Managing Back Pain While Traveling: Tips and Strategies
10 minutes read - Download the "Guide to Managing Health and Comfort for Prolonged Travel" below.
What holiday and business travel have in common - back pain
The World Health Organization describes lower back pain as the single leading cause of disability globally. Although prevention is the most effective strategy for avoiding back pain, our modern lifestyle often makes it challenging for our bodies to cope with daily stressors. Prolonged seated travel often contributes to the development or exacerbation of back pain. This article aims to explain practically how travel affects our bodies and offers information on preventing back pain.
1. From Seat to Suite: A Travel Story of Back Pain Management
Planning a holiday or a business trip is very similar. Once we know where to go, we can choose how to get there, who and what to take and what to consider during the journey. However, we often underestimate the weight of our luggage and extra items. Preparing for the trip can already put strain on our body. Done at the last minute, packing equals a workout, and might just give us enough adrenaline to mask any pre-existing discomfort and physical stress.
Occupying our thoughts with anything important for our destination, we tend to forget items which might be required for the travel itself. Forgetting required medications, or comfortable cloth can become problematic when discomfort or back problems are already a known issue.
We made it into the airplane or bus, arranging ourselves within limited space. It is not just the lack of aircon which keeps us hot during boarding, it is much more the physical stress keeping our temperature up. Shortly after the departure the cabin cools down and our bodies lose temperature and start to relax.
- Our body starts to activate our parasympathetic nervous system, and as the stress hormones decrease, the heightened awareness of pain and discomfort becomes more pronounced. Your body is now signalling its need for recovery and care.
However, we are squeezed between other travellers and our family, making movement nearly impossible. If this were a short trip, we would be back on our feet soon. Unfortunately, the trip has just begun.
During the flight, we find ourselves trapped in a seat that was not designed to accommodate our morphology for an extended period of time, with limited ability to meet our needs. Time seems to move slowly, especially when you already are in pain. Instead of enjoying the time off from emails, phone calls, and meetings, we find ourselves in an internally stressful situation. We are convinced that the solution to our acute problem is to finally arrive and get out of the seated position; we simply need to get through this now. We believe it is better to remain calm and distract ourselves with movies, music, and podcasts.
- While sitting on the plane during our trip, our hip flexor muscles become engaged and might become tight over time, while the hamstrings and gluteal muscles (buttocks muscles) disengage. This seated posture applied pressure to the spine, especially in the lower back, the lumbar section. Remaining in this seated position with little movements slowly stretched the muscles on one side of the spine, which applied increase tension on ligaments. The opposite side of the spine is compressed, causing an uneven pressure on the vertebral discs, and altering the liquid distribution and shape of the discs. One of the discs began to press against tissue and nerves on the less compressed sides. Our spine signalled a loss of integrity. Muscles activated to prevent forward or backward movement of the vertebrae around the compressed disc. We noticed this spasmodic response as tightness with mild pain.
Finally, the plane has landed, and we anticipate being free from our painful journey soon. Leaving our seat and standing up brings immense relief—the pain seems to vanish.
- Our body has activated the sympathetic nervous system; adrenaline and cortisol surge through our systems, readying us for action.
The pain is almost forgotten, and the holiday can begin. A few minutes later, we find ourselves in the arrival hall waiting for our luggage. Standing feels great, but gradually, we start to feel a bit unstable in our lower back, and our neck and shoulders begin to ache slightly. This discomfort grows as we worry about the arrival of our luggage. We are nearly there, and this is not the time to fret over back pain; its time to get into the holiday mood and push through. Leaning on the trolley or against a wall might offer some relief. Our back feels somewhat unstable, but soon we'll be at the hotel where we can lie down for a while.The luggage arrives, and we quickly weave through the other passengers to reach the baggage carousel. As the baggage continues to move away from us, we grab it with one hand and with a skilled sideways movement, pull it off the conveyor. Surprised by its weight, we hastily make our way out of the crowd and skilfully lift it onto the trolley. Done, we've made it.
- Between leaving the seat and rushing to the baggage claim, the spine did not have enough time to return to it natural state, homeostasis. When grabbing the luggage, the activated muscles protecting our spine did not relax during the sideways movement, adding additional pressure on the compressed or adjacent discs. Consequently, we may have caused a mild injury to the connective tissue of the discs, muscles, or ligaments. Additional supportive muscles engage to support the spine.
Upon arriving at the hotel, we cannot wait to lie down and take care of our backs, allowing them to recover from all the stress. It feels great lying on this soft mattress, letting my body relax and sink in. Waking up after a short nap feels less joyful than expected, but it's time to go for dinner. Perhaps it would be better to stay in bed and recover? No, there is business to attend to.Transitioning to a seated position works well, though the back feels somewhat rounded. As we get onto our feet, shifting our body weight, a shooting pain strikes, like a lightning bolt to the spine. After a moment of consideration, we manage to move and lie down sideways in a foetal position, waiting for the pain to ease. We decide to call it a day and conclude that it would be better to have a long sleep.
- After the short nap at the hotel, the healing process began. Inflammation around the torn tissue increased blood flow and temperature, causing swelling of adjacent structures. When trying to stand up from the bed, our discs had not yet returned to their functional shape, therefore our spinal muscles continued to protect the spinal cord. While the surrounding tissue remained swollen, the compressed disc bulged against the spinal nerve roots, signalling a threat to the body's survival.
Painkillers and heat packs helped us get through the night. Our back still aches, but the shooting pain has eased. Finally, for now, all appears to be okay, and we can make it on time to the conference or start our truly deserved vacation.
- During the night, lying down significantly reduced the pressure on the mildly injured back, and the swelling eased. The length of the spasmodic muscles adjusted, allowing the intervertebral disc to even out its shape. However, while the injured tissue began to heal, our muscles continued to protect the mildly injured back.
Even though the holiday went well and the conference was a success, the mild back pain persisted upon returning home, lasting for days or weeks. The sad part of the story is just about to begin.In the following weeks, we reduced physical activities and minimized changes in position, especially from seated to standing, preferring to spend time in bed or on the couch as our back constantly reminded us to be careful. A month later, we had almost forgotten about our back pain.
- While our minor injury caused antagonistic muscles to spasm simultaneously, it created a reflex arc, which required constant feedback from the Central Nervous System to remain active. As this process is quite inefficient in the long run, another mechanism began to take control. Our Central Nervous System signalled through the spinal cord to the muscles surrounding the affected area to protectively guard it as a long-term solution.
From now on, our bodies took full control of guarding the affected area, which allowed us to start physical activities; even going back to the gym was possible. Two months later, while dropping a box of groceries sideways into our car, the lightning strike hit again. This time it remained for six weeks, and the doctors suggested it would require surgery before returning to work.
- Our actively engaged muscles restricted the movement of the lower spine during that rotational movement, causing immense pressure on the lower intervertebral disc, which then failed. The disc tore and compressed spinal nerves, leaving us severely injured and in immense pain.
The story above is just an example of a typical scenario in which back pain can develop. It explains some causes, but other causes like underlying injuries, diagnosable tissue damage, referred impact from organs, and other conditions have not been discussed.
You might be very lucky if you have never experienced back pain; however, at least 25% of people have experienced similar situations, most likely on a regular basis. For many people, back pain is part of their daily life, and they have established controls to reduce the impact of the pain. They often become high performers in managing their ailments, covering up their pain, all while performing at the same level as their pain-free colleagues.
At times when the pain becomes unbearable, affected people might consult a doctor, a physiotherapist, or a chiropractor, which can help alleviate the pain. However, in most cases, a single consultation is insufficient to fully understand the cause of the back pain, and treatments often provide only temporary relief. Consequently, people receive treatment for their pain, while the underlying cause often remains unidentified and unresolved.
For instance, according to the World Health Organization, 90% of lower back pain cases are diagnosed as non-specific lower back pain (WHO 2020). This means that 9 out of 10 people experiencing lower back pain are told that the cause of their pain is unknown. Furthermore, approximately 16% of all Australians with back pain develop chronic back problems, with conditions lasting longer than six months (ABS 2022). This equates to every sixth person suffering from chronic back pain at home and in the workplace. Chronic pain often leads to ongoing stress, both physically and mentally, affecting the quality of life of the individuals and their families, as well as the economy and the community.
Therefore, back pain is not merely an individual problem but a culturally significant disease, and our society would greatly benefit from efforts to prevent, mitigate, and treat it.
2. Prevention through planning
Maintaining a healthy body and mind is the most effective way to avoid developing physical problems.
Avoid long periods of seated travel. Check if there are other ways to achieve your travel goals without putting yourself at risk of developing physical problems, especially if you believe that prolonged sitting will harm your body.
If you already have back pain or expect to have it during your journey, plan your mitigations ahead of time. Check with your General Practitioner to see if you are fit for long-term travel, and get advice on what to do before, during, and after the trip to stay healthy.
Notify your manager of any pre-existing conditions, as well as any special needs you may have during the trip. Ask your employer to book a seat with legroom and discuss how to handle heavy luggage, espiecially if corporate equipment is needed for the trip.
Travel lightly and comfortably. Make sure your luggage is only as much as you can comfortably handle, and that weights are evenly distributed. Consider getting appropriate suitcases, such as those with four casters, which make it easy to push the luggage while walking.
Make sure your travel itinerary includes plenty of time for breaks, especially if you are driving yourself. Allowing the body to maintain its natural functions is essential for preventing back pain caused by prolonged travel.
3. Mitigation while traveling
Ensure that everything required to maintain a good health during your journey, will be available, like water, required medications and aids, inflatable pillows, spare cloth, entertainment, noise and light cancelling equipment.
Ask the cabin crew for an aisle seat when your assigned seat cannot be left without disturbing other passengers.
Leave the seat at least every 30 minutes as recommended by Safe Work Australia. Walk around the plane to stretch your muscles, improves circulation, and reduces the risk of blood clots (i.e. deep vein thrombosis). Gentle stretches are good to perform at the rear of the plane. (Examples of gentle stretches can be found in the "Guide to Managing Health and Comfort for Prolonged Travel" below)
While seated, change your seating position regularly, aiming for every 5-10 minutes to prevent stiffness and improve circulation. Avoid crossing your legs as it can restrict blood flow and lead to discomfort; instead, keep your feet flat on the floor or use a footrest if available. Perform simple seated exercises like ankle circles, leg lifts, and shoulder and neck rolls to promote blood circulation and relieve muscle tension while seated.
Use Lumbar Support or a rolled-up blanket to provide lumbar support and maintain proper spinal alignment while seated. Use inflatable cushion to change your seat position, adjust level of inflation regularly to reduce localised pressure on hamstrings, pelvis, and lower spine. Adjust your seat's recline function, footrest (if available), and headrest to find a comfortable position that supports your back and reduces strain.
The most important mitigation to avoid back pain is to keep moving, comfortably. Muscle activation and relaxation, regular posture changes, adequate hydration and nutrition, and a calm and satisfied mind will assist you in arriving safely and performing well at your destination.
4. Act when pain arises
If you experience any new severe or moderate pain during travel, please notify the cabin crew and your fellow passengers. Get medical assistance if necessary!
Even if you did everything you could to prevent and mitigate back problems, you may still experience discomfort or mild pain, which you should not ignore. Now it is time to act and pay attention to your body. Avoid any additional physical and mental stress.
After leaving your seat, continue walking, avoiding prolonged standing, sitting, or laying, to allow your body to regain its natural functions, increase blood flow to tissues, and activate cell metabolism. Stay hydrated! Light exercises and stretches help to engage muscles, stimulate the Central Nervous System, and restore your body's balance.
In this challenging situation, staying calm and optimistic can help alleviate stress. Utilising breathing exercises and maintaining positive thoughts can effectively reduce both mental and physical strain. The "5-4-3-2-1" technique often helps calming down: Identify five things you can see, four you can touch, three you can hear, two you can smell, and one you can taste. This method brings your attention to the present moment, calming the mind.
When we experience back pain, our bodies naturally guide us toward what needs to be done. It is important to listen to these signals. However, we must be aware that behaviours can quickly turn into habits, potentially hindering future healing. For example, if lying down initially eases the pain, there is a risk of gradually incorporating longer periods of rest into our daily routine. While this may alleviate the physical discomfort initially, our mindset and behaviours might adapt, leading to persistent pain. Therefore, it is crucial to consistently reflect on our physical state. Taking a quiet moment to close our eyes and objectively observe our bodily sensations can provide insightful understanding into what our body truly needs.
5. When the pain persists
If your pain persists, the first step should be to consult your General Practitioner, who will discuss and treat the conditions and refer you to specialists if necessary.
However, when the cause of the back pain is unclear, or degenerative diseases have been identified as the cause of the pain, it is crucial to seek solutions to alleviate the pain, as it can significantly impair your quality of life and lead to secondary, often more severe injuries. Physical therapies, psychological support, behavioural changes, and modifications to daily routines such as diet and physical activities, along with environmental adjustments, can all contribute to resolving the issue. Often, relieving muscle spasms and freeing impinged nerves allow the body to return to its natural state. It is essential to recognize that most back pain conditions improve and may even heal over time. However, this healing process requires an awareness of your sensations, identifying actions, behaviours, and factors that reduce the pain and enhance mobility. To achieve pain relief, possessing a positive mindset and a strong willingness to heal is essential.
In closing, remember that back pain is not only preventable but also treatable, with many cases resolving over time. The key to a successful journey towards becoming pain-free lies in thorough planning and a proactive approach to health, both individually and within the workplace. Employers can significantly contribute to this process by accommodating the needs of their employees, thus fostering an environment conducive to physical well-being. By taking these steps, we empower ourselves and others to overcome the discomfort of back pain, leading to a healthier, more active lifestyle. Let us embrace the journey toward healing and become advocates of a pain-free life, both at home and on the move.
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Published by NQ Spine Health April 2024