Long Car Journeys and Your Back: Set Your Seat Up Right

By Leslie Budzynski DC, GCC-registered chiropractor (GCC No. 00043) with 39 years’ experience. Here he explains what connection between back pain and long car journeys and how to set your car seat and head rest up to help prevent it.

School summer holidays begin. Time off beckons. The car is packed, the children are in the back and you have a three or four hour drive ahead of you before the holiday properly begins. Then you arrive, open the car door and your lower back has quietly seized up somewhere around the second service station.

If that sounds familiar, you are not alone. Few things provoke back pain quite as reliably as a long car journey and most of it comes down to two things we can actually do something about: how long you sit still and how your seat is set up.

In this post I want to explain why the spine dislikes a long drive so much and why back pain and long car journeys often go hand in hand. Then I can explain how to set up your car seat properly so you arrive in at your destination, wherever you are heading for your holiday, feeling like yourself and ready for action.

Why a long car drive is hard on your back

Sitting is not the villain it is sometimes made out to be, but sitting still for hours, in a seat that vibrates, is a real mechanical challenge for the lumbar spine.

Two things are happening at once which can cause back pain and long car journeys to be closely associated. First, holding a fixed posture allows the soft tissues of the spine to creep, the slow viscoelastic stretch of ligaments and the intervertebral discs under a sustained load. Second, the engine and road feed a continuous low-frequency vibration up through the seat and the seated human spine happens to be most sensitive to vibration in the region of four to five hertz, which is exactly within the band that a car produces.

The intervertebral disc is the part that takes the strain. Direct pressure recordings inside a living lumbar disc show that muscular tension raises intradiscal pressure and keep constantly changing position matters because movement drives the fluid exchange the disc relies on for nutrition (Wilke and colleagues, 1999). Sit rigidly for two hours solidly and you deny the disc that pumping action. Add vibration on top of that and the epidemiology is not subtle: a systematic review and meta-analysis found that whole-body vibration exposure is associated with an increased risk of both low back pain and sciatica (Burstrom and colleagues, 2015), and in a cohort of 537 professional drivers the 12-month incidence of low back pain reached 36.3 per cent (Bovenzi, 2009).

Wilke HJ, Neef P, Caimi M, Hoogland T, Claes LE. New in vivo measurements of pressures in the intervertebral disc in daily life. Spine. 1999;24(8):755–762. doi:10.1097/00007632-199904150-00005

Setting your car seat up properly

Most people adjust their seat once and that might have been years ago and then they never touch it again. It is worth five minutes before a long drive. The order that you do the seat adjustment matters, because getting the whole positioning right depends on the earlier ones.

The car seat set up for your pelvis and lumbar spine

Start by thinking about the pelvis, not the backrest first. Slide right back so your hips are at the base of the seat and make sure you are not sitting on a posteriorly tilted pelvis, that rounded, slumped position that flattens your natural lumbar lordosis (the inward curve of the lower back). A rolled towel or a proper lumbar support placed at roughly belt height, around the L3 to L4 level, supports that curve. Crucially, lumbar support does very little if the pelvis underneath it is already slumped, so fix the pelvis first.

The car head rest set up

Next, set the backrest recline to somewhere around 100 to 110 degrees rather than bolt upright. A slightly reclined, relaxed posture reduces the load on the lumbar discs and lets the erector spinae muscles that run alongside your spinerelax.

The height of the car seat matters too

Then adjust seat height and the knee-to-hip relationship so your hips sit level with or just above your knees and check the seat pan is not digging into the back of your knees. Finally, bring the seat close enough that you can reach the pedals with a soft bend in the knee and the wheel with a relaxed, slightly bent elbow, so you are not stretching forward and losing your lumbar support every time you clutch or brake.

Make it the best it can be

If you already live with a grumbling lower back, a well-set seat will not cure the underlying problem, but it stops the drive making it worse and could ultimately help to avoid or reduce the back pain and long car journeys cause and effect. You can read more about how we assess and manage that on our back pain page. I will add here that if the low back pain has ever travels below the knee or comes with pins and needles, that is worth attention.

If you are experiencing back pain that is being aggravated by driving, I would be happy to help. Call me on 01202 937568, or book a free 15-minute consultation at bournemouth-chiropractic.co.uk.

suggested positioning for your car seat and headrest for a long journey

The head rest: the safety feature most people set incorrectly

Here is the part of the car seat that almost nobody adjusts and it matters more than comfort. Your head restraint is not a pillow. It is a whiplash device, designed to stop your head snapping backwards in a rear end shunt car accident, the classic mechanism behind a cervical acceleration-deceleration injury. Two measurements decide how well the headrest works and does its job.

Height: the top of the restraint should reach at least the top of your ears  and ideally the top of your head, so it is behind the head’s centre of gravity rather than your neck.

Backset: the gap between the back of your head and the restraint should be as small as you can comfortably manage.

Why fuss over a few centimetres? Because the geometry of the headrest is directly linked to injury risk. Biomechanical work on head restraint position found that a larger backset allows greater rearward head travel and more strain through the mid and lower cervical spine and that an initial backset greater than around ten centimetres is associated with a higher risk of neck injury in rear impacts. (Ivancic PC, 2009) Setting the restraint up and forward is a thirty-second job that could save you months of neck pain.

It is the same driving-posture and headrest point we cover briefly on our page on desk related pain page, where whiplash sits alongside the tension headaches and stiff necks that desk work and long drives share.

Ivancic PC, Sha D, Panjabi MM. Whiplash injury prevention with active head restraint. Clin Biomech (Bristol, Avon). 2009;24(9):699–707. doi:10.1016/j.clinbiomech.2009.06.011

On the road: breaks, getting into the car and loading the boot

No seat setup beats simply moving. Because a static posture lets the discs and ligaments creep, so I advise breaking the journey every 90 minutes or so to stand, walk and gently arch backwards reverses that loading and importantly, restarts the fluid exchange your discs depend on. On the drive down to the ferry over to France at Poole or along the A31, that is not lost time, it is maintenance.

Before a big trip and after

If you know a long journey tends to leave you sore, it is far easier to set off already moving well than to unpick a locked-up back on arrival. A check before you travel means we can address any restriction, give you a couple of targeted exercises for the comfort breaks and make sure your setup suits your body.

The drive is only half the story. Unfamiliar beds, holiday footwear and the odd glass of wine take their own toll once you arrive, which I have writtn about separately in holiday aches and pains, watch this space it’s a blog post coming soon. Between the two reads, you’ll have the journey and the holiday stay covered.

Frequently asked questions about back pain and long car journeys

Can a chiropractor help with back pain from long drives?

Yes, most certainly for advice before hand and aches and pains after you return. Driving-related back pain is usually mechanical, meaning it comes from the joints, discs and muscles of the spine rather than anything sinister. A chiropractor can assess how your spine is moving, ease restricted joints and give you practical seat-setup and exercise advice tailored to your body and your car. Either saving your holiday or helping recover from it, chiropractic care is a positive and helpful solution for both. Get in touch anytime to have a chat and find out more.

What is the best seat position for avoiding back pain?

Set the pelvis back first, support the lower-back curve at about belt height and recline the backrest to roughly 100 to 110 degrees rather than sitting bolt upright. Keep hips level with or slightly above the knees, and sit close enough to reach the pedals and wheel without stretching.

How often should I stop on a long car journey?

I suggest aiming to have a break from driving roughly every 90 minutes. Even two or three minutes to stand, walk and gently arch backwards reverses the sustained loading on your discs and helps the spine recover, which matters far more than any single seat adjustment. Nobody said a walk round the service station wasn’t allowed and perhaps a coffee to fuel you onward.

Does my head restraint really affect neck injury risk?

It does, it a really important small detail. A head restraint set too low or too far back allows the head to travel further in a rear-end collision, which is linked to a higher risk of whiplash. Raise it so the top is level with the top of your head and keep the gap behind your head as small as is comfortable.

Why does my back hurt more after driving than after sitting at a desk?

A car adds continuous low-frequency vibration to the sustained sitting and the seated spine is particularly sensitive to vibration around four to five hertz. Long term exposure to this whole body vibration is associated with a higher risk of low back pain, which is why drivers report it so often.

Where is the clinic if I want a check before I set off?

I am at 42 Branksome Hill Road, Bournemouth BH4 9LE, a couple of minutes from the Wessex Way and easy to reach from Westbourne, Branksome, Canford Cliffs, Lilliput, Parkstone and Poole. I open at 7.30am Monday to Friday and until 3pm on Saturday, so an appointment before the drive is usually straightforward to arrange. You can see the full list of places I see patients from on the areas we cover page, or book an appointment online.

Written by Leslie Budzynski DC, GCC-registered chiropractor (GCC No. 00043) with 39 years of clinical experience. Principal chiropractor at Bournemouth Chiropractic, 42 Branksome Hill Road, Bournemouth BH4 9LE.

References for this article on back pain and long car journeys

1. Wilke HJ, Neef P, Caimi M, Hoogland T, Claes LE. New in vivo measurements of pressures in the intervertebral disc in daily life. Spine. 1999;24(8):755–762. doi:10.1097/00007632-199904150-00005
2. Burstrom L, Nilsson T, Wahlstrom J. Whole-body vibration and the risk of low back pain and sciatica: a systematic review and meta-analysis. Int Arch Occup Environ Health. 2015;88(4):403–418. doi:10.1007/s00420-014-0971-4
3. Bovenzi M. Metrics of whole-body vibration and exposure-response relationship for low back pain in professional drivers: a prospective cohort study. Int Arch Occup Environ Health. 2009;82(7):893–917. doi:10.1007/s00420-008-0376-3
4. Ivancic PC, Sha D, Panjabi MM. Whiplash injury prevention with active head restraint. Clin Biomech (Bristol, Avon). 2009;24(9):699–707. doi:10.1016/j.clinbiomech.2009.06.011