Low back pain is often treated as a spine problem. In reality, the spine is rarely the only issue. In many cases, the missing link is how well the muscles behind it are doing their job.
The posterior chain includes the glutes, hamstrings, and spinal extensors. These muscles play a critical role in managing load during bending, lifting, standing, and walking. When they are undertrained, the spine is forced to tolerate stress it was never meant to handle alone.
Strengthening the posterior chain is one of the most effective strategies for improving low back pain, supported by both biomechanical and neurological mechanisms. Here are reasons why:
1. Reduces Mechanical Stress on Passive Structures
Strong hip and back extensors, including the glutes, hamstrings, and erector spinae, help absorb and distribute load during everyday activities such as bending, lifting, walking, and standing.
This reduces reliance on passive structures like intervertebral discs, facet joints, and ligaments.
Effect: Less irritation, compression, and strain placed on sensitive tissues.
2. Improves Spinal Stability
The posterior chain acts like scaffolding for the spine. As strength improves, so does control.
Improved control reduces excessive micro-movement at painful spinal segments, which is often perceived as slipping, pinching, or guarding.
Effect: Better segmental stability and improved confidence with movement.
3. Encourages Better Movement Patterns
When the posterior chain is weak, compensations tend to occur, such as overusing the low back instead of the hips during bending or lifting.
Strengthening retrains the nervous system to hinge more effectively at the hips and activate the right muscles at the right time.
Effect: Healthier movement patterns and improved long-term protection.
4. Breaks the Cycle of Deconditioning
Low back pain often leads to less movement, which leads to weakness and increased stress on the spine, creating a pain–deconditioning cycle.
Strength training interrupts this cycle by rebuilding strength, improving circulation, reducing stiffness, and restoring confidence to move.
Effect: Reversing the downward spiral and building momentum in recovery.
5. Triggers Natural Pain Relief
Strength training, particularly compound movements like RDLs, bridges, and deadlifts, stimulates endorphin release and modulates pain through descending inhibitory pathways in the nervous system.
Effect: Natural pain relief through movement rather than reliance on passive treatments.
6. Optimizes Hip–Pelvis–Spine Mechanics
Strong hip extensors help control pelvic position, balance forces through the sacroiliac joint, and maintain healthy lumbopelvic rhythm.
Effect: Smoother, more coordinated movement with less shear and compression.
Backed by Research: Here are a few of our favorites!
Multifidus atrophy is common in chronic low back pain, and strength training has been shown to help reverse it (Daneels et al., 2001)
Strength-based exercise demonstrates stronger long-term outcomes than passive modalities alone (Hayden et al., 2021 Cochrane Review)
Glute weakness is associated with compensatory lumbar motion and increased pain (Cooper et al., 2016)
Single Leg Romanian Deadlift (RDL): Click here to watch!
Intention: Strengthen the low back, upper back, hamstrings, glutes, and trunk while improving hip mobility, balance, and coordination.
Frequency: 1-2 times/week or as tolerated.
Reps and Sets:
Weeks 1–4: 5 sets of 15 reps (light-moderate weight)
Weeks 5–8: 4 sets of 8-10 reps (moderate)
Weeks 9–14: 3-5 sets of 3-6 (heavy)
Perceived Effort:
Weeks 1–4: 4 to 6/10 effort
Weeks 5–8: 6 to 8/10 effort
Weeks 9–14: 8 to 10/10 effort
Emphasize:
- Progress gradually
- Stay consistent
- Sleep (you need adequate sleep, typically 7+ hours to ensure adequate recovery from training sessions)
Please note: Barbell RDLs are also great but require more equipment and slightly more skill in our opinion, hence why our recommendation is the single leg RDL for most people.We also believe that single movements offer superior for hip and spine mobility, both of which are vitally important for low back health.
Reverse Sorensen: Click here to watch!
Intention: Improve muscular endurance of the low back, glutes, and hamstrings.
Frequency: 2-3 times/week or as tolerated.
Reps/Sets/Perceived Effort: (No reps technically, these are isometric holds)
Weeks 1–4: 3 sets at 5 to 7/10 perceived effort
Weeks 5–8:4 sets of 7 to 8/10 perceived effort
Weeks 9–14: 4-5 sets to 8/10 perceived effort
Some muscular fatigue or tightness for thirty to sixty minutes after training is expected and part of adaptation.
Please note: There are many ways to improve hip and spine extensor endurance. This is just one option that tends to work very well.
Keep these things in mind for both exercises:
Think of your back like a bridge. The stronger the cables and supports, the more stable it feels and the less stress on the structure itself
Working through some discomfort is perfectly acceptable.
Use the traffic light guide for safe pain:
Green light – 1-3/10 pain. This level of discomfort is safe, expected, and acceptable. Movements feel controlled and confident. Keep going.
Yellow light – 4-6/10 pain. Proceed with caution. If you feel safe and in control then, you are likely okay. Just pay attention to how you feel 8, 16, and 24 hours after your session to assess whether you did too much and need to scale back.
Red light – 7+/10 pain. This usually means the load, volume, or exercise is too much right now. Stop, scale it back, or choose a different option.
Low back fatigue from exercise can be uncomfortable, especially within the first 3-60 minutes after your session. But it’s important to understand that we need to stress the lumbar spine extensors in order for them to adapt, and feeling tight after training is perfectly acceptable.
When to Get Help
If low back pain keeps coming back, it is often not because something is broken. It is because strength and load tolerance have not been rebuilt.
If you are unsure where to start or how hard to push, we can help.
Book a free discovery visit here to see if posterior chain strengthening is the missing piece in your recovery.
Dr. Cameron Whitehead
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