A large number of my patients have difficulty with car seats. They drive long distances to get to and from work or drive their children around to school and their sporting or social activities. They may also do a lot  of driving as part of their occupation such as pharmaceutical reps. There are many variables that determine if an individual will have problems with the car seat. In general, car seats are designed to be comfortable but also safe just in case of a crash. Most car seats are classified as bucket seats while some trucks have bench seats. the back of the seat is generally lower than the front of the seat. this is to prevent the occupant sliding under the seat belt in the event of the crash. The back of the seat usually come with an adjustable lumbar support. Unfortunately most headrests and upper part of the seat curves forward. I think this is because it is the safest position to prevent whiplash in the majority of people who have a slouch. This forces the occupant into the head forward position which then contributes to Hip Rib Impingement ( HRI ). To alleviate this problem I ask my patients to purchase a semicircular shaped lumbar cushion and place it vertically along the thoracic spine and adjust the lumbar support in the seat to maximum. They should adjust the back of the seat such that the angle between the back and bottom cushion is equal or greater than 90 degrees.

I then ask the patient to sit with their head touching the headrest at all times as this will increase the Hip Rib Gap (HRG ) and also reduce the risk of whiplash injuries in case of a crash. Putting the seat belt on and leaning across the passenger seat to get things will cause impingement on that side and is worse if they twist to get something from the back seat. If they have pain on one side with prolonged sitting in the car then they require a hemipelvic raise usually on the painful side ( I use a hand towel folded in half to raise the pelvis by about 2-3 mm. They are also asked to perform the Air bag Technique when getting in and out of the car and keep their torso as upright as possible. They should also do the Air Bag Technique every 15 to 20 min throughout the journey to reduce lateral abdominal muscle fatigue due to HRI. HRI can also occur if they go over speed bumps or potholes on the road. They should perform the Air Bag Technique if they are able to anticipate the bump. Tight belts and wallets in the back pocket may also aggravate back pain with prolonged sitting in a car. This advice also applies to air plane seats. Some of the exercises recomended to prevent DVT during flights unfortunately may cause or exacerbate HRI and back pain.

For some people some cars and their seats are just too low for them to get in and out of and they need to get a car or a 4wd with higher seating. I regulary have to convince some of my taller patients that their dream mid life crisis sports car is not good for their backs. Thats it from www.drchrischinbackpain.com