Pushing Through Back Pain: What Pain Doctors Need You to Know
A woman who suffered from chronic back and neck pain for years reveals the surprising solution that helped her find relief—and pain experts share why more and more doctors and pain sufferers are following suit.
Courtesy Ellen Schirmer/Peggy Bird
Ellen Schirmer stood before her military medical board, nervous, on edge, and in excruciating pain. She was in her 40s at the time and midway through her military career—or so she hoped: Schirmer was waiting for the board to reach a verdict that would determine her future. “I had been in the military for 18 years: While I wasn’t afraid that they would kick me out before I reached 20, I had no idea whether they would allow me to stay in beyond that. And that really freaked me out,” she says.
The reason for the medical review was that her ongoing, agonizing back issues were impacting her desk job: “The pain in my back and neck had become constant and unbearable and it was clearly affecting my life and my ability to work.”
While the board did finally decide to allow her to return to her public relations job, Schirmer would spend the better part of a decade looking for a solution to her chronic pain. As luck would have it, Schirmer’s military connection led her to a radical program that targeted back pain. Though the program was daunting for Schirmer, it ended up leading the way to lasting relief.
Dealing with constant pain
Back pain started to become an issue for Schirmer in her mid-30s. “It was sporadic, but at times it would just catch and become agonizing,” she recalls. “I was in Korea at the time, and we took part in exercises in which we had to wear a 25-pound flack vest. The pain was so bad in my back that I had to get medical approval to get out of the exercise. And that was just the beginning.”
Schirmer’s family had a history of arthritis and degenerative discs, so she always assumed she would deal with back pain at some point—but she didn’t expect it to have such an enormous impact on her daily life. “I couldn’t walk long distances because my lower back would be killing me and I had to sit down,” she says. “Sometimes it even hurt to hold my head up because my neck hurt so bad.” By the time she reached her mid-40s and had to face the medical board, she was dealing with a persistent ache that regularly reached a seven or eight out of ten on the pain scale.
Years of failed treatments
Over the course of five or six years beginning in her late-40s, Schirmer tried numerous treatments for getting rid of the pain. “I tried electrical stimulation, dry needling, pain medication, muscle relaxants, chiropractors, and injections, but nothing was more than a temporary fix,” she says. By 2015, she was seeing a chiropractor regularly in Germany, where she was stationed. “It got to the point where the chiropractor said, ‘We’ve done everything we can do.’ And they recommended me for this 12-week pain program that involved exercise,” she shares. “I’d always thought that if I was hurting, I was supposed to rest. But nothing else had worked and I wanted to feel better, so I agreed to give it a shot.” After being cleared by her primary care physician to take part in the program, Schirmer began.
A surprising solution
The exercise portion of the program lasted for 90 minutes, three days a week. “Each session was 20 minutes of warm-up, then 20 minutes of boot camp-style exercises, typically all bodyweight. Common exercises like pushups, lunges, squats, dips, and sit-ups. And then 50 minutes of yoga to help promote healing,” says movement specialist and certified yoga instructor Samantha Parker, author of Yoga for Chronic Pain…WTF? Parker taught the yoga portion of Schirmer’s program. “Everybody did the same sequence of exercises and it hit every body part.” Parker also notes that she and the other trainers would monitor participants’ progress and abilities and modify exercises accordingly to avoid the risk of further injury.
For someone like Schirmer, who had been avoiding serious exercise for years, it was far from easy. “The first day I got there, it made me feel nauseous because it was so intense,” admits Schirmer. “Before I was trying to walk and do some exercise on my own, though I never would have tried anything like that. But you had to try every single exercise, and you had to keep going until you finished it. A lot of people quit when it hurts, but they didn’t let you quit and they kept you motivated. So I stuck it out.”
Exercise as a multidisciplinary approach to pain management
“The number one approach for many chronic pain conditions is exercise and movement more than anything else,” says pain management expert Robert D. Kerns, PhD, a professor of psychiatry, neurology, and psychology at Yale University. The reason: Pain is not a purely physical phenomenon. “The primary framework for understanding pain and pain treatment is called the bio-psycho-social model,” explains Kerns. “Pain is always a function of all those inputs. It’s physical, but it’s also always psychological.”
The combination of these elements can trap chronic pain sufferers in a cycle of pain and immobility. “The body doesn’t like pain and the brain doesn’t like pain. So if something is painful, you avoid it,” says anesthesiologist Ronald White, MD, former head of clinical research for Pain Medicine at U.S. Army Hospital Landstuhl Regional Medical Center and Chief of Pain Medicine for the U.S. military bases in Europe, Africa and most of Asia; Dr. White developed the program that Schirmer took part in. “Over time, this avoidance leads to deconditioning and more pain. So you get a toilet bowl kind of cycle where the chronic pain gets worse and worse. I call this cycle the dwindles.”
How activity helps you break free
Exercise can help chronic pain sufferers break free from the dwindles. “This type of approach takes into account a person’s threshold of pain and the activity that is associated with increasing pain,” explains Dr. Kern. “Then it starts low and slow and gradually helps the person realize that it’s not that they can’t do certain activities, but that they’ve been avoiding them. And if they gradually build up strength and tolerance they will be able to do much more than they are now, plus raise their pain threshold and reduce the experience of pain.”
The result: First, pain sufferers improve their muscular strength, flexibility, and circulation. “Muscle strength and flexibility help support the skeletal system,” explains Parker. “And movement improves circulation, which means you’re able to get more oxygen to the areas that need to be healed.” Then, armed with newfound knowledge of their bodies’ physical capability, sufferers are able to overcome their fear of movement and change their perception of pain. “Our preliminary data shows that when using physical activity, we were able to double functional outcomes in half the amount of time,” says Parker. “Patients also self-reported an improved overall quality of life, a decrease in prescription medication use, and that pain was no longer a limiting factor to function.”
Treating the mind helps heal the body
“Preventing the dwindles is not something that’s really taught in medical school,” says Dr. White. “But it’s a combination of movement, activity, mindfulness, and positive thinking.” Indeed, studies show that addressing a patient’s mental health—even if they view their pain as purely physical—can have a profound effect on their discomfort. In a 2016 study published in the journal Brain and Behavior, back pain sufferers who took part in four weeks of weekly mindfulness training saw reductions in depression symptoms and pain, while the control group saw no change in pain measures. And a 2018 Australian study published in JAMA Internal Medicine found that low-dose antidepressants reduced disability levels and lowered pain intensity in patients with chronic lower back pain. “Mind approaches are associated with physiological changes in the body and in the brain,” says Kerns. “They help people develop a sense of pain as something potentially controllable when they didn’t see it that way before.”
Finding freedom from pain
“At the start of the program, my pain was between a six and an eight,” says Schirmer. “I didn’t know how to manage it without medication and I didn’t realize that exercise could help with chronic pain like that. But it definitely did! During the boot camp portion, I was more focused on the breathing and other things so the pain was in the back of my mind. I could feel it, but it wasn’t something I was focused on. Then we would go into a hot room for the yoga portion—the heat kept the body loose and helped us move.”
“The education piece, especially, really opened my eyes,” she adds. “I learned that if you’re hurting, you move and get past that hurt until you can get better and stronger. And I definitely got stronger. I could feel it in my core, which helped support my lower back. I also lost probably 10 or 12 pounds and the yoga helped with my flexibility. I really felt good at the end of each session and felt like I got better each time I went.” As for her pain? “I couldn’t believe how dramatic the improvement was,” she says. “At the end, my pain was down to a one. It pretty much disappeared. And even today, the overall mentality of moving when you’re hurting, whether that’s hurting physically, mentally, or emotionally, has helped me immensely. It has improved all aspects of my life. I believe that movement is the key to being pain-free.”
Courtesy Ellen Schirmer/Peggy Bird
How you can use exercise to eliminate pain
“I think most pain patients could benefit from a program like this,” says Dr. White, who splits sufferers into three categories. For generally healthy people who have pain in the back or knee, for example, he recommends seeking out a personal trainer who can offer exercise suggestions. Those with significant health problems in addition to their pain would require a much more directed and personalized program. As for those in the middle who have been feeling chronic pain for a few years, Dr. White believes they would all benefit from the program that Schirmer went through. “But finding those programs is hard,” he admits. “I would tell those people to seek out a physical therapy center or a pain doctor who works with a physical therapy group who can help them mix it up with easy and more aggressive exercise.” Also smart: Attending group fitness classes, which Dr. White says can play a huge role in maintaining motivation.
In the end, any movement that is done safely will be beneficial for overcoming chronic pain. “The body is afraid of pain, and exercise can be uncomfortable,” says Parker. “But even though it seems counterintuitive, movement is actually one of the best things you can do.”
- Samantha Parker, C-IAYT, E-RYT 200, CPT, founder and lead movement specialist of Neoteric Movement Systems, author of Yoga for Chronic Pain…WTF?
- Robert D. Kerns, Ph.D., professor of psychiatry, neurology and psychology, Yale University; co-director of the NIH-DoD-VA Pain Management Collaboratory Coordinating Center, Yale University School of Medicine.
- Ronald White, M.D., chief of pain medicine, Travis Air Force Base and former chief of pain medicine and head of clinical research for the U.S. Army covering Europe, Africa and most of Asia.
- Brain and Behavior: "Brain and behavior changes associated with an abbreviated 4-week mindfulness-based stress reduction course in back pain patients."
- JAMA Internal Medicine: "Efficacy of low-dose amitriptyline for chronic low back pain: A randomized clinical trial."