by Last updated on October 22, 2026 (originally published on July 22, 2016)
As exercise professionals, we’re likely to encounter clients who have either suffered from, or are suffering from, low-back pain. After all, low-back pain is the leading cause of disability worldwide. When it comes to low-back pain, whether it is acute or chronic, or a result of a strain, sprain or disc degeneration, it can be extremely debilitating and can limit one’s ability to function in daily life.
Just as you would individualize programming for a client with a healthy back, give the same considerations to clients suffering from low-back pain. Before establishing a lower-back exercise program for your client, it’s important to understand the nature, duration and severity of the low-back pain. If it is a symptom of another serious condition, it is important that exercise program design be performed in consultation with the healthcare team managing that condition. It’s also essential to gather information regarding specific limitations, based on the clinical diagnosis, during the preparticipation health screening process and before designing and implementing an exercise program. In the absence of comorbid conditions, exercise program design should align with that for healthy individuals.
In some instances, completely eradicating low-back pain may not be feasible, so the focus should be on improving function and reducing pain while being as physically active as possible within pain limitations. It is important to inform your client that pain reduction and improved function may not be immediate and may take several months to become evident. Gradual progression, while monitoring pain levels and focusing on incremental increases in intensity, difficulty and volume for both cardiorespiratory and muscular strengthening activity, is effective for reducing pain and disability. Avoid positions and exercises that aggravate symptoms or cause pain to spread into the lower limbs.
Before implementing a lower back exercise program, determine which movements create discomfort or pain for your client. Clients should inform you of any postures, movements or positions that produce pain. The major focus in programming for low back pain is on improving muscular endurance, which can improve the function of the muscles supporting the spine.
In programming and training:
- Be aware of proper posture and alignment
- Teach clients how to adopt and maintain a neutral spine
- Teach clients to be aware of their lumbar spine, abdominal bracing and glute activation
- Monitor discomfort and regress or cease exercise, if necessary
Listed below are five exercises of varying difficulty to help improve function and relieve low-back pain. Exercises should be selected based your individual client’s condition, limitations and the severity of the pain. As function improves and pain diminishes, you can incorporate more challenging exercises to improve strength.
Start with one set and increase to two to three sets as tolerated and as function improves The recommended range for muscular endurance is 12 to 16 reps depending on the client’s fitness level and lowback pain. You may start with fewer repetitions for beginning clients until they are able to work up to the muscular endurance repetition range.
1. Wall Roll
Improves torsional control and encourages abdominal bracing through co-contraction
- Assume a plank position with both elbows planted on a wall.
- Brace the abdominals.
- While on the balls of the feet, pivot, pulling one elbow off the wall.
- Avoid any motion at the spine while the movement occurs.
- Work up to approximately 10 repetitions.
2. Clamshell
Retrains the gluteals, which is important for improving back health
- Lie on the side, and anchor the fingers on the anterior superior iliac spine.
- Keeping the heels together, open the knees like a clamshell.
- The position of the fingertips on the gluteus medius should allow the client to feel glute activation.
3. Side Bridge
Targets lateral muscles, which are important for optimum spinal stability
- Lie on your right side with extended legs, placing your left leg directly over your right leg and stacking your feet one on top of the other.
- Exhale, gently contract your core muscles to stiffen your spine and lift your hips and knees off the mat.
- If this is too much for your client, they can perform a modified version with the knees on the ground.
- Hold for 20 seconds.
4. Bird Dog
Safely and effectively develops spinal extensors
- Begin on all fours, with hands under shoulders and knees under hips.
- Extend the opposite arm and leg (hold this position, as tolerated by the client).
- Work up to holding the extended position for seven to eight seconds on each side.
5. Glute Bridge
Improves core stability via glute activation
- Lie supine and elevate the hips off the ground.
- Activate the glutes as the hips are elevated.
- Hold for three to five seconds.
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