This week I received these questions from readers of the column: “Paul, I am a teacher and wonder how do you continue to stay fit and active when a long-standing back injury keeps recurring? It seems that during a course with the physio things are fine, but as soon as it stops my problem return. I know the obvious answer is more physio, but I feel this only masks the problem.

Neil, 37, Hartlepool

“Hi Paul, because of lower back problems I am unable to do any exercise and have consequently put on weight which I am struggling to get off. I have a quite healthy diet but really need to do some exercise. I’m sure the extra weight I’m carrying isn’t helping my back problem. In fairness, the weight gain wasn’t due to inactivity but a thyroid problem. Do you have any advice?

Frances, Bishop Auckland

THESE are the type of questions I am asked quite regularly as a physio and hopefully I’ll be able to advise Neil and Frances, as well as anyone else suffering from similar problems, on what they can do to help themselves.

I’ll start with Neil’s issue and why his back problem keeps happening over and over again. I note that he feels visiting a physio only seems to “mask” the problem, and to some extent agree, because physio sessions are not a full-blown cure that will make your problem go away forever. The most important way of fighting things like back pain is what you do. I’m talking about lifestyle changes you make, the exercise classes you attend or do in your own home, the type of exercise that you do or don’t do, right down to the length of time you spend sitting and even how you sit.

As a teacher, I bet the bulk of Neil’s day is spent sitting at a desk or in meetings and that means chronic back pain is more likely because we aren’t actually designed to spend long periods sitting down.

The long-term solution? Regular posture exercises can help increase muscle control using Pilates routines mixed with Yoga exercises as these will make the muscles and joints more supple and flexible.

One thing I must point out: Things like running, swimming and golf rarely make the back stronger and there is a huge difference between exercising and doing exercises like Pilates and Yoga.

Pilates exercises are also perfect for Frances. Back pain is made worse by the amount of weight the lower back has to support, but the issue is the same in that having constant pressure added to the lower back make it even more vital to do strength and control exercises to support your back on a daily basis. This will allow you to exercise and therefore loose more weight, quicker.

So, the answer to both questions will be found in long-term commitment and discipline to doing the right exercises. I'm talking at least three months before you may even notice any difference so you’ve got keep at them to feel the benefits.

A free special report (worth £58) with nine top tips to keep active with less back pain (and a £24 bonus to find further relief from back pain) is waiting when you visit my website: www.paulgoughphysio.com/back-advice. Be quick, there is only 23 available.