How to train a client w/ fused discs Become A Personal Trainer

A client tells you they have a fused disc and suddenly every squat, hinge, and loaded carry feels like a liability. We break that moment down into a repeatable coaching process so you can stop guessing and start programming with clarity. From the first questions we ask about surgery timing and what level was fused, to when it’s worth looping in the surgeon or physical therapist, we map out how strong coaching begins long before the first rep.

We also lean hard into the biopsychosocial model because post-surgery training isn’t only about anatomy and range of motion. It’s about fear, guarding, confidence, and the story the client tells themselves about being “broken.” You’ll hear exactly how we cue safety, what we look for during an assessment, and how we choose movements that build trust fast without chasing risky positions. If you coach low back pain clients, this is the mindset shift that changes your results.

Then we get practical: warm-ups that emphasize spine stability, beginner-friendly circuits with TRX squats, regressable push-ups, planks and side planks, step-ups with bilateral pulls, bridges, landmine presses, and glute work that supports the frontal plane. Finally, we talk progression and long-term strength training after spinal fusion: why trap bar deadlifts and loaded carries can be a smart next step, how to manage fatigue, why 6–8 clean reps beat 20 sloppy ones, and how bone mineral density and heavier loading fit into the big picture. If you found this helpful, subscribe, share it with a trainer friend, and leave a review so more coaches can build healthier backs.

Training a client with fused discs isn’t just advanced—it’s essential knowledge for any serious personal trainer. In this episode, we break down exactly how to safely and effectively work with clients who have undergone spinal fusion or deal with chronic spinal conditions.

You’ll learn what spinal fusion really means, how it impacts movement and mobility, and the biggest mistakes trainers must avoid. We also cover smart programming strategies, exercise modifications, and coaching techniques that prioritize core stability, injury prevention, and long-term progress.

If you want to build confidence, deliver safer sessions, and stand out as a highly skilled coach, this episode gives you the practical tools to do it right.

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Transcript

Show Intro And Quick CTAs

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Welcome to the Show Up Fitness Podcast, where great personal trainers are made. We are changing the fitness industry one qualified trainer at a time with our in-person and online personal training certification. If you want to become an elite personal trainer, head on over to showupfitness.com. Also make sure to check out my book, How to Become a Successful Personal Trainer. Don't forget to subscribe, rate, and review. Have a great day and keep showing up. Howdy all. Welcome back to the Show Up Fitness Podcast. Today we're going to help you design a program for a client who has the fused disc. Low back pain is one of the biggest problems you're going to come across with your clients and also just people in general, you probably including, because a lot of trainers have low back pain. This is being addressed from one of our trainers online. Also in Chicago, we're going to hang out with you, Dan, on the 17th and 18th, and we're going to head to Chicago Lifetime in April. Excited to see you again, bud. He has a really cool story, and he has a client who came in with a fused disc. So let's address what's going on. A lot of it is going to be determined when did it happen? This isn't the end all be all where you have to freak out about it. Now, if it's within three months of the surgery, you want to take that as an opportunity to reach out to the surgeon and also physical therapist. But three months post, you're pretty good to go. Is it one fuse disc? Is it two or three? Is it more of a rod like you see with scoliosis? So you want to find out what exactly went into the body because if they fuse just one, probably not going to be as limited as you would be if you had two or three in the lumbar area. I'm assuming this is more lumbar because that's generally where it's going to be. If it's going to be more in the neck or in the thoracic region, you're just your range of motion is going to be restricted. That's the biggest thing. So it's really looking at the biopsychosocial model. How does the client feel? Do they feel like they are broken? Do they feel insecure? Are they hesitant in their movement? I want for them to demo to me what they're comfortable with. I'm not going to have them touch their toes right away. I'm going to say, what do you feel comfortable with? What are you doing on a daily basis? Where are you restricted? How does your brain talk to you? And I'm really going to observe their facial expressions, their eyes, because if they're really hesitant, that's going to all go into my programming. It's going to be a CCA. I'm going to implement the accessories in a good little warm-up that's going to keep the spine nice and stable. But as we progress, after you know, a good six months, we want to optimize the loading because via Wolf's Law, we want to strengthen the bones. And as we age, if we get this surgery, we can't be doing Pilates and yoga and water aerobics. Nothing wrong with that stuff, but we're not going to be strengthening the bones. We need to get to that 75-80% of a one rep max to allow for those osteoblasts to reform and create stronger bones. That's going to be via bone mineral density test. It would be awesome if they had a test and they gave you that data because over a good six-month period, you could have them retest it to see the improvements of strength training with you. So the biggest piece of advice that I can give during that assessment process, listen to the client, have them talk through their worries, their concerns. I'm going to assume compression forces may irritate it. Movement is probably going to be restricted, but I'm going to be very, very positive, letting them know that, well, you got surgery. That's awesome. We can definitely help you get stronger, but it's going to be a journey. I need for you to communicate with me very, very clearly on what you're comfortable with and what you're not comfortable with, because we have a lot of options that are going to be appropriate for your exercise selection. So with it being known, you're just going to have a limitation in range of motion. You're probably not going to want to be going ass to the grass because if you have that butt wink and if you have an L4, L5 or an L5, S1 fusion, that could irritate it. So I want to learn how it happened, when it happened, when they had their surgery, and how the client is feeling. Reach out to your physical therapist. If you don't have one on your team, that would be a great opportunity just to connect with them and ask for any contraindications on things that they think you should or should not do. I would even take it as an opportunity to go and watch them observe a session, link up with the therapist. That's how you build your network. So my assessment process is going to be the biggest, most important thing. And then when they feel ready and they've talked about everything that's gone on, we're going to get out there on the floor, take them through a good warm-up that hits all 10 checkpoints of movement within their comfort zone. And then I'm going to get into what their goal is. So if it's a male and wants to focus more on upper body, or if it's a female, it's more lower body. Dan did say that this is a girl. So we're going to assume it's more lower body emphasis, do some planks part of the warm-up. Get them feeling confident, most importantly. After the warm-up, let's do some TRX squats into some push-ups that we can modify. If she's not strong enough, be mindful if you have that sway back that could put compression forces there. And we just don't want that. So we may need to regress to a bar or even some type of banded push. And let's do some more planks, keeping that spine nice and stable. Three rounds of that first CCA moving into the second one, into the second CCA. Let's do some step ups into a bilateral pull. If you want to do a cable, if you want to do bands, whatever you feel is appropriate. I would start there because unilateral could just put some tension forces with rotation. And again, it's a lot of it's just going to be their guard. And if they feel uncomfortable doing a movement, that could produce discomfort and pain for the days to come. That brain is really, really important. So you want them to feel comfortable with the movement. I would definitely be walking around, constantly be touching their back in an appropriate way, letting them know that they are safe working with you. And let's do some side planks. We'll do that for three rounds. In the last circuit, let's do some floor bridges into some landmine presses or maybe a band press. And let's end off on some side band walks to focus on the glutes in the frontal plane. A lot of times when we get that surgery, we're going to be inactive for a long period. Again, whatever the assessment that you discover during that process, if they've been training for the last six months and now they just want to take it that next step, or if this is their first workout, that all goes into the programming. But months two, three, and four, we're going to get into RDLs and trap bar deadlifts. I would prefer to get into a trap bar deadlift when we start going a little heavier. And just be mindful that when we do more reps, they're going to get fatigued. And the fatigue is what's going to compromise the integrity of that movement. And they could potentially irritate or re-injure themselves. So we're not doing trap bar deadlift for 20 reps. We're not doing goblets for 20 reps. Because what happens when they get fatigued, movement's going to get a little faulty and they're just going to go back in their brain to the time when they originally hurt themselves. And we don't want that. So you can do six to eight reps of a movement, but not to volitional fatigue. So let's take a look at month two or three, and they're getting a lot stronger. You're loading up the step ups. You're now doing some goblet squats. Get into a trap bar. I would put the trap bar first, and maybe we're doing six to eight reps. Loaded carries would be very beneficial to strengthen the bones and that comfort level because it's all about progressive overload. In the beginning, neuromuscular communication, making sure they're comfortable with movement. Check in with them and then progress, progress for that first month. Repeat those same movements, but then complement the accessories. It's that cherry on top, or as Adam likes to say, it's the dressing of the cake. It's the frosting. That's what really separates cake A from cake B. You could be doing the same patterns, the same exercises, but just changing up the accessory. And in your client's mind, it's a completely different cake. So I really like that analogy because the core patterns are what's going to help them get stronger, progress, get the physique that they want and the tone that they want. The accessory is adding in those new little fun things that are appropriate within the scope of the individual. Maybe in weeks two and three, you start doing some anti-rotations, depending on how they perform. I would definitely want to do a non consecutive day. So, like a Tuesday and a Thursday or a Monday, Wednesday, Friday. Make sure it's appropriate for that. If you have any clients that you want some case examples design, let us know. Info show up in us, throw this into your story, leave that five star review. We're trying to get more on the Apple Podcast. And remember, healthy backs are better than bad backs, and keep showing up.