I recently finished reading Dr. Stuart McGill’s Back Mechanic book during my return flight from presenting at the Encore Sports Medicine Symposium in Alabama. One of the world’s best spine experts, Dr. McGill presents some extremely practical methods for identifying, avoiding and relieving many types of back pain, along with a slew of back friendly exercises. I highly recommend the book to trainers and lifters alike.
Dr. McGill repeated one message over and over: avoid your painful movements and perform as much pain-free movement as possible. This really stuck with me because many people are too quick to stop training entirely when they get injured.
Not coincidentally, I had the opportunity to watch Eric Cressey assess several clients with lower back pain recently, which prompted me to pick up Dr. McGill’s book. Between these two movement experts, I picked up some commonalities in exercise selection and programming specific to back pain. Again, not coincidentally, they relied heavily on avoiding identified painful motions and grooving non-painful motions.
As strength coaches, it’s our job to teach good movement, not to treat pain. That said, I’m no doctor, so if you’re in pain, go get it checked out. These suggestions are merely for those looking to train AROUND pain, or for those lifters who want to minimize spinal loading.
1. Choose Single Leg Exercises Over Bilateral
It turns out a lot of people with back pain simply aren’t good candidates for axially-loaded bilateral lower body exercise. In plain English, that means two-legged exercises that apply compressive or shear loads to the spine, like squats and deadlifts.
Reducing spinal motion and increasing hip motion is key for back health, and single leg exercises do just that. Movements like lunges and split squats put one hip in flexion and one hip in extension. This makes it much less likely that the spine will go into a lot of flexion or extension.
And as much as it pains me to NOT include squatting and deadlifting in someone’s program, it’s entirely possible to train hard and heavy with single leg exercises. If you’re not injured and desperate to move some heavy weight, try holding onto a power rack for balance.
Opt for dumbbells at your sides or an anterior load (goblet or front squat position) rather than holding the bar on your back. Both these options help engage your abs and reduce the chance of moving through your spine.
2. Groove the Hip Hinge
As I just mentioned, learning to move through the hips instead of the spine is crucial for back friendly exercises. The hip hinge is the most important movement you can master to keep your back happy.
Deadlifting is the most common loaded form of the hip hinge, but you don’t need to deadlift to groove this essential pattern. There are many exercises that are pattern-assisted (i.e. the exercise is designed to make the hinge easier to learn) and don’t aggressively load the spine. Here are my favorites:
Cable Pull Through
The pull-through is my favorite because the cable assists you into a posterior weight shift. This teaches you to load your hips instead of your knees. Make sure to avoid arching or rounding your lower back.
3-Point PVC Hip Hinge
Using a PVC pipe behind your back teaches you what it means to maintain a normal spinal curve while moving your hips. Make sure to keep the pipe in contact with the back of your head, your mid-back and your butt.
3. Get to Neutral in Your Warm-Up
Using warm-up exercises to familiarize yourself with what a neutral spine feels like helps that feeling “stick” once you start lifting heavier weights. What is neutral? It’s slightly different for everyone, but 
typically means:
- A neck position where the ear stacks directly over the shoulder
- A slight rounding to the upper back
- A slight arch in the lower back
Any significant deviation from this alignment adds stress to the spine. And while we use some exaggerated drills to correct some exaggerated postures (for example, the All Fours Belly Lift uses a lot of flexion to reduce a gross extension posture), it’s best to avoid end ranges if the goal is simply to find neutral.
Prone bridges are an excellent place to start. Make sure to use a low-threshold strategy (i.e. brace your abs at about a 4-out-of-10 effort) to keep your spine straight from head to toe.
Then, progress to Dead Bugs and/or Bird Dogs to work on your ability to stay neutral while moving your limbs.
4. Do More Concentric-Only Assistance Work
Eliminating the eccentric portion from lower body assistance exercises helps spare the spine, simply because most concentric-only exercises can’t be performed with a bar on your back or held in your hands!
My preferred method is dragging or pulling a sled. On top of being spine-friendly, sled work does well to train for aerobic fitness (if done at a lower intensity for longer duration) or fat loss (if done at high intensity for short duration with incomplete rest).
Other options include glute bridge and hip thrust variations, of which single-leg options would be my first choice because of the aforementioned back-friendly nature of unilateral movements.
Give Your Back a Break
Whether you’re training around an injury or simply want to limit your back stress after you’re done doing your big, heavy lifts for the day, these strategies can give your back a break by reducing spinal motion and loading with more back friendly exercises. They won’t cure an existing injury, but they may open up avenues to keep training hard and keep making progress.
