterproductive. There are times to back off and let the body heal, but stagnation is a bigger problem. Movement and gradual loading tend to yield better long-term results. Starting with a reasonable, pain-free range of motion is fine, but life requires moving in many positions, not just staying still. The idea that strength isn’t relevant until pain is gone is outdated. Movement can correct issues, and its gradual application is crucial for lasting improvement.
2) Move, but move well
There are three key elements to movement: structure, coaching/technique, and programming. People vary anatomically—hip structure, shoulder mobility, and more—so tailor exercises to the individual. Not everyone should deadlift from the floor or use a straight bar; adjust the lift to the lifter. The coach should adapt the exercise to the person, not force the person to fit the exercise. Even how you coach a simple plank can matter. The goal is to find a training approach that produces durable, pain-free movement.
3) Finding and expanding a pain-free spinal range of motion
A practical starting point is to identify actions that hurt or aggravate symptoms and avoid them. Begin in a comfortable, neutral position, then gradually test movements that involve flexion or extension to see what’s tolerable. For those with flexion-related pain, reduce excessive bending, improve posture, and build spinal endurance through controlled exercises. For those with extension-related pain, use cues to avoid overextension. The aim is to establish a pain-free ROM, then progressively widen it with proper technique, so everyday activities and training can occur outside the neutral spine.
4) Don’t treat people like patients
In many cases, a well-structured deadlift or hip-hinge progression can be central to rehabilitation, tailored to goals and injury history. If needed, use variations such as kettlebells, trap bars, or offset loading to suit mobility and strength levels. The focus is on resilience and building a trainable menu of exercises that fit the person’s goals and limitations, rather than labeling them as fragile.
Bottom line: LBP has multiple possible causes—tightness, looseness, weakness, kinesthetic issues, or asymmetries—and there isn’t a single root cause or universal remedy. Yet focusing on movement quality, appropriate loading, and individualized programming can vastly improve outcomes. I hope this helps.
