Back pain has taken enough of your life.

If you have suffered from chronic back pain for years, you have probably done the PT sheets and bought the lumbar pillow. I did. Pain was chronic and consistent. Some days were better than others.

Low Back Pain Coach is a four-stage back-extension program on a 45-degree bench. How your back feels the morning after each session sets the next one. No bench yet? The app starts you on floor work until you have one.

New to the bench? Week one on a 45-degree bench covers where the pad goes, where to stop, and what to write down tomorrow, with a free printable card.

What the guidelines say

Three clinical guidelines put exercise among the recommended treatments for persistent low back pain.

• World Health Organization, December 2023. For chronic primary low back pain in adults, it recommends education, exercise programs, some physical therapies such as spinal manipulative therapy and massage, psychological therapies and some medicines. It advises against routine use of lumbar braces, belts and supports.
• NICE guideline NG59 (England). For low back pain with or without sciatica, it advises considering a group exercise program, such as biomechanical, aerobic or mind-body exercise, for a flare-up or episode, and advises against belts and corsets.
• American College of Physicians, 2017. For chronic low back pain it recommends initially choosing non-drug treatment, with exercise among several options.

These guidelines back exercise in general. They did not test this app or this 45-degree bench progression. A 2021 Cochrane review of 249 trials found that exercise probably reduces pain more than no treatment, usual care or placebo. Compared with other conservative treatments the pain difference was small, and compared with manual therapy the review found no clear difference (Hayden and colleagues). No guideline promises a result for any one person.

Price comparison: what care and equipment cost

This is a price comparison, not a comparison of results. A clinician can examine you and check for a cause that needs different care, and an app cannot. Fees vary by city, and insurance copays depend on your plan and deductible. Each figure comes from the source linked beside it, as of the date shown. Retail prices change.

What	Price	Source
Physical therapy session, cash	$118 MDsave national average, in a range of $42 to $179	MDsave marketplace, 205 reviews from people who purchased, read October 4, 2026
Specialist office-visit copay on employer plans	$45 average, for covered workers whose plan uses a copay for an in-network specialist physician visit. This is not a physical therapy figure. The American Physical Therapy Association says some physical therapy copays exceed $60.	KFF Employer Health Benefits Survey, October 2025, and APTA
How much physical therapy was used (a count, not a price)	9.1 visits over about 8 weeks, among Medicare patients with newly diagnosed low back pain who had more than one visit. This does not say how many visits anyone needs.	Moran Company for APTQI, 2017, using 2014 claims
Chiropractic visit	$80 average fee, from $66 to $93 by region. This is the fee practices list, not what each patient pays.	Chiropractic Economics annual survey, 2024
Massage, 60 minutes	$125 to $155 for a non-member at five Massage Envy locations. One chain, so not a market average.	Massage Envy location pages in Phoenix, St. Louis, El Paso, Minneapolis and San Francisco, read October 4, 2026
A 45-degree back-extension bench, bought once	$295 to $365 across three retailers	ISF Fitness, Titan Fitness and Extreme Training Equipment, listed October 4, 2026
Low Back Pain Coach	$59.99 a year or $9.99 a month, with a 7-day free trial for eligible new subscribers	App Store and Google Play

For a wider view, US survey data for 2021 put out-of-pocket medical spending at about $1,902 a year for adults with chronic pain and $786 for adults without it (Guy and colleagues, Medical Care, 2025). The study used selected chronic noncancer pain diagnosis codes, not back pain alone, and the figures cover all of those adults' medical spending, not only spending on pain treatment. The bench is a separate cost, and the program needs one.

Why this app exists

The person who built Low Back Pain Coach had low back pain for about ten years, from his early twenties into his thirties.

He tried several treatments and exercise routines. A doctor prescribed anti-inflammatories. Chiropractors offered weekly adjustments. Physical therapy helped more than anything else, but it was expensive, and the exercises came on a printed sheet and never got harder. Dry needling, YouTube stretch routines and the McGill Big 3 didn’t change much for him. An MRI showed disc degeneration at two levels, which he later learned is common in people with no pain at all (what an MRI means).

What he did next was follow a slow back-extension progression on a 45° bench. He started with a few bodyweight reps. Over about eight months he worked up to loaded sets. He did a little, checked how his back felt the next day, and only then did a little more. His pain went down a lot.

He believes long-term back pain is partly physical and partly a spiral of avoidance: you protect your back because it hurts, it gets weaker from not being used, and the weakness and the worry keep the pain going. That is his explanation of his own back, not a research finding. He wanted a way to build strength slowly and check the next day, so he built an app he sells, Low Back Pain Coach, around that progression, with your daily pain log setting the next session.

Everyone's back is different, so results vary and aren't guaranteed. A Cochrane review of 249 trials found that exercise programs for chronic low back pain reduced pain on average compared with no treatment, usual care or placebo, by about 15 points on a 100-point scale at the first follow-up (closest to 3 months), and improved day-to-day function by a smaller amount. This exact progression has not been tested in a trial. The app is not medical treatment; talk to your doctor before starting a new exercise program, and stop and get help if you have any of the warning signs listed in the app.

The full story

You do two things at once

The physical part is a 45-degree back-extension progression: holds first, then partial reps, then full-range reps with your body weight, then a plate held at your chest. The app compares the morning after each session with your usual pain. A next-morning check-in below your usual steps the dose up when it is not higher than the pain you logged before that session. The same as usual repeats the session, unless the previous training day's next-morning check-in was also at or below your usual, and neither was higher than the pain you logged before that session. Higher cuts the next one back. A pain score cannot tell you what caused a change.

The other half, for me, was the fear that I would never get better. It was the first thought when I woke up and the last when I went to bed, along with the hopelessness that the pain would run the rest of my life. I did not drop the physical work. Keep the training.

Walking is part of the flare-up plan. The strength work is the loaded back extension. How it works, in full.

The four stages

Every stage starts easy. You move up when you meet the stage target on each of your last three training days (partial sessions do not count), you logged pain on at least 3 of the past 7 days with none above your usual level or in your legs, and your next-morning check-ins allow a step up.

• Stage 1 · Holds

  Hold still at the top. Starts at 3 holds of 15 seconds (the setup questions can set your very first session to 10, 13, 15, 18 or 20).

  Moves on at a hold of about a minute, or about 3 minutes of holding across the session, with the conditions above.

• Stage 2 · Partial reps

  A short range below the top. Starts at 3 sets of 3 reps over half your range.

  Moves on at a set of at least 5 reps at 80% of your range or more, repeated on each of the last three training days at this stage (partial sessions do not count), with the pain and check-in conditions above.

• Stage 3 · Full reps

  All the way down and back up. Starts at 3 sets of 5 with body weight.

  Moves on at about 20 reps in a session, with the conditions above.

• Stage 4 · Weighted

  A plate at your chest. Starts at 3 sets of 8 with 10 lb.

  Add 5 lb to every set and go back to 8 reps only after every set reaches 12 reps on each of the last two training days, both with a qualifying next-morning check-in.

No bench yet

This program requires a bench. If you do not have one yet, start on the floor today. A floor session is three rounds of a prone hold, 6 bird-dogs, and 8 glute bridges, about ten minutes in all. Stage 1 needs the bench. You can start it the day you have one: confirm it in the app and the next session is Stage 1, unless a flare or a leg-pain stop is on. If you already said in the setup questions that you have a bench and you are still on the floor, the app moves you on by itself when each of your last three floor training days includes a prone hold of at least 30 seconds (or 90 seconds of holding in total; partial sessions do not count), your pain is logged on at least 3 of the past 7 days with none above your usual level or in your legs, and your next-morning check-ins allow a step up. What to look for in a bench.

• 

  Prone hold. Lift the chest a few inches and hold. This is the number that grows.

• 

  Bird-dog. Opposite arm and leg, 6 slow reps.

• 

  Glute bridge. Hips up until level, 8 reps.

How the next morning sets the next session

You start by telling the app your usual pain on an ordinary day, from 1 to 10. That is your baseline. The morning after a session you log how your back feels, and the app compares it with that baseline.

• Worse than usual: the next session is cut back. Holds and full reps drop about 30%, partial reps lose up to a rep and up to 10 percentage points of range (stopping at 2 reps and 40% range), and weighted sessions drop 5 lb while the plate is above 5 lb or lose up to 2 reps at 5 lb (stopping at 6). From Stage 2 on, a session already at the minimum steps back one stage. Stage 1 stays on the bench and eases to a minimum of 5-second holds.
• The same as usual: the app repeats the session, unless this next-morning check-in is at your baseline and the previous training day's was also at or below baseline, and neither was higher than the pain you logged before that session. Then it steps up.
• Better than usual: a small step up from that next-morning check-in alone, as long as it is no higher than the pain you logged before the session that day. That is 5 more seconds on the shortest hold (the first, if several match), one more rep on the set with the fewest, or, once every partial-rep set has at least 5 reps, 10 percentage points more range on every set. On Stage 4, one more rep on the lowest set until every set has reached 12 on each of the last two training days, both with a qualifying next-morning check-in, then 5 lb more on every set and back to 8.
• Pain in your legs: stop the extension work. The app shows no session while the newest log that records a location says legs. A legs log in the past seven days also blocks a dose or stage increase after a later reading is recorded in your lower back.
• A week or more off: the next session starts easier, whatever the logs say.

A rough week means a smaller dose. You do not throw out the program and start over. Flare-up mode pauses bench work while you walk and keep logging, then offers an eased first session after two days at or below your usual level (maintenance mode keeps its own dose). The flare-up plan.

The app

I built Low Back Pain Coach to do the bookkeeping: it reads your logs, writes the next session, and a voice counts the holds, reps and rest so the phone can stay on the floor. It also keeps a pain graph against your baseline and makes a PDF of your history for a doctor or physical therapist. It works offline with no account. A notebook can run the same rules if you would rather keep the decisions on paper. Everything the app does, and what it costs.

Guides

Each guide lists its sources. Start with the progression or the next-morning rule.