Exercise is the best medicine to banish back pain and stop people taking sick days, a new study found.
Together with education to prevent back pain, these were the most effective ways to stop it reoccurring within a year.
But other remedies, including education alone, back belts and shoe inserts do not appear to be associated with the prevention of low back pain.
Back pain is a common problem that affects most people at some point in their life and is triggered by bad posture while sitting or standing, bending awkwardly, or lifting incorrectly.
It is most common in the lower back.
In most cases, back pain will improve in a few weeks or months, although some people experience long-term pain or pain that keeps coming back.
The NHS recommends sufferers remain as active as possible and try to continue with their daily activities, take painkillers and use hot or cold compression packs.
For those with long-term back pain their GP may prescribe stronger painkillers or refer them to exercise classes where they are taught specific exercises to strengthen muscles and improve posture or for physiotherapy, chiropractic or osteopathy.
Surgery is generally a last resort.
Now a review of medical literature suggests that exercise, alone or in combination with education, may reduce the risk of low back pain.
Dr Daniel Steffens of the University of Sydney said: “Low back pain (LBP) is one of the most burdensome health problems worldwide, generating enormous costs in treatments and time lost from work.
“The global point prevalence of LBP is 12 per cent. With the ageing population, the number of people affected is likely to increase over the coming years.
“A key contributor to the burden is the high recurrence rate.
“Approximately one-half of patients experience a recurrence of LBP within one year after recovering from a previous episode.
“It is therefore important to know whether it is possible to prevent LBP and, if so, which interventions are most effective.
“The results of this systematic review and meta-analysis of randomised clinical trials indicate that exercise in combination with education is likely to reduce the risk of LBP and that exercise alone may reduce the risk of an episode of LBP and sick leave due to LBP, at least for the short-term.
“The available evidence suggests that education alone, back belts, shoe insoles, and ergonomics do not prevent LBP.
“It is uncertain whether education, training, or ergonomic adjustments prevent sick leave due to LBP because the quality of evidence is very low.”
The study published by JAMA Internal Medicine involved 21 different randomised clinical trials including 30 850 unique participants.