A rehab physio or a personal trainer – who do you trust to look after your back?

lady doing squats with bar weights for back pain

It’s a valid question for those who have Back Pain

People seem to see physios are somebody who does hands-on mobilisations massage techniques and somebody to go to when you have paid to get rid of pain, but not so much when you want to start moving and exercising – which is hilarious as todays physio are coming out with the opposite training – the current physio training seems to have them be more hands off and to get people moving!

People don’t appear to see physios as The Experts in movement and function – which is what we are.

We as physios’ are best placed to assess movement and biomechanics and understand what muscles drive certain movements and how that occurs and how best to re-train it when it gets faulty.

I see heaps of posts on Facebook groups asking for recommendations for personal trainers who specialise in managing people with back pain…

And with no apology – that triggers the hell out of me!

And whilst I get that if you are in pain you want to get moving what I don’t get is why you go to a non medical person to help you achieve that if it’s greater than mild discomfort.

As a physio I’m obviously very biased

As a physio I obviously have strong views and opinions

My view is if you’re in pain that causes you to second guess what you do, alter what you do, or avoid certain things – then it’s affecting how you normally move and function and that needs expert intervention.

I’ve seen numerous clients come into our clinic worse for having tried to manage their back pain on their own or with a personal trainer, or advice from someone else who had the same and did XYZ…


Because is just words  – Back Pain is a symptom of SOMETHING

It’s like going to a garage and say my car rattles – but just polish it and put some padding on to dampen the rattle…. don’t fix or address the rattle, just disguise it.

To successfully look after back pain you need to know what the different conditions are and what you can do with them – and what to watch for and avoid.

It scares me that people put something as important as their back in the hands of people who have no medical training

And whilst I see that some trainers advertised they’ve done a weekend course or they’ve done a shoulder workshop there’s so much missing when you’re trying to manage somebody in pain, that a weekend course won’t cut it.

The management of pain if you have pain and you see someone in the personal training field in my experience from my clients has been that’s ok it hurts – it’s because you’re weak just push through it or is that hurts just don’t do it with avoid it and we’ll do something else

 What that leads to is imbalance

 Strong muscles get stronger, weak muscles get weaker 

I’ve had a client who has had stenosis in her spine which basically means if she left her arms above her head or arches her back the muscles in the back and the bones get pinched and her nerves get pinched and her legs collapse.

Management of people with stenosis is don’t extend them. If you extend their spine you pinch the nerves and their legs may go numb or weak or collapse. You’re irritating the nerves and it leads to massive issues – and that’s NOT something we can change – that is a mechanical problem that is there for life and won’t get better without potential surgical intervention – but it can be managed well conservatively if you avoid irritating it.

This particular client we worked with her and her gym program and explained what she should and shouldn’t do so she could continue with her gym program safely but please don’t do anything that puts her back into extension in the lower spine.

She came back to us complaining that she wasn’t getting any better. She felt better for a few days and the pain comes back as soon as she goes to the gym –  so her problems are still the same.

When we checked everything that she had been doing her trainer had been continuing with overhead squats with weights behind her head and she was in back extension.

Not only was she being put into back extension – but back extension under load!

Completely in the wrong position and her legs were continuing to collapse and her back was continuing to be painful.

So clearly here there is a disconnect.

Clients want to move and they’re getting conflicting advice and guidance. Physio’s says avoid this – trainer says no it’s fine – your form is good.

Clearly there is a mismatch between how we as physios work and where the line becomes grey as clients move into wanting to do more and wanting to be more active

There is a massive gap here

A gap that is being filled in in that grey area and the people losing out are clients.

How can we close that gap.

How can we manage it that clients are in a better position to start exercise when they have pain, and don’t get hurt by starting exercise too soon either….

How do we work together.

How can we get better connected so that professions aren’t so protective of what they do and feel that they are not being dissed or disrespected by another.

We’re all here for clients

We all need to do the best by our clients

I’ve been a physio for 30 years –  I want to go back and manage everybody I managed 5 years ago because I know so much more now and I’m such a better physio than I was 5 years ago. 

After 30 years I have a fountain of knowledge.

I have never stopped learning – and I never will.

But also after 30 years I know my area of expertise and I know my limits and can work within my scope of practice and I refer on when I can’t help – or need to bring out bigger guns than I have!

The line is grey now

Everything is blending in.

Everyone seems to want to be everything to everyone.

I see posts for personal trainers, massage therapists, instructors and coaches  telling people their successes with managing clients who have  pain or injury… come to me – I can get you better.

And whilst some people can have great success

What about those who don’t?

What about those who get worse that you don’t hear about – they just fall off the wagon

What about those whose problem with pain and  injury intensifies to cause catastrophic issues.

We as physios should be leading the charge

We are the movement and function experts

We know how to recognise and correct faulty movements

We know the healing process, the stages of healing, and the load that tissues can tolerate in any given stage of progress. 

But I don’t have an answer!

The general gist from when I’ve given my POV before has been – 

“yeh I tried physio but it didn’t help so I’m gonna try a personal trainer – I don’t need medical management I just need to get strong.”

Physios – we need to do a better job at helping our clients get where they want to be and actually LISTENING to them.

WE need to be better at that disconnect between the client feeling pain free and able to move – yet still vulnerable and at risk of injury if they push themselves too soon.

We should be filling that gap – and getting them READY to get strong in the gym – 


Personal Trainers, instructors and massage therapists – please work within your scope of practice and expertise and refer clients on if they’re struggling. If you have a client in a lot of pain – they want to please you so they WILL push through it.

Better yet – make friends with your local physio – I know I’d be happy to refer my clients on when they are ready to someone who will look after them – over someone who ignores what my client has just spent time, energy and money fixing.

We should be working together. 

It is the client that we’re here for after all – not our ego’s.

Back Pain Management for Health Professionals – Online Program –

If you’d be interested in an online program which teaches you how to recognise the main presentations of back pain – and exercise selection considerations for them – them register your interest in the form below.



About Saree Hewlett (149 Articles)
Saree has 20 + years as a physio, training in the UK and completing her Masters in Manual Therapy in Perth, UWA. She has integrated Pilates into her practise having trained in the Polestar method and currently owns and runs two Studios in Perth's Northern Suburbs. A previous international Artistic Skater she understands the needs of sports people and also those suffering from chronic pain and reduced function - we all want the same thing - to be the best we can be! She is married with two active young boys!

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