Flying with Back Pain
Updated: May 6
Flying and back pain creates a great deal of anxiety. Here are some evidence based travel tips for flying with back pain.
Seven things to do before your flight
1. Stay on top of your exercise routine. Staying fit is the single most important thing you can do to ward off pain related to flying. Arrive to the gate so you have time to stretch. Focus on spinal mobility stretches, hamstrings, calf and quad stretches before boarding. Travelers commonly make comments to me while I’m rolling on the floor doing spinal twists and cobra’s (back extension) stretches. I mostly here things like, “Wow, that looks like it feels really good. I should do that.” I agree and leave it at that. If I tell them I’m a PT, which I have stopped doing, it usually turns into a long consultation about their particular problem and my routine is interrupted as they want help for their list of problems.
2. Pack lightly. This is probably the most important strategy one can do to prevent low back pain from traveling. More injuries to low backs and shoulders are related to pulling, lifting and pushing luggage around from the ground to the overhead bin.
3. Keep your medications on hand. This goes without saying, be prepared and be smart.
4. Bring a Doctors note / contact airline about your diagnosis. This is a good idea only if you are dealing with a recent and significant back problem such as a recent spinal surgery or acute flare up. Contacting the airlines can help in getting an early boarding pass, getting a seat with ample leg room and have a wheelchair available to board. The MD note could explain the use of a transcutaneous electrical nerve stimulation (TENS) unit used for pain control for getting through security quickly.
5. Schedule smart. Travel when the flight may be less full so you can get up and move around much easier.
6. Book that aisle seat (If flying Southwest Airlines, pay the extra fee to get early check-in. You will likely get an A group boarding pass).
7. Pack your neck and back pillow.
Nine ways to stay pain-free while flying
1. Load luggage in the overhead bin slowly. If you slow down someone might jump in and help you load your luggage. If not, take the bag from the floor to the backrest of the aisle seat and then to the overhead bin. Do the same process in reverse when departing the plane.
2. Move around regularly. Aisle seats are the best seats in the house. You can move around virtually as much as you like. I spend a lot of time stretching my hamstrings with my foot on the seat and backwards bending in the aisle several times in long flights. Other stretching areas are the aisle while walking to the bathroom, the flight attendants quarters and bulkhead area.
3. Recline the seat (slowly). A reclined seat with the angle between the femur bone and trunk being greater than 130 degrees decreases the intra-discal pressure up to 30%. This will help keep your hips and pelvis loose by repeatedly crossing your legs back and forth.
4. Unload / traction your back. While seated with the seat belt on. Push down on the armrests to stretch the low back. Push for 5-10 second intervals as needed.
5. Use your pillows and keep moving them around. There is no “one way” to support your back with pillows. However, I still have patients telling me they use a lumbar roll (small tube-like foam pillow) in the small of their back to “support the curve” and eliminate slouching. There is no medical evidence that slouching causes low back pain. However, if you slouch for extended periods of time, you will have pain. My first alternate pillow position is, sit on it. This will put your sit bones slightly higher than your knees which will lower disc pressure and allow for a good option in sitting for long periods. Keep moving and remember, “Your best posture is your next posture”.
6. Alternate between heat and ice. Your best travel heat packs are ThermaCare and there are several gel ice packs one can buy that are great when traveling. Bring a few gallon sized ziploc bags and get ice from the flight attendant for an instant ice pack.
7. Wear compression stockings (knee highs). This has become a popular amongst traveling endurance athletes to minimize the risk of a deep vein thrombosis (DVT). Studies show the gear has little to no effect on athletic performance, but some people swear by it. The evidence for faster recovery is better, but not enough to make a difference for weekend warriors.
8. Use layover time to walk and stretch. Don’t get off the plane and sit in the seats at your next gate. Get moving, remember my mantra, movement is medicine.
9. Bring something to keep you entertained in a positive and healthy manner. Great novels for reading, listen to positive healing music or getting involved with your work on a laptop computer are all things that keep your mind occupied on a task and not your pain.