Working around a Client’s Low Back Pain – Strategies and Exercise Progressions

by Nicholas Rolnick, DPT, CSCS and Jacob Templar
Personal Training Quarterly July 2023
Vol 10, Issue 1


The primary focus of this article is to provide personal trainers with an evidence- and practice-based approach to exercise selection and implementation in those with low back pain.

Research has supported that the long-standing belief of resting during an acute bout of lower back pain (LBP) may worsen chances of recovery and increase the likelihood of chronicity (2,22,23,27). Given that LBP is one of the most common causes of disability worldwide, with around 75 – 80% of all individuals experiencing LBP at some point in their life, the likelihood is that most personal trainers will work with clients who have current or past histories of LBP (24). Awareness of the current published guidelines and beliefs surrounding LBP and exercise can assist the personal trainer in the decision-making process regarding exercise selection.

The focus of this article is to provide personal trainers with an evidence- and practice-based approach to exercise selection and implementation in those with LBP and to shed light on signs and symptoms that may warrant immediate referral to a medical provider. It is important for the personal trainer to be able to recognize signs and symptoms of potential pathology because personal trainers are considered one of the key professionals promoting physical activity to the public (30). Yet, only 20% of physicians report referral to a personal trainer due to fears of being poorly trained (30). The intent of this article is to help personal trainers become better educated on ways to work with clients with LBP and further, to understand when exercise is not appropriate. It is assumed that if a client is presenting with LBP that he or she has been seen by a medical provider and cleared for exercise. If a client presents with new onset of LBP, the personal trainer should use discretion to determine whether exercise without clearance from a medical provider is safe and within scope of practice.

This article originally appeared in Personal Training Quarterly (PTQ)—a quarterly publication for NSCA Members designed specifically for the personal trainer. Discover easy-to-read, research-based articles that take your training knowledge further with Nutrition, Programming, and Personal Business Development columns in each quarterly, electronic issue. Read more articles from PTQ »

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Nicholas Rolnick, DPT, CSCS

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Nick Rolnick, AKA The Human Performance Mechanic is a world class Physical Therapist & Performance Enhancement Specialist. Nick teaches Kinesiology I ...

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