Should low back pain exercises always be pain free, or is some pain during exercise acceptable, and even beneficial?
In this practical presentation, Dr David Toomey (NZ Titled Musculoskeletal Physio, PhD) explores the pros and cons of painful versus painless exercise approaches for low back pain, and how the meaning, context and messaging around exercise can dramatically influence patient outcomes.
You’ll discover how to confidently decide when to reduce pain, when to allow some pain during exercise, and how to use exercise as an opportunity to address fear, unhelpful beliefs and movement avoidance. David also reveals how to tailor exercises to each patient, adapt movements without stopping meaningful activity, and avoid common pitfalls that unintentionally reinforce fear or fragility beliefs.
Through practical examples and real-world clinical reasoning, you’ll explore:
- The benefits and drawbacks of painful and painless exercise approaches for low back pain, and how to choose the right approach for each patient.
- How exercise can reinforce or undermine messages such as “hurt doesn’t equal harm”.
- Why context, patient expectations and meaning attached to exercise often matter more than whether exercise is painful or pain free.
- Questions to ask patients that reveal beliefs, fears, confidence levels and barriers to exercise adherence.
- How to use graded activity, pacing and flare-management strategies with persistent pain patients.
- When time or volume-contingent exercise approaches are likely to be more effective than pain-contingent approaches.
- Practical exercise dosage principles for chronic low back pain, including strengthening, stretching, aerobic exercise and flare management.
- How to tailor and modify exercises while keeping patients active and engaged in meaningful activities.
- Strategies to adjust exercises through load, stance, movement cues, range of motion and exercise substitution.
- Common clinician biases that influence exercise prescription and how to avoid them.
- How your explanations around exercise shape recovery.
You’ll finish this presentation with practical frameworks, communication strategies and adaptable exercise principles that help patients move with more confidence, reduce fear around pain, and stay engaged in rehabilitation and activity.
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