An alternative therapy used to improve posture is more effective at treating back problems than conventional treatments, research has found.
The first major scientific trial of the Alexander technique discovered that after a year's treatment, it could dramatically reduce symptoms. Massage, by contrast, offered little benefit after three months.
The technique teaches people to move and hold their bodies correctly by using frequently forgotten muscles to aid balance, and avoiding poor posture.
Problems stem from overusing some muscles and neglecting others in various parts of the body, not just the stomach or back.
However, once the imbalance is corrected sufferers are better able to adopt a more upright posture, such as when seated, standing or walking. Sitting correctly becomes more comfortable, reducing the desire to slouch.
It is popular with a host of professions, including performing artists and office workers, and is used by women to cope with labour pains.
After a year of treatment patients in the study receiving normal care, such as massage, endured 21 days of back pain in the previous month.
However, those who received 24 lessons of Alexander technique experienced 18 fewer days of misery.
In addition the Alexander technique group reported improved quality of life, according to the findings published online today by the British Medical Journal Online.
Professor Paul Little, a primary care specialist who led the study, said: "Massage is helpful in the short term, but the Alexander technique retained effectiveness at one year.
"The results should apply to most patients with chronic or recurrent back pain."
The method was devised in the 19th century by Frederick Matthias Alexander, a Tasmanian actor who performed in Sydney and Melbourne and was affected by vocal and breathing problems.
Seeking a cure he watched himself in the mirror, reciting Shakespearean sonnets, and found the answer appeared to lie in his posture. He had to re-educate both body and mind, he believed, to resist his instincts and learn new behaviour.
Many continue to follow his technique, among them John Cleese, Paul Newman and the Duchess of York.
It helps people overcome problems, such as hunching over at the desk or while climbing stairs, by making them aware of overusing some muscles and neglecting others.
By bringing greater balance in muscle use it allows the neglected muscles to strengthen without the need for exercise.
The Alexander technique, which has limited availability on the NHS, involves one-on-one sessions with a qualified teacher.
It is estimated as many as 85 per cent of the population experiences back pain at some point, and the problem costs the NHS about £500m a year.
Previous research had shown the Alexander technique and massage may help relieve pain in the short term, but little was known about the long term outcomes.
Prof Little, of the University of Southampton, and colleagues at the University of Bristol recruited 579 patients with chronic or recurrent back pain to compare the effectiveness of massage, exercise and the Alexander technique for relieving back pain.
Patients were sent disability questionnaires at three months and one year to record which activities were limited by their back pain, such as walking more slowly than usual or getting out of the house often. Exercise was least effective in reducing days of pain.
Professor Little said: "Back pain is a common condition managed in primary care and one of the commonest causes of disability in Western societies.
"As yet few interventions have been proved to substantially help patients with chronic back pain in the longer term.
"A series of 24 lessons in the Alexander technique taught by registered teachers provides long term benefits for patients with chronic or recurrent low back pain."
Kamal Thapen, chairman of the Society of Teachers of the Alexander Technique (STAT), said: "For over 100 years people from all walks of life have learned the Alexander Technique to overcome back pain.
We are delighted that this major clinical study now demonstrates that Alexander Technique lessons are effective.
One-to-one lessons, provided by STAT teachers, taught trial participants to improve body use, natural balance, co-ordination and movement skills, and to recognise and avoid poor movement habits that cause or aggravate their pain."