Planes, Trains, Automobiles and Back Pain, Oh My!

Many people spend a significant amount of time driving or riding in a vehicle on a regular basis. For some, it’s a daily commute or occupation, others may take long trips.  Then there are the road-trippers.  As summer approaches, people of all ages are looking forward to, and often counting the days until, their vacation.  That magical time when individuals and families step outside their routines in an attempt to have fun and recharge.  It’s a time to get away from the usual causes of stress and strain.  However, as many occupational drivers know, the act of traveling can in and of itself be a source of physical stress and strain.

A 1992 study on the role of occupational environment in the occurrence of low-back pain among commercial travelers was published in the Scandinavian Journal of Work, Environment & Health.  They found time spent driving a car at work, comfort of the car seat, to be 2 of the primary risk factors associated with low back pain.  When subjects were re-interviewed a year later, they specifically found that driving 10 hours per week or more, was associated with first occurrence of low-back pain.

A few years later, a study compared workers from Sweden and the US.  In both countries, 50% of the study participants reported low back pain.  Again, driving, or more specifically long-term vibration exposure that is experienced while driving, was one of the highest risk factors for back and neck pain.

Recently, researchers reviewed 56 studies conducted in 23 different countries across a total of 14 types of occupational transport that had been conducted from 1990 to July 2019 and published their findings in the Journal of Occupational Health.  Together, the studies included almost 19,000 professional drivers.  The overall prevalence of musculoskeletal pain (MSP) ranged from 43.1% up to an astounding 93%!.  The most frequent type of MSP was low back pain, which was reported by 53% of the subjects, followed by followed by neck, upper back, shoulder, knee, hip/thigh, wrist, ankle, and elbow.

Whether you travel alone, or with family, for business or pleasure, long hours driving or flying can make a person feel stressed, tired, stiff and sore.   “Prolonged sitting can wreak havoc on your body,” says Dr. Scott Bautch, past president of the American Chiropractic Association’s (ACA) Council on Occupational Health. “Even if you travel in the most comfortable car or opt to fly first class, certain pressures and forces from awkward positions can result in restricted blood flow. One of the biggest insults to your system from prolonged sitting is the buildup of pressure in the blood vessels in your lower legs. Contracting and relaxing the muscles helps the blood flow properly.”

Dr. Bautch and the ACA suggest the following tips and advice to fight the pains and strains of travel before they occur:  Many of the tips for planes will also apply to traveling by train.

“Warm Up, Cool Down Treat travel as an athletic event. Warm up before settling into a car or plane, and cool down once you reach your destination. Take a brisk walk to stretch your hamstring and calf muscles.

In the Car:

  • Adjust the seat so you are as close to the steering wheel as comfortably possible with knees at or slightly lower than hips.
  • If your vehicle’s seat doesn’t have adjustable lumbar support, consider a back support. Using a support behind your back may reduce the risk of low-back strain, pain or injury.
  • Exercise your legs while driving to reduce the risk of any swelling, fatigue or discomfort. Open your toes as wide as you can, and count to 10. Count to five while you tighten your calf muscles, then your thigh muscles, then your gluteal muscles.
  • Roll your shoulders forward and back, making sure to keep your hands on the steering wheel and your eyes on the road. Tighten and loosen your steering wheel grip to improve hand circulation and decrease muscle fatigue in the arms, wrists and hands.
  • Make sure your seat raises your eye level at least three inches above the steering wheel while allowing sufficient clearance between your head and the roof.
  • Set the top of the headrest between the top of your ears and the top of your head, just touching the back of your head when seated comfortably.
  • While always being careful to keep your eyes on the road, vary your focal point while driving to reduce the risk of eye fatigue and tension headaches.
  • Take rest breaks. Never underestimate the potential consequences of fatigue to yourself, your passengers and other drivers.

In an Airplane:

  • Stand up straight and feel the normal “S” curve of your spine. Then use rolled-up pillows or blankets to maintain that curve when you sit in your seat. Tuck a pillow behind your back or just above the beltline. Use a neck pillow for added support.
  • Check all bags heavier than 5-10 percent of your body weight. Overhead lifting of any significant amount of weight should be avoided to reduce the risk of pain in the lower back or neck. While lifting your bags, stand right in front of the overhead compartment so the spine is not rotated. Do not lift your bags over your head, or turn or twist your head and neck in the process.
  • When stowing belongings under the seat, do not force the object with an awkward motion using your legs, feet or arms. This may cause muscle strain or spasms in the upper thighs and lower back muscles.
  • While seated, vary your position occasionally to improve circulation and avoid leg cramps. Massage legs and calves. Bring your legs in, and move your knees up and down. Prop your legs up on a book or a bag under your seat.

Safe Travel For Children:

  • Know and follow car seat regulations for infants, toddlers, and school aged children. Find information through state government websites or also
  • Ask the airline for their policy on child car seat safety. Car seats for infants and toddlers provide added resistance to turbulent skies, and are safer than the lap of a parent in the event of an unfortunate accident.
  • Car seats should always be placed in the back seat of the car-ideally in the center. This is especially important in cars equipped with air bags. If an air bag becomes deployed, the force could seriously injure or kill a child or infant placed in the front seat.
  • Make sure the car seat is properly secured to the seat of the vehicle. Many local fire departments and hospitals have trained individuals who can assist with installations.”

Remember that chiropractic care is an excellent method of both preventing and treating musculoskeletal pain that may result from travel.  Your chiropractor can help you devise a plan to treat your pain and provide posture tips to help avoid future discomfort.  You want to spend your time enjoying the trip, not battling back pain.  Your chiropractor can help!


American Chiropractic Association  “Summer Travel Aches and Strains Can be a Pain in the Back”  June, 2016

American Chiropractic Association “Prevent Aches & Pains on Your Next Road Trip”  July 17, 2020 accessed 4/21/22

Pietri F, Leclerc A, Boitel L, Chastang JF, Morcet JF, Blondet M. Low-back pain in commercial travelers. Scand J Work Environ Health. 1992 Feb;18(1):52-8. doi: 10.5271/sjweh.1614. PMID: 1532455.

Magnusson ML, Pope MH, Wilder DG, Areskoug B. Are occupational drivers at an increased risk for developing musculoskeletal disorders? Spine (Phila Pa 1976). 1996 Mar 15;21(6):710-7. doi: 10.1097/00007632-199603150-00010. PMID: 8882693.

Joseph L, Standen M, Paungmali A, Kuisma R, Sitilertpisan P, Pirunsan U. Prevalence of musculoskeletal pain among professional drivers: A systematic review. J Occup Health. 2020 Jan;62(1):e12150. doi: 10.1002/1348-9585.12150. PMID: 32810918; PMCID: PMC7434558.