"My back hurts" is the message every coach dreads. Here's the line between coaching around it and staying out of a physio's lane.
E3 Rehab's lower back pain video is one of the most-shared evidence-based explainers on the topic - and its calm, don't-catastrophise, keep-loading message is exactly what most clients need to hear. But there's a hard line for coaches: you can coach movement and load, you cannot diagnose or treat back pain. This breakdown covers their argument in our own words, adds our honest take for a coaching business, and shows how to build a defensible screen-and-refer workflow instead of freezing every time a client's back flares.
By Markus Evers · September 2026 · a Coachway video breakdown
the short version
E3 Rehab's video argues that most lower back pain doesn't need a scan, isn't reducible to one "cause," and responds to graded exposure and progressive loading rather than endless rest, stretching what feels tight, or chasing perfect posture. For a coach, the takeaway is two-part: use that calm, keep-moving framing so you don't catastrophise a client - and, just as importantly, know the line. Coaches screen and refer; they do not diagnose or treat back pain. This is general coaching education, not medical advice.
read this first · medical safety
This is coaching education, not medical advice
Lower back pain is a clinical issue. Nothing on this page diagnoses, assesses or treats it, and neither should you as a coach. Your job is to coach general movement and loading for clients who are cleared to train, to keep the reassuring, non-alarmist tone the evidence supports - and to refer. If a client has red-flag symptoms (pain after significant trauma, numbness, tingling or weakness down a leg, loss of bladder or bowel control, unexplained weight loss, fever, or night pain that won't settle), or simply wants to know what's wrong, that is a physiotherapist or doctor, not a coach. When in doubt, refer out. It is never the wrong call.
E3 Rehab - Lower Back Pain Rehab (Exercises | Education | Myths | Prevention)
Source: E3 Rehab on YouTube - "Lower Back Pain Rehab (Exercises | Education | Myths | Prevention)". Watch on YouTube. E3 Rehab is a channel run by physical therapists; the video, title and channel belong to them. We embed the public video and summarise it in our own words as general coaching education, and nothing here implies E3 Rehab's endorsement of Coachway.
Who is E3 Rehab, and why coaches watch
E3 Rehab is a physical-therapy channel - run by physical therapists - known for evidence-based rehab and pain education rather than fear-based "you're broken" messaging. Their material leans on research and a graded-loading philosophy, which is why coaches trust it: it lines up with how we already think about progressive training. The reason this particular video matters to a coaching audience is simple - "my lower back hurts" is one of the most common messages a coach receives, and E3 Rehab gives you a calm, defensible mental model for it. Just remember the lens this page is written through: not "here's how to treat your client's back," but "here's how to talk about it responsibly and know exactly when to hand it off."
What E3 Rehab actually argues (our summary)
This is our summary of the ideas in the video, in our own words - not a transcript, and not medical advice. Watch the original for their exact examples and exercises.
- 1
Most low back pain doesn't need a scan. A recurring education point is that imaging (X-ray/MRI) is usually not needed or helpful for typical low back pain, and scan "findings" often don't explain the pain a person feels.
- 2
Back pain is multifactorial. It rarely reduces to a single mechanical "cause" like one bad rep or one weak muscle - which is why hunting for the one thing to fix tends to disappoint.
- 3
Resilience is built by loading, not avoidance. The emphasis is on graded exposure and progressive strengthening rather than prolonged rest or only stretching whatever feels "tight."
- 4
"Perfect posture" is not the fix. Chasing an idealised posture is downplayed in favour of building a body that tolerates a range of positions and loads.
- 5
It's education, not a diagnosis. The framing throughout is reassurance and general principles - not a substitute for individual assessment. That is the same boundary a coach has to hold.
Coachway's take
We love the mindset E3 Rehab models here, because the single biggest mistake coaches make with a hurting client is over-reacting: either freezing the whole program in fear, or - far worse - playing amateur physio and "diagnosing" a disc or a weak core. The calm, backs-are-adaptable, keep-moving framing is the right emotional default, and it usually keeps a client training instead of quitting the second something twinges.
But the coaching-specific point the video doesn't have to make is about your scope. E3 Rehab are physical therapists talking to the general public. You are a coach talking to a paying client, and the professional (and legal) line is bright: you don't diagnose the cause of pain and you don't treat it. What you can do is coach general movement and load for a client who's medically cleared, keep the reassuring tone, and modify sessions around ordinary discomfort. The moment it stops being ordinary, you're a referral service, not a rehab clinic.
So the practical version we'd give a coach is a three-step reflex. First, screen: is this an ordinary tweak in a healthy client, or is there anything red-flag about it? Second, if it's ordinary, don't stop - modify the load, keep the client moving, and lean on graded, progressive work rather than bed rest. Third, if there's any doubt at all, refer to a physio or doctor and coach around whatever they clear. That last step isn't you failing the client. It's the most professional thing you can do, and it protects both of you.
The other honest note: the coaches who handle this well aren't winging it in the DMs. They have a written screen-and-refer process, a reassurance script they can send without sounding cold, and a way to modify a program without rebuilding it from scratch. That's a systems problem - and it's the part a platform actually helps with.
Build a screen-and-refer workflow, then modify load without starting over
A responsible back-pain response is a repeatable process, not a panicked one-off. In Coachway, that starts at intake: use the forms and intake to capture medical history and screening questions up front, so you know who's cleared to train and who needs a green light from a professional before they start. When an ordinary tweak shows up mid-program, the workout builder lets you swap or de-load exercises and slot in gentler, progressive patterns without rebuilding the whole plan - so "keep moving, modify the load" is a two-minute edit, not a rewrite.
Then use client progress and check-ins to track how the client actually responds over the following weeks - so you can see whether things are settling and easing back up, or whether it's time to pause and refer out. If you want more coaching-education context, our breakdowns of Squat University on knee pain and how to program around client injuries cover the same screen-modify-refer discipline for other complaints.
Coach's back-pain screen-and-refer flow (+ client message)
A copy-paste reflex for the "my back hurts" message. It is deliberately built around the boundary: coaches screen and refer, and coach movement only for clients who are cleared. This is general coaching education, not medical advice, and it is not a diagnostic tool - anything on the refer list means send them to a professional, full stop.
Screen-and-refer flow
Step 1 - Screen (before you say anything about training)
Refer to a physio or doctor immediately - do not coach through - if there's any of: significant trauma or a fall; numbness, tingling or weakness spreading down a leg; any loss of bladder or bowel control; unexplained weight loss; fever; or night pain that won't settle. Also refer if the client wants to know what's wrong. These are reasons to seek assessment, not a checklist you use to diagnose.
Step 2 - If it's an ordinary tweak in a cleared client
- Reassure with the evidence-based framing: backs are strong and adaptable; most everyday back pain isn't structural damage.
- Don't stop training - modify. Reduce load, swap aggravating movements for tolerable patterns, keep the client moving.
- Favour gentle, progressive loading over total rest or only stretching what feels tight.
Step 3 - Track, then re-decide
Use check-ins to watch the trend over the next weeks. Easing and tolerating more load? Progress gradually. Not settling, or worse? Stop and refer. When in doubt, refer.
Client message you can send (cleared client, ordinary tweak)
"Thanks for flagging this. Backs are strong and adaptable, and most everyday back soreness isn't damage - so we're not going to panic or stop everything. For now I'll modify your load and swap anything that aggravates it, and we'll keep moving, which is what actually builds resilience. I'm not able to diagnose or treat pain, though - so if you notice anything like numbness or weakness down a leg, it followed a fall, or it's just not settling, I want you to see a physio or doctor, and I'll happily coach around whatever they clear."
COACH'S LOWER BACK PAIN SCREEN-AND-REFER FLOW (via Coachway) General coaching education, NOT medical advice. Coaches screen and refer - they do not diagnose or treat. STEP 1 - SCREEN FIRST Refer to a physio/doctor immediately (do NOT coach through) if any of: - Significant trauma or a fall - Numbness, tingling or weakness spreading down a leg - Any loss of bladder or bowel control - Unexplained weight loss - Fever - Night pain that won't settle - The client wants to know what's wrong / a diagnosis (These are reasons to seek assessment, not a checklist to diagnose.) STEP 2 - IF IT'S AN ORDINARY TWEAK IN A CLEARED CLIENT - Reassure: backs are strong and adaptable; most everyday back pain isn't structural damage. - Don't stop - modify: reduce load, swap aggravating movements, keep moving. - Favour gentle progressive loading over total rest or only stretching "tight" muscles. STEP 3 - TRACK, THEN RE-DECIDE - Use check-ins to watch the trend. - Easing / tolerating more load -> progress gradually. - Not settling or worse -> stop and refer. When in doubt, refer. CLIENT MESSAGE (cleared client, ordinary tweak): "Thanks for flagging this. Backs are strong and adaptable, and most everyday back soreness isn't damage - so we're not going to panic or stop everything. For now I'll modify your load and swap anything that aggravates it, and we'll keep moving, which is what actually builds resilience. I'm not able to diagnose or treat pain, though - so if you notice anything like numbness or weakness down a leg, it followed a fall, or it's just not settling, I want you to see a physio or doctor, and I'll happily coach around whatever they clear."
Coaching around lower back pain - FAQ
Can an online coach help a client with lower back pain?
A coach can help around ordinary, non-specific back stiffness by keeping a client moving and loading sensibly - which is exactly the resilience-through-graded-loading message E3 Rehab teaches. But that is general movement coaching, not treatment. A coach does not diagnose the cause of back pain and does not treat it. The professional move is to screen: if anything looks beyond everyday muscular discomfort, or the client wants a diagnosis, you refer them to a physiotherapist or doctor and stay in the movement-and-accountability lane where you belong.
Does a client need an MRI or X-ray for lower back pain?
One of E3 Rehab's core education points is that imaging is usually not needed or helpful for most low back pain, and that findings on a scan often do not explain the pain. That is useful for a coach to understand so you do not accidentally catastrophise - but it is not your call to make. Whether a client needs imaging is a clinical decision for a doctor or physio. A coach can reassure a client that backs are generally strong and adaptable, and then point them to the right professional for anything diagnostic.
Should a client rest or keep moving when their back is sore?
The general principle E3 Rehab emphasises is that back pain is multifactorial and that resilience comes from graded exposure and progressive loading rather than prolonged rest, only stretching what feels tight, or chasing a perfect posture. In coaching terms, that usually means modifying load and keeping the client moving instead of stopping everything. The caveat: this applies to ordinary, non-specific soreness. If a client has red-flag symptoms or the pain is not settling, that is a referral, not a programming tweak.
What back-pain symptoms should make a coach refer a client to a doctor?
When in doubt, refer - that is the safe default, and it is not a failure of coaching. Widely recognised reasons to send a client to a doctor or physiotherapist rather than keep coaching through it include pain following a significant fall or trauma, numbness, tingling or weakness spreading down a leg, any loss of bladder or bowel control, unexplained weight loss, fever, or night pain that will not settle. These are general reasons to seek medical assessment, not a checklist a coach uses to diagnose anything - the coach's job is to notice something is off and hand it to the right professional.
More movement & rehab-education breakdowns
- · Squat University on knee pain - the same screen-modify-refer discipline for a different complaint.
- · Kelly Starrett on mobility for coaches - the movement-quality side of keeping clients resilient.
- · How to program around client injuries - the practical playbook for training through and around limitations.
Keep coaching movement responsibly
all guidesSquat University on Knee Pain: Screen, Correct, Retest (Coach Breakdown)
Squat University's approach to squatting with knee pain, broken down for coaches: the 'test, don't guess' screen-correct-retest loop, and the hard line between coaching education and medical treatment.
Read the guideKelly Starrett on Mobility: The Couch Stretch Test (Coach Breakdown)
Kelly Starrett's couch stretch mobilization test, broken down for coaches: why test-retest beats a generic stretch routine, and how to add mobility screening to a client roster without overstepping into treatment.
Read the guideHow to Program Around Client Injuries: A Coach's Guide
Train a client with a cleared or chronic injury without playing physio: what to ask, the pain-free menu, regressing load and range, and when to refer out.
Read the guideFree tools for this: One-Rep-Max Calculator · Warm-Up Set Calculator · Protein Calculator
Screen, modify and refer - without living in your DMs
Handling the 'my back hurts' message well is a systems problem, not a willpower one. Coachway lets you screen clients at intake, modify a program around ordinary discomfort without rebuilding it, and track how a client responds so you know when to progress and when to refer out. Start your 14-day free trial and set up a screen-and-refer workflow you can trust.
