• Increase flexibility . Exercises like yoga are particularly good for keeping the spine flexible and less prone to injury.
• . . . then work on strength. Back-pain sufferers often have weak, poorly functioning back muscles. Regular aerobic activities that don’t strain or jolt can increase strength and endurance in your lower back, allowing your muscles to work better. Good choices include walking, swimming and bicycling.
• Good posture. It can take years (or even decades) for pain, stiffness and other symptoms to develop in response to poor posture. But don’t wait for the pain to start. When standing, keep a neutral (level) pelvic position. Try alternately placing one foot on a low footstool to take some of the load off. When sitting, keep your knees and hips level, and choose a chair with good lower-back support, or place a pillow or rolled towel in the small of your back to maintain a normal curve.
• Acupuncture is an important complement to conventional orthopaedic treatments for chronic low-back pain. Regular treatments may also prevent relapses of back problems.
• Lift smart. Push rather than pull when you must move heavy objects. If you have to lift, let your legs do the work. Hold the load close to your body, keep your back straight and bend only at the knees. Avoid lifting and twisting simultaneously.
• Sleep smart. Old saggy mattresses can make pain worse - and so can overly firm ones. Recent evidence suggests that sleeping on a medium-firm mattress can improve low-back pain, and result in less daytime pain and disability, and cut down the use of painkilling drugs. Use pillows for support, but don’t use a pillow that forces your neck up at a severe angle.
• Wear flat shoes, or shoes with low heels (one inch or lower).
• Quit smoking, as it is associated with more low-back pain and a higher risk (18 per cent) of disc degeneration. Smoking leads to malnutrition of the spinal discs, which, in turn, makes them more vulnerable to mechanical stress.
• Consider hydrotherapy. Spa treatment has been shown to improve the range of movement and intensity of pain. In one study when patients were randomly assigned to either spa treatment or a control group, the spa group showed improvement of pain and mobility as well as a reduction in drug use. Spa treatment included a mixture of mineral baths, warm mud applications and high-pressure showers, six days a week for three weeks.
• Hypnotherapy. Pain management through hypnosis may also be an effective way of dealing with back pain for which no physical cause can be found. Hypnosis works by relieving stress and promoting relaxation. However, behavioural modifications can also be incorporated into each session.
• Reduce caffeine. In one small study, back pain sufferers consumed more than twice the amount of caffeine daily than non-sufferers. Caffeine consumption among men was 86 per cent greater than among women.

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