How to Train with Lower Back Pain Safely

Stop panicking about your back

I tweaked my back deadlifting 405 about six years ago. Felt a sharp pull in my lower right side, dropped the bar, and spent the next 20 minutes lying on the gym floor convinced my lifting career was over. I went to my doctor, got an MRI, and was told I had a "bulging disc at L4-L5." The doctor told me to stop lifting heavy.

Here is the thing. I am still deadlifting in my mid-30s. My back is fine. That bulging disc is probably still there (most of them never fully resolve on imaging). And I have pulled heavier since that injury than I ever did before it.

Lower back pain is incredibly common among lifters. It is also incredibly manageable in most cases. The worst thing you can do is catastrophize, which is the medical term for convincing yourself that your back is broken and you will never train again. Stuart McGill, arguably the world's foremost spine biomechanics researcher, has said repeatedly that the spine is a remarkably resilient structure. Most acute back pain resolves significantly within 6-12 weeks regardless of treatment.

That does not mean you should ignore it. It means you should manage it intelligently rather than either pushing through stupidly or shutting down completely.

When to see a doctor versus when to train through it

Let me be very clear about this. There are certain symptoms that require medical attention immediately:

• •Numbness or tingling that radiates down your leg below the knee
• •Loss of bladder or bowel control (this is a medical emergency)
• •Weakness in your foot or leg (not just pain, but actual inability to lift your foot or straighten your knee)
• •Pain that wakes you up from sleep consistently
• •Pain that is getting progressively worse over 2-3 weeks despite rest and modification

If you have any of those, go see a doctor. Not a chiropractor (sorry, chiro fans), an actual medical doctor or a sports medicine physician who can order imaging if needed.

For the vast majority of lifting-related back pain, though, you are dealing with one of these:

• •Muscle strain (the most common)
• •Facet joint irritation
• •Disc irritation (not necessarily a full herniation)
• •General inflammation from overuse

These are all manageable with intelligent training modification and they all heal. The key word is "modification," not "cessation."

Why complete rest is usually the wrong answer

This is going to sound counterintuitive, but decades of research support it: bed rest and complete inactivity make back pain worse, not better.

A landmark 1995 study by Malmivaara et al. compared three groups of acute back pain patients: one group was prescribed bed rest, one was told to continue normal activities as tolerated, and one was given back exercises. The exercise group and normal activity group both recovered faster than the bed rest group. The bed rest group had the worst outcomes.

More recently, a 2010 Cochrane review by Dahm et al. confirmed that staying active produces better outcomes than rest for acute and subacute lower back pain.

Why? Because movement increases blood flow to the injured area, maintains muscle strength that supports the spine, prevents the fear-avoidance cycle (where you stop moving, which makes you stiffer, which makes pain worse, which makes you more afraid to move), and keeps you mentally healthy. Lying on a couch for two weeks worrying about your back is terrible for recovery.

Understanding what is actually happening

Most lifting-related back pain falls into a few categories:

Muscle strain. You overloaded a muscle or tendon in the lower back. It is inflamed and spasming. This hurts like hell but heals relatively quickly, usually 2-4 weeks. The pain is usually localized to one side, right at the belt line or slightly above. It gets worse with specific movements (usually flexion or rotation) and better with others.

Disc irritation. The intervertebral discs can get irritated from repeated flexion under load (think: rounding your lower back during deadlifts). This can range from mild irritation to a full herniation. Disc issues tend to cause pain that radiates into the glute or hamstring, are worse in the morning (discs absorb water overnight and are more pressurized), and are aggravated by sitting and flexion.

Facet joint irritation. The facet joints are the small joints on the back of each vertebra. They can get irritated from extension and rotation. This pain is usually worse with arching your back, standing for long periods, and rotational movements. It tends to be localized right at the spine rather than off to one side.

Knowing which one you are dealing with helps guide your exercise selection. Disc issues get worse with flexion, so avoid rounding. Facet issues get worse with extension, so avoid aggressive arching. Muscle strains need light loading in the pain-free range.

Exercises to avoid temporarily

I am saying "temporarily" because these are not permanent restrictions. Once your back heals and you rebuild your tolerance, you can return to all of these. But during the acute and subacute phase (first 2-8 weeks), pull these from your program:

Conventional deadlifts from the floor. The bottom position places the most stress on the lower back. Pull from pins or blocks at knee height instead if you want to keep deadlifting. Or switch to trap bar deadlifts, which keep the load closer to your center of mass.

Barbell back squats with heavy loads. The axial loading and the tendency to lean forward under heavy weight compresses the spine. Switch to goblet squats, leg press, or belt squats.

Barbell bent-over rows. The isometric demand on the lower back in the bent-over position is significant. Switch to chest-supported rows, cable rows, or machine rows.

Good mornings. Should be obvious, but I have seen guys try to "stretch their back out" with good mornings during a back flare-up. Don't.

Sit-ups and crunches. Repeated spinal flexion under load is exactly what McGill warns against for people with disc issues. Replace with anti-extension exercises like planks and dead bugs.

Exercises you can and should keep doing

Upper body pressing. Bench press, overhead press, dumbbell work. As long as you are not arching excessively (looking at you, powerlifting bench arch), pressing movements should not bother your back. They keep your training consistency going and your upper body does not need to detrain because your lower back is pissed off.

Machine and cable work for lower body. Leg extensions, leg curls, hip abduction/adduction machines, cable pull-throughs. These let you train your legs without loading the spine directly.

Belt squats. If your gym has a belt squat machine, this is the holy grail for training legs with a bad back. The load hangs from your hips instead of sitting on your spine. You get all the quad and glute stimulus with zero spinal compression.

Leg press. Most people tolerate the leg press well with back pain as long as they do not let their hips tuck under at the bottom (which rounds the lower back). Keep the range of motion moderate and do not go for max depth.

Trap bar deadlifts (from blocks if needed). The more upright torso position and the handles being at your sides rather than in front of you reduces the shear force on the lower back. Start light and see how it feels.

Walking. Seriously, walking is one of the best things you can do for an angry lower back. It provides gentle movement, increases blood flow, and keeps you active. Aim for 20-30 minutes daily.

The McGill Big Three

Dr. Stuart McGill developed three core exercises specifically for people with lower back pain. These are evidence-based, spine-sparing, and should be done daily during recovery. They train the core muscles that stabilize the spine without putting the spine through flexion, extension, or rotation under load.

1. Curl-up (NOT a crunch)

Lie on your back with one knee bent and one leg straight. Place your hands under the small of your back (this preserves the natural lumbar curve). Brace your core, then lift just your head and shoulders off the ground by about one inch. Hold for 10 seconds. Do not flex your spine. This is not a crunch. Your lower back should not move at all. The range of motion is tiny.

Start with 3 sets of 6 reps (10-second holds). Progress to 3 sets of 10 over several weeks.

2. Side plank

Lie on your side with your elbow directly under your shoulder. Stack your feet or stagger them (top foot in front). Lift your hips off the ground so your body forms a straight line from head to feet. Hold. If a full side plank is too much, bend your knees and do it from the knees.

Start with 3 sets of 10-20 second holds per side. Progress to 3 sets of 30-45 seconds.

3. Bird dog

Start on your hands and knees. Extend your right arm forward and left leg back simultaneously while keeping your torso completely still. No rocking, no rotating, no arching. Hold for 10 seconds, return, and switch sides.

Start with 3 sets of 5 reps per side (10-second holds). Progress to 3 sets of 8-10.

Do these three exercises every day. First thing in the morning is ideal since your back tends to be stiffest then. They take about 10 minutes and they work. I have used them with dozens of clients recovering from back pain and the results are consistently good.

Building back to normal training

Once the acute pain has subsided (usually 2-6 weeks), you can start building back toward normal training. The key is to be gradual and systematic.

Weeks 1-2 post-pain: Foundation

• •McGill Big Three daily
• •Upper body training as normal
• •Lower body: machines only (leg press, leg curl, leg extension, belt squat)
• •Walking 20-30 minutes daily
• •No axial loading of the spine

Weeks 3-4: Reintroduce basic patterns

• •Add goblet squats (light, focus on perfect form)
• •Add trap bar deadlifts from blocks (start at 50% of your normal working weight)
• •Add cable rows or chest-supported rows
• •Continue McGill Big Three

Weeks 5-6: Build load gradually

• •Progress goblet squats to front squats or safety bar squats
• •Lower the block height on trap bar deadlifts, add weight gradually
• •Add barbell rows with light weight
• •Start using RPE 6-7 on lower body compounds

Weeks 7-8+: Return to normal

• •Reintroduce barbell back squats (start light, build over 2-3 weeks)
• •Reintroduce conventional deadlifts (start at 60% of previous working weight)
• •Gradually increase intensity back to RPE 8-9
• •Maintain McGill Big Three as part of your warm-up

The whole process takes about 8-12 weeks from injury to full training. That feels slow when you are living through it, but it is much faster than the alternative: pushing too hard too soon, re-tweaking your back, and starting the whole cycle over again.

Preventing lower back pain from coming back

Once you have recovered, here is how to keep your back healthy long-term:

Warm up your spine before heavy lifting. The McGill Big Three make an excellent warm-up. Five minutes of curl-ups, side planks, and bird dogs before you squat or deadlift is cheap insurance.

Stop rounding your lower back under load. I know, you have heard this a thousand times. But it is the number-one cause of lifting-related back pain. If you cannot maintain a neutral spine during a deadlift, the weight is too heavy or your technique needs work. Film yourself and be honest about what you see.

Train your core for stability, not flexion. Planks, Pallof presses, loaded carries, ab wheel rollouts (done correctly). These train the core to resist movement, which is its actual job during heavy lifting. Sit-ups and crunches train spinal flexion, which is the opposite of what you want under a heavy barbell.

Do not sit for extended periods. If you have a desk job, get up every 30-45 minutes. Set a timer if you have to. Prolonged sitting increases disc pressure and deactivates the muscles that support your spine. A standing desk or a sit-stand setup helps a lot.

Keep your glutes strong. Weak glutes force the lower back to compensate during hip extension movements. Heavy hip thrusts, Romanian deadlifts, and glute bridges keep the glutes strong enough to do their job so your lower back does not have to pick up the slack.

Maintain hamstring flexibility. Tight hamstrings pull your pelvis into a posterior tilt, which flattens the natural lumbar curve and increases stress on the lower back. Stretch your hamstrings 3-4 times per week, 30-60 seconds per side.

Back pain sucks. I get it. But it is manageable, it is temporary in most cases, and it does not have to end your training. Work around it, address the root cause, rebuild gradually, and you will come back stronger than before. I have lived it, I have coached dozens of people through it, and the pattern is almost always the same: panic, then patience, then progress.