Deborah's back pain seemed to come out of nowhere. One day the then-51-year-old New Yorker was sprinting from meeting to meeting; a few weeks later, she was struggling even to get dressed. She suffered from a constant, sharp sciatic pain that started in her lower back and radiated down her right leg. Laughing hurt. Sneezing hurt. Movement of almost any kind was agonizing. Standard doses of over-the-counter medication like ibuprofen brought no relief. Deborah started using a cane to get around and avoided making plans with friends. "I'd never been in that much pain for that long," she says. "I got to the point where I would have done or taken anything to make it stop."

A month in, Deborah called her primary care physician, who prescribed oxycodone. To her surprise, it did nothing for her, so she stopped taking it and, after consulting with her doctor and pharmacist, tried a prescription dose of Advil instead. This helped, but not enough. She feared that surgery was her only hope for functioning normally again.

Then Deborah's primary care physician referred her to Christopher Visco, MD, a physiatrist and sports medicine doctor at New York-Presbyterian Hospital who specializes in spine injuries. ("A psychiatrist?" said Deborah, at first misunderstanding Visco's specialty. "It's not my head, it's my back!") Visco had the "secret sauce of a good doctor": He listened to every detail of Deborah's story before offering advice.

First Visco recommended an MRI. "Back pain patients don't typically need imaging," he says, "but if the pain lasts longer than a month, or if there are other complicating factors, an X-ray or an MRI can be helpful." After reviewing Deborah's MRI, he ruled out surgery and advocated for physical therapy (PT) to get her moving again. Assuming the patient doesn't have a fracture, Visco strongly believes in the power of movement. It can help with healing and prevent pain from becoming chronic, he says. "If you asked for my top five recommendations for low-back pain, aerobic exercise would be numbers one through five," he says.

Visco acknowledges that this advice presents a psychological hurdle for many patients: "The pain is telling you not to move." However, meditation and treatments like cognitive-behavioral therapy can help you override that voice, he says. "And there's never been a study demonstrating that exercise makes back pain worse."

Deborah, too, was skeptical—not because she feared pain ("Things were so bad that it didn't matter to me whether I was suffering at home alone or in rehab"). She'd tried PT for a short time before seeing Visco, and while she hadn't gotten worse, she hadn't gotten better, either. Would another round make a difference?

But Deborah was desperate for relief, so she hobbled back to the rehab facility. Some of the exercises were uncomfortable, sure, but her physical therapist guided her through (and offered "treats" like ice, a hot pack, or muscle kneading). The therapist also showed her low-impact moves she could do at home. When things didn't feel right, or when she didn't notice improvement, Visco fine-tuned her program, prescribed new moves, and made sure the therapist was helping her do them.

Within four weeks, Deborah was able to give up the Advil and the cane. By eight weeks, she was walking and living normally—no pain at all. "I felt 20 years younger!" she says. She kept up with the exercises for another few months because she wanted to make sure she never felt that helpless again. Nine months later, when her pain returned in the other leg, she went to PT, did her exercises, and was back to normal in less than a month.

Deborah has now been pain-free for more than a year and feels like she's moving better than ever. "It's still kind of amazing to me that I was able to exercise my way out of this," she says.

Read More: Doctors Say Opioids Should Be a Last Resort for Back Pain and Studies Find that Exercise Might Be the Best Way to Relieve Back Pain


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