How do you create a workout plan for a client with low back pain?

With low back pain you avoid exercises that repeatedly flex or rotate the spine under load. Classic sit-ups, weighted Russian twists and good mornings with a heavy bar drop out as long as the complaints are active.

Exercises where the trunk forms a long lever under external load also raise the compressive forces on the intervertebral discs more than most alternatives. A heavy unsupported barbell bent-over row is the textbook example. There is almost always a supported variant, such as a chest-supported row or a seated cable row, that trains the same muscle group with less spinal load.

Stuart McGill, a spine biomechanist, developed a protocol known as the Big 3: the curl-up, the side bridge and the bird dog, in which opposite arm and leg are raised. The premise is that with back complaints the trunk should be trained for endurance and stability, not for maximal strength or range of motion.

The key principle behind it: each exercise covers a different protective direction. The curl-up trains the flexors without fully flexing the spine, the side bridge the lateral chain, the bird dog stability under contralateral load. Picking three arbitrary ab exercises does not cover those three directions.

In EasyGym this principle is built in: as soon as you tick low back pain for a client, the engine deliberately selects one exercise per direction instead of three exercises from the same family.

For core work with back complaints, use short repeated efforts with limited rest rather than a few heavy sets. A commonly used dosage is 2 sets of about 8 reps or a 30 second hold, with 30 seconds of rest. The emphasis is on the quality of the position, not on the number.

A useful rule: if the client can no longer keep their breathing calm during the exercise, the load is too high or the set too long. That is more usable than a percentage of a one-repetition maximum, because with stability work you rarely deal with such a maximum.

A common mistake is stripping the whole plan bare because the back is sensitive. That is rarely necessary. Lower body work in controlled forms such as the goblet squat to a comfortable depth, the split squat and the hip bridge, supported upper body work, and low-impact cardio all remain perfectly possible.

Build the load up progressively across a block of 3 to 6 weeks rather than improvising week by week. A predictable build-up gives the back time to adapt and makes it immediately clear when a particular step came too soon.

Training is not a substitute for diagnosis. Pain radiating into the leg, numbness, loss of strength, complaints after trauma, or pain that keeps someone awake at night are all reasons to send your client to a physician or physiotherapist first.

As a personal trainer you work with non-specific, stabilised complaints. Making that distinction clear to your client is also the safest position professionally.