Plane Speaking: Your flight plan to avoid back pain

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Anyone who’s ever flown in coach or economy class already knows that the C-shape design of airplane seats is neither anatomically-friendly nor comfortable and that most seats “offer no lumbar support,” says Alan Hedge PhD, CPE professor of Design & Environmental Analysis at Cornell University.
three airplane seats connected togetherWhat can passengers with back pain do to alleviate discomfort? Photo Source: add to our travel misery, seat width and pitch (industry speak for the distance between seat rows that provides leg room) has been steadily shrinking.

Recently, bills proposed in the House and Senate aimed to stem and stop the shrinkage by requiring the Federal Aviation Administration (FAA) to establish minimum dimensions (including width, length, and seat pitch) for passenger seats on aircraft. According to the office of Senator Charles Schumer (Dem-NY), who proposed the Senate bill, since airline deregulation in the 1970s, seat pitch has decreased from 35 to 31 inches while the average seat width has contracted from 18.5 to 17 inches.

Both bills failed to pass. Schumer’s legislation was voted down by the Senate on April 7, 2016. The Senator says he isn’t giving up.

So until Congress steps in to expand onboard real estate, what can passengers with back pain do to alleviate discomfort? Booking a seat in business or first class is the obvious alternative, but it’s not an option for most of us. Second best?  If seat width isn’t a primary factor, “prioritize for leg room,” advises Professor Hedge. More leg room “allows you to recline and keep your spine in a neutral position.”  And the differences among carriers and jet models—more than 4” of legroom on some equipment—is significant. You can compare airlines and airplane configurations at SeatGuru.

Hedge, a frequent flyer himself (he’s taken 106 trips, travelling 130,000 miles in the past year) also recommends flyers follow these helpful tips:

Planning the trip

  • When possible, choose a direct flight. If you must change planes, choose a route with the fewest transfers.  
  • Book an aisle seat, if available, so you can move around the cabin more easily.
  • Pack light and keep your carry-on luggage weight to a minimum.
  • Wear comfortable, loose clothing that allows you to move freely.

On board

  • Don’t be shy about asking cabin crew for help to lift your carry-on into the overhead bin.
  • Take frequent “stretch” breaks.
  •  If your height requires it, bring a folding foot stool. Don’t let your feet dangle.
  • Bring a back pillow or roll up a blanket to support your lower back.
  • Experiment with different back-saving accessories such as lumbar support pillows and seatpans that are designed to maintain your spine in an optimal seated position. According to Hedge, that “optimal angle seems to be between 100-110-degrees.”

And, as for neck pillows, the jury is out. The C-shape of airplane seats tends to push the neck and head forward so a neck pillow may not be the best choice if you’re sitting upright.

Molly Roberts MD, MS, CEO and President of San Francisco-based LightHearted Medicine offers a unique prescription: “Honor your back,” she says.  It’s a prescription she’s followed fervently since she suffered a serious back injury in 2013, Ironically, Dr. Roberts injury happened the day she returned home from a romantic getaway to Venice with her husband. At her door, she tried to lift a heavy suitcase and immediately felt her back react. A week later, she “woke up in a lot of pain and unable to straighten up.” For weeks, she was confined to a wheelchair, her upper body bent over like a question mark. Following surgery to repair a ruptured disc and other damage, she was able to walk upright. “But there is still pressure on the spinal cord that results in ongoing pain. I still can’t lie flat and am best when I'm standing or walking,” she explains. “Sitting is my most difficult position.” Since she flies at least once a month for work, Dr. Roberts, now 54, has “gotten creative” about managing her back pain in flight. Among her techniques:

  • She concentrates on posture. “Slouching is bad for the back,” she says.
  • She uses a U-shaped neck pillow to support her lower back.
  • To prevent leg swelling and pain, she exercises her feet and legs by spelling out the alphabet, one foot at a time.
  • She stays well hydrated and avoids junk food, caffeine and alcohol
  • She only watches comedies in flight. “Laughing releases feel-good chemicals in the brain,” she says.

And the self-described techie is always on the lookout for a back-friendly gadget or accessory. She recently tried out the Lumo Lift, a “posture coaching wearable device” that vibrates when the wearer slouches. Her husband is using it now. Currently, she’s looking forward to trying a Baubax Travel Jacket, made with a detachable, inflatable neck pillow hidden in the collar, a travel eye mask tucked into the hood, pockets for sunglasses, passport, iPad, gloves and other travel necessities.  Dr, Roberts hopes the jacket might be replacement for her usual carry-on, a small laptop backpack that she always wears on both shoulders. “Never on just one shoulder,” she says emphatically.

Updated on: 09/10/19
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Common Back Pain Questions
Stewart G. Eidelson, MD
SpineUniverse Founder
Orthopaedic Surgeon
Southpalm Ortho-Spine Institute
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