Treating Athletic Low Back Pain

Aug 5, 2025

Explore the complexities of athletic low back pain, distinguishing between chronic sensitization and acute flare-ups. The conversation reveals how daily habits and movement patterns play a crucial role in recovery. Simplifying rehabilitation, they stress the importance of gradual progression to sport-specific activities. Insightful tips on modifying daily activities help recalibrate pain sensitivity. Plus, discover the limitations of clinical guidelines and the value of patient education in achieving lasting results.

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INSIGHT

Blend Pain Science With Mechanical Models

Dave Tilley blends pain-science, CPG categories, and mechanical strength approaches for athletic low back pain.
He finds a movement-based classification plus workload and education works best for athletes.

INSIGHT

CPGs Give Options, Not Direction

Clinical practice guidelines list many plausible treatments but give little direction for an individual patient.
That laundry list frustrates new grads who need a clearer, actionable system.

ADVICE

Prioritize A Deep Subjective Evaluation

Spend a large portion of the eval on a detailed subjective history to categorize pain behavior and triggers.
Use movement testing to confirm buckets (extension, flexion, compression) and then treat accordingly.

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Get $100 off my brand new course, Rehabilitation of Athletic Low Back Pain, with Mike Reinold!

https://mikereinold.com/athletic-low-back-evaluation-treatment-online-course/

We tackle how to assess and treat different types of back pain, combining evidence-based approaches with movement-based classifications that actually work for athletes and active individuals.

• Creating a systematic approach to back pain starts with understanding whether it's chronic sensitization or repeated acute flare-ups
• Clinical Practice Guidelines (CPGs) often provide overwhelming lists of possible treatments without clear direction
• Differentiating between extension-intolerant, flexion-intolerant, and compression-intolerant patterns guides treatment
• Daily habits and postures often contribute more to pain than specific incidents
• Modifying activities throughout the day helps reset pain sensitivity - "like recalibrating an alarm system"
• Education about what patients do outside of PT is often more important than any specific exercise
• For athletes, progression must include sport-specific movements and correcting technical flaws
• Basic exercises like bird dogs and dead bugs are starting points, not complete solutions
• Return to sport requires gradual progression through strength, power, and sport-specific movements
• Proper bracing techniques and movement patterns are essential for long-term prevention

Check out our comprehensive back pain course at the link in the show notes - $100 off this week only!

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