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When you are being consumed by the iron jaws of back pain, it’s easy to forget what your lovely, ache-free days were like — and that there are methods of relief. Here are a few common ones.

Traditional Medicine

Medical doctors used to wildly overreact to back pain, throwing drugs and surgery at the mystery, until the federal Agency for Health Care Policy and Research issued new clinical treatment guidelines in 1994. “The era of routine radiography, strict bed rest, corsets, and traction has passed,” says Dr. Richard A. Deyo, a member of the AHCPR panel. “It’s been replaced by early return to normal activity and greater emphasis on exercise to prevent recurrences or to treat chronic pain.” Now your family practitioner is more likely to send you for some ibuprofen and to look at epidural cortisone injections or surgery only as last resorts.

Chiropractic

Gone are the days when your HMO balked at covering chiropractic bills. The AHCPR also endorses manipulation as a safe and effective form of back pain treatment, largely stifling those accusations of quackery that dogged chiropractors in the past.

“Compression equals back pain,” explains chiropractor Leroy Perry, president of the International Sports Medicine Institute. By twisting, pushing, or pulling the spine, a chiropractor relieves compression, thus increasing mobility. Long a satisfying avenue for a majority of lower-back pain sufferers, chiropractic certainly has allure — instant relief — over the ibuprofen approach.

Osteopathic Medicine

It’s a helpful oversimplification to think of osteopathic physicians as a cross between chiropractors and medical doctors. An osteopath will crack your back just like a chiropractor, but D.O.’s also enjoy the same legal status as medical doctors, meaning they can diagnose and treat illness, employ medical technology, prescribe medications, and perform surgery. However, the osteopathic approach tends toward the noninvasive: They prefer to lay hands on the musculoskeletal system, help to improve posture, and prescribe prevention by exercise. For osteopaths, tugging on the spine is only the starting point for curing what ails you, whereas it’s the raison d’Å tre for chiropractors.

Acupuncture

Widely accepted for treating chronic symptoms, acupuncture can also alleviate acute back problems. “If you walk into an acupuncturist’s office with low-back pain, there’s a good chance that you’ll feel better in the next 24 hours,” says Whitfield Reaves, cofounder of the National Sports Acupuncture Association. In Eastern terms, acupuncture releases blocked energy (qi, pronounced “chee”) that should flow freely through so-called meridians in the body, thereby restoring homeostasis. If you must look at it from a Western point of view, studies suggest that needling certain points on the body boosts the production of endorphins, those feel-good hormones familiar to athletes of any bent.

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Though the definitive root of your back pain may be murky, your immediate course of action is clear.

Back off strenuous activity, but stay mobile. Trying to override the pain by ignoring it won’t do any good, but neither will spending a week in bed. If you let your pain be your guide — do what you’re able to do without making it hurt — you won’t feel so stiff. Get up and move around, even if it’s difficult. Perform a few exercises. If you are incapacitated, stay in the sack, but for no more than 24 to 48 hours.

Apply ice and heat. Ice is particularly therapeutic for acute spasms and inflammation. When your back goes, ice it immediately and follow up two to three times a day for the first several days — more often if you need it. (A bag of frozen peas works great, because it conforms to your body.) After 72 hours, if the pain persists, you might try contrast therapy, in which you apply ice for ten minutes and then take a hot bath with Epsom salts or apply a hot pack.

Take mild pain relievers. Aspirin and nonsteroidal anti-inflammatory drugs, such as ibuprofen, will help reduce inflammation and thus pain. If it persists without improvement for a week, seek help.

Injury or no, enhancing the mobility of the spine with stretching is a good thing. And when the acute agony of lower-back pain passes, strengthening the postural muscles, which run along either side of the spine between the shoulder blades, will help prevent a recurrence. We’re not talking the old toe-touch here, perhaps the most widely known and worst exercise for any back. Rather, this is a combination of moves culled from several disciplines. Be sure to combine these exercises with crunches — squeezing a pillow between your thighs makes the standard technique work that much better — to strengthen your abdominals. Indeed, your abs serve as the body’s built-in corset, maintaining stability in the lower back.

Pelvic Tilt
Restores mobility in the lumbar spine

Lie on your back, knees bent, feet flat on the floor, and arms at your sides. Keeping your legs relaxed, tighten your lower abdominal muscles to press the small of your back into the floor, as if you’re crushing a grape. Then arch the small of your back.

Knee-hugger
Stretches lower-back and gluteal muscles

Assume the pelvic tilt position, holding the phase when the small of your back is pressed into the floor. Keeping back and legs relaxed, hug both knees to your chest, pulling them to your armpits. Hold for a ten-count.

Horse Stance
Strengthens back extensors and postural muscles

Start on all fours and, keeping your back flat, extend your left arm and hold it slightly to the side, with your thumb pointing toward the ceiling. Now raise your right leg; hold each limb parallel with the floor for ten seconds. Alternate sides to complete one rep. To advance, “draw” the alphabet in 12-inch-high letters with your raised foot.

Heel-Hand Rock
Stretches lumbar muscles, increasing range of motion

Start with what’s known in yoga as the cobra position: Lie on your stomach, toes pointed and hands on the floor alongside your chest. Press your torso up until your arms are straight, keeping your pelvis on the floor. Now roll your shoulder blades down and raise the crown of your head toward the ceiling, elongating your spine. Keeping your hands planted, go onto your knees, lift your hips, and rock back onto your heels until your butt rests over them; you end up prostrate with your head down. Finally, uncoil back into the cobra and repeat.

Million-Dollar Hamstring Stretch
Stretches hips, hamstrings, and back

Sit on the floor with one leg extended in front of you, the other bent with your foot flat on the floor. Rest your chin on your bent knee, grasp the arch of that foot with your hands, and slide your heel along the floor until you feel that slight twinge of muscle discomfort that indicates a good stretch. Then, while you are holding the stretch for six seconds, rotate your straight leg inward, which improves the mobility of your nerves, allowing you to stretch even further. Now switch legs and repeat the whole routine.

TRIAGE
You’ll want to take a different tack with your back when you’re hurting, but don’t stop exercising altogether-no matter what the temptation. In the midst of a painful flare-up, adopt the following therapy routine using the exercises laid out on this page, and be sure to forgo anything that inflicts more pain.

Therapy
Do a set of 20 pelvic tilts several times a day, especially after a period of inactivity.
Prevention
Do 15 pelvic tilts, holding the up position for five seconds, interspersed with sets of 30 crunches.

Therapy
Do three repetitions of knee-huggers; increase to ten reps as you’re able.
Prevention
Do a set of five knee-huggers, holding the position for 30 seconds.

Therapy
Segment the heel-hand rock, doing the cobra and rock-back portions independently, five reps each. Your cobra may not get far off the floor at first.
Prevention
Do ten reps minimum of the heel-hand rock.

Therapy
Do five reps of the horse stance one limb at a time, holding each for five counts. As your condition improves, extend opposite limbs simultaneously.
Prevention
Do ten reps of the horse stance, holding the pose for up to a count of ten. Then, if you can draw the entire alphabet with each foot, you’re doing well.

Therapy
Take a rain check on the million-dollar hamstring stretch until the pain subsides.
Prevention
Do six to ten reps of the million-dollar ham- string stretch. Repeat set with opposite leg.

Here’s how: Each week you’ll go short on Wednesday and Sunday, middle-distance on Tuesday and Thursday, long-distance on Saturday, and take Monday and Friday off. Run at 70 percent of your maximum heart rate except on Saturdays, when you’ll reduce your pace slightly. Stick to the plan, and by race day you’ll be harvesting miles with the best of them.

After a five-minute aerobic warm-up, kneel on your right knee with your left foot on the floor in front of you and that knee bent at 90 degrees — like Reggie White resting on the sidelines. Hold a chair with your left hand for balance and, keeping your torso upright with your back slightly arched, reach back with your right hand and grasp your right ankle. Now, ever so gently, pull toward your backside until you feel a slight burn, and hold for 15 seconds. Relax, reposition the chair to your right, and repeat by stretching the same leg with the opposite hand. Repeat both variations with the opposite leg.

SWIMMING

Vertical Kicking: A leg-intensive workout provides a natural rut-buster for thick-shouldered swimmers. Warm up with a 400-yard freestyle swim, finishing by kicking hard to loosen your legs, recommends George Block, president of the American Swimming Coaches’ Association. Hit the deep end and try to keep your head above water relying on nothing more than a fast flutter kick. Without using your arms, sweep your legs back and forth from your hips, keeping your knees straight. For something harder, raise your hands overhead-you’ll earn a whole new respect for water polo players. Start with a 15-minute set, alternating 40 seconds of kicking with 20 seconds “off,” treading water.

Block Sprints: Cranking out lap after lap just doesn’t seem as fun without that rush of adrenaline. So try invigorating your pool time with block sprints. Warm up with an 800-yard swim. Then hop out on the deck, bribe the lifeguard if need be, and snug down those goggles for a set of 15 50-yard sprints, alternating one hard with two easy efforts. Take a deep breath, launch yourself off the blocks, and make like Amy Van Dyken. Assuming that you’re in a 25-yard pool, do your best flip turn at the end and sprint back. “Don’t turn into a windmill,” Block says. “Keep your stroke long and strong.” Rest ten seconds after each salvo, and swim the easy laps at 50 percent and 70 percent effort, respectively. Cool down with a 400-yard swim.

RUNNING

Water Work: One alternative for runners is simply running in place-in a pool. Water offers considerably more resistance than air yet eliminates the bang-bang-bangs of repeated pounding, important for those nursing nagging injuries. Put on a life vest, slip into the deep end, and start striding. Be sure to maintain an upright posture, mirroring your dry-land form, lest you start motoring across the pool. “Cup your hands as you pump your arms, and you’ll get an intense upper-body workout too,” says Steve Plasencia, former Olympic runner and now the men’s cross-country coach at the University of Minnesota. Incidentally, don’t pay much attention to your heart rate, since water pressure can reduce it by 10 percent. “Run” for 30 minutes, treading water every ten minutes for a brief rest.

The Plod: A slow run of twice your normal distance will force you to abandon your standard pace and push back your “wall.” Consider it a Saturday-morning project; get an early start. Begin at a seemingly embarrassing pace: three minutes per mile slower than normal, walking one minute after every half-mile. “That way, fatigue doesn’t have a chance to build up,” says Jeff Galloway, author of the best-selling Galloway’s Book on Running. “At first it seems pitifully slow, but then it’s great.” Obviously, you’ll want to hydrate throughout the run; Galloway recommends downing carbohydrates after the halfway point.

CYCLING

Noodling: To break the monotony of spinning along at 80 rpm every ride, Dr. Arnie Baker, coach of San Diego’s gritty Cyclo Vets, suggests alternating between high-gear and low-gear repetitions using one leg at a time. Sounds silly, but just be sure to keep your resting leg off its pedal-and out of your spokes. After a 15-minute warm-up, find a flat stretch of pavement and pedal for three minutes at 50 rpm with your right leg. You’ll have to experiment to find the right gear. Ride easy with both legs for three minutes, and repeat with your left leg. After another easy interlude, do a speed set: Pedal for three minutes at 100 rpm with your right leg, do three minutes of spinning, and repeat with the left. Do three sets for a complete workout.

Stand and Deliver: Give those bulky quads a break by climbing a long hill out of the saddle, says 12-time U.S. National Champion road racer Kent Bostick. It’ll reintroduce such overlooked muscles as glutes, hamstrings, biceps, and deltoids. If you live in Iowa, sorry, but perhaps you can improvise on a freeway overpass. Ride 20 minutes to warm up and then, at the base of a long, steady hill, shift into a gear that’s two cogs harder than if you were sitting. Stand upright with your back straight and your hips in front of your saddle, and rock the bike back and forth, opposite each downstroke. Stay up as long as you’re able, sitting down to climb for three minutes at a stretch if you need the rest. “Cool down with ten minutes of spinning,” says Bostick, “but coasting doesn’t count.”

We’re creatures of habit, which is why we tend to languish in programs that have us grunting away at the same 12 lifts for the requisite three sets of ten repetitions, season after season. As it turns out, advice from on high suggests that such an approach is too much time spent doing too many exercises anyway. The alternative? Something called breakdown training, says Wayne Westcott, strength training consultant for the National YMCA and author of the recently published Building Strength and Stamina.

With breakdown training, you employ no more than five lifts that cover the major muscle groups and heft the weight in a completely different manner. “It makes you dig deeper, push harder, and stimulates muscle tissue,” Westcott says. Here’s how it works: Lift the usual ten to 12 reps on your first set, but then quickly reduce the weight by 10 to 20 percent and crank out another set. You’re striving for the same number of reps, but you’ll probably never get there, because you haven’t rested. No matter-your muscles will be plenty sore, foreshadowing improved strength. Rest one minute after each lift.

Machines are more convenient than free weights, because reducing the weight typically means simply moving a pin. Give your muscles a wake-up call with the following five exercises, but regardless of how enthralling this method seems, don’t get too carried away: You shouldn’t lift more than every other day.

Lat Pull-Downs
Sit beneath the lat bar with your back straight. Grasp the bar with an overhand grip, your arms spread in a V (a narrow grip works your biceps more, while a wider grip focuses on your latissimus dorsi muscles). Pull the bar down in front of you until your hands draw even with your collarbones. Slowly let the bar return to its starting position, stopping when your arms are straight.

Ab Press
Strap yourself into an ab press machine, anchor your feet, and push your chest into the pads in front of you. Fold your arms across your stomach and crunch the weight all the way to your knees, being careful not to jerk the machine into motion. Let the weight up slowly-you’ll feel it burn-and return to the upright position.

Leg Press
Position yourself in a hip sled machine with your feet on the weight platform. Keeping your back straight and your neck relaxed, let the weight down, but don’t let your knees touch your chest. Now, press the weight until your legs are fully extended. Let the weight down slowly for the next rep. This is the one machine on which you’ll need a partner to swap the weights for your next set.

Back Extension
Climb into the machine just as you would with the ab press, the only difference being that the weight pads are behind your shoulders. Lift the weight smoothly by leaning back into the pads, and go as far as the machine will allow you to go. Lower the weight by slowly folding your torso back toward your thighs, but don’t let the weights touch down.

Chest Press
Settle into the seat of a chest press machine and strap yourself in if there’s a belt. Grip the weight levers with your hands and, you guessed it, press until your arms are fully extended. Let the weight back toward you slowly, until your hands are again even with your shoulders, which should be just before the weights touch back down.

Jim Harmon, who’s been following the same running program for 17 years, wrote “Be a Thigh Master” in the May issue of ºÚÁϳԹÏÍø.

Belly Breathing
Breathing from deep within your belly, not your chest, most effectively utilizes the diaphragm, drawing more oxygen into your lungs and thus allowing you to push your pace harder. Before hitting a hill that typically leaves you gasping, take five deep breaths-watch to see that your stomach expands on each inhalation-and you’ll feel the difference.

Rhythmic Breathing
The harder we work, the more we want to pant, which increases blood pressure and muscular tension. Fight the urge to hyperventilate by establishing a breathing rhythm. Many runners find this by exhaling on every other stride.

Pressure Breathing
The thinner air at high altitude saps your energy when you exercise. Those who train above sea level would do well to follow this strategy: Inhale deeply through your nose, and then forcefully exhale all your breath. The result is a vacuum-like effect that helps your next breath be bigger.

According to Jeanne Goldberg, director of Tufts University’s nutrition center, it is. “There’s no justification to pay more for a so-called natural vitamin,” she says. “Vitamins are chemical compounds, so getting it from rose hips is no better than getting it from a lab.” The synthetic-versus-natural debate-a skirmish in a multimillion-dollar battle to perk up aging boomers-promises to rage, but in the meantime, a few label-reading points will help you separate marketing from medicine.

Percentages
Look for 100 percent of the U.S. Daily Values in supplements you take. Despite the implied claims of megadosages, twice as much isn’t twice as healthy, and 30 times as much is useless.

Quality
The letters “USP” (U.S. Pharmacopeia) indicate the brand has voluntarily met rigid standards for potency, quality, and purity. Given the nonprofit advocacy group’s more than 175 years of experience, “USP” is worth seeking. In a recent study at Tufts, some supposedly top-shelf calcium supplements without the seal didn’t so much as dissolve.

Time release
Forget highly touted time-release coatings said to keep certain nutrients-such as water-soluble vitamins B and C-from going to waste by being absorbed all at once. Just take your vitamins and minerals with meals, and you won’t have to fuss with various coatings. A National Institutes of Health study, for example, suggests that tissues can’t use more than 200 milligrams of vitamin C a day, rendering a time-released pill overkill.

Source
For minerals in particular, provenance matters. Calcium supplements from oyster shells, for example, may also give you a dose of lead. Look for calcium citrate or purified calcium carbonate instead.

Dosage
Taking one multivitamin a day may be sensible, but some high-potency brands suggest up to nine pills a day — questionable advice, at best.

Squat-thrusts may seem like a handy bit of torture employed only by demented Hollywood drill sergeants, but military outfits such as the Navy SEALs really do use the exercise. “They work the arms, shoulders, chest, and thigh muscles,” confirms Mark De Lisle, a SEAL reserve who recently revised his self-published book, Navy SEAL Exercises.

To execute the exercise with true SEAL zeal, stand with your feet shoulder-width apart, hands on your hips. In one fluid motion, squat until you can place your palms flat on the floor alongside your feet. Keeping your weight planted over your arms, kick your feet straight back so that you end up in a straight-armed push-up position. Do one push-up, hop your feet back to the starting squat, and stand up. Add squat-thrusts to an existing thrice-weekly strength routine by starting with 20 reps and working up to 60. Ten reps in quick succession also make a good warm-up.