Nearly every adult in America suffers from lower back pain at some point in life, whether it's from shoveling snow or doing something else.

That doesn't mean we have to live with it.

"We shouldn't be thinking that "Oh, I have to put up with back pain,' " says Jan Hornack. "Having back pain is not normal.

"There's exercises, there's activities, there's changes in behavior that can significantly change your pain."

She should know. Hornack's been a physical therapist at Cleveland's MetroHealth Medical Center for 37 years. And she teaches the hospital's Physical Therapy Back School.

Hornack doesn't recommend exercises in the 90-minute outpatient class. Those, she says, need to be tailored to each patient. But she's got a lot of tips to keep your back pain-free:

1. Grab a pillow. Especially when you fly. Airplane seats are tough on backs. So as soon as you get on a plane, ask for one or two of those little pillows and tuck them behind your lower back. This helps support that curve at your waist, which puts the joints and muscles in a more relaxed and comfortable position. If the pillows are as scarce as the snacks, use your hat or coat sleeve - anything that will help fill that void. Do the same when you're in the car, unless your seats have built-in lumbar support.

2. Sleep with two pillows. Bed pillows aren't just for under your head. If you sleep on your back, pull one under your knees, taking the pressure off your hips. If you sleep on your side, slide that pillow between your knees to keep muscles properly aligned and take pressure off your back. You can also tuck a rolled-up bath towel under your waist to keep your spine from curving down into the bed. Try not to sleep on your stomach: It arches your back, and that causes trouble.

3. Watch where you sit. Try to avoid low, soft chairs and sofas. You end up throwing yourself forward to get up, and that wrenches your back.

4. Watch what you eat. Carrying extra weight puts stress on your back. And if you don't eat well, your muscles and joints don't have the calcium, protein and other nutrients they need to keep you upright.

5. Watch what you eat II. Be careful transferring groceries from the cart to your car. If you plant your feet parallel to the cart, you'll twist your back as you move the bags to the car. Instead, move your feet so they're perpendicular to the cart when you remove the groceries and perpendicular to the car when you load the groceries into your trunk. Your hips and shoulders should always be parallel. If you twist, you put seven times more force on your spine than you normally would.

6. Find the perfect worktable. When you're standing - to chop onions, iron or fix a broken toy - your worktable should be no more than 2 to 4 inches below elbow level. That keeps you from bending over and straining your back. When you're sitting, your workstation should be at elbow level. If it's not, adjust your chair height.

7. Pack smart. Distribute weight evenly if you're packing suitcases or other heavy bags. Use two, carrying one in each arm so you don't overload one side of your body.

8. Try the two-step. If you have to stand for a long time, put one foot in front of the other once in a while, then switch. Even better: Put one foot on a stool, about 4 to 6 inches high, to keep you from putting stress on any one joint for longer than it can tolerate.

9. Learn to lift. It's easy to remember if you follow the Five L's.

- Legs: Keep them slightly apart for good balance and bend knees and hips, not your back.

- Lever: Keep whatever you're lifting close to your body to reduce strain on your lower back. Don't twist (don't let the middle of either forearm pass your belly button).

- Lungs: Take a deep breath and exhale as you lift and tighten your abdominal muscles. Your back will be more stable and better supported.

- Lordosis: This is the natural curve in your spine that creates the hollow in your lower back. Try to maintain it as you lift.

- Load: See if a load is too heavy by lifting it just an inch or two at first.

10. Stay active. This is the most important tip, Hornack says.

Get up, go for walks, live your life. Don't put yourself to bed if your back hurts, she says.

"When we're active, our muscles are in better shape, we're more flexible, we have more conditioning, we have more strength," Hornack says.