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A loaded 45-degree back-extension progression, and the mental side of persistent pain.
You train the back on a 45-degree bench. You add a little over weeks. You judge a session you already did by how you feel the next morning. You also deal with the fear that you will never get better. Those two run together.
This is for chronic low back pain that has stubbornly stayed for months, if not years. If you had a recent acute injury or surgery in the past few months, finish the recovery plan your clinician set before you start a loading program.
The bench
You do the program on a 45-degree back-extension bench. The pad rests against the upper legs and you bend over it. Most gyms have one. Home models show up on Amazon around $80. A vertical 90-degree chair is a different machine and is outside this program.
Holds first, then a small range, then full-range bodyweight reps, then a plate. One variable at a time. I started smaller than I wanted to in the room. I added the next time based on how I felt the next morning. Too much sets you back. Too little and you do not move.
If you do not have a bench yet, there is a short floor routine so the habit can start while you get one. That is an on-ramp. It does not replace the loaded bench work.
Back extensions without a bench
The next morning
Write down what your back usually feels like on an ordinary morning. That is the baseline.
After a session, wait until the next morning and compare. A morning near baseline means that session was tolerable. A clear, lasting increase means you reduce range, reps, hold time, or load the next time.
You are grading work you already did. You are not using a morning that has not happened yet to invent a session you have not done.
Sleep, stress, and a long day on your feet can move a single score. Look at a few sessions in a row before you jump.
The mental side
The back is the first thing you think about in the morning and the last thing at night. You almost do not want to get out of bed, even though staying there can make it worse. Energy drops. You get more irritable and less patient. A general negativity that is hard to make positive changes from.
There is the fear that you will never get better, and the hopelessness that the pain will control your life going forward. Both feed a downward spiral. Succumbing to it can make the pain worse.
I also recommend reading Healing Back Pain (Sarno) and The Great Pain Deception. Both make a real case for the mental side of pain. I do not agree with dropping all the physical work as Healing Back Pain suggests. Someone who has hurt for years has usually not been training the back. Mine got weak and tight. You need the extension progression to rebuild strength and confidence. Keep the training.
The first days that are noticeably better, or even just the same, matter.
After about an hour of standing or walking, the rest of my day used to be shot. On a trip through Italy, France, and Spain I hunted benches and hunched on the ground to stretch. Loading the back extension ended that standing and walking pain. I can stay outside with my wife and kids. A walking routine helps you get comfortable on your feet again. Loading the back extension is the program.
The app
I built Low Back Pain Coach to hold the timers, the log, and the next session in one place. It reads recent entries and next-morning scores. A notebook still works if you would rather run those decisions yourself.