A central theme of current evidence-based guidelines for managing low back pain is endorsement of the resumption of activities despite the presence of pain. This task can be challenging for both therapists and patients, and there are many essentially psychological obstacles to implementing the guidelines. These obstacles can be overcome by knowing how to recognize potential psychological obstacles and understanding the options for managing psychological obstacles in combination with activity-based interventions. This article is intended to address these tasks by explaining and describing the application of empirically based psychological principles and strategic clinical reasoning. Importantly, the roles of skills in assessment, treatment planning, and communication with patients are identified as essential but feasible skills for physical therapists to acquire with appropriate training.