Put Yourself (Pain-Free) in the Driver’s Seat

Setting Up Your Driver’s Seat to Prevent Low Back and SI Pain: Ladies especially, listen up.

This is really for everyone, but the seats in cars are designed with the average man in mind, so they don’t quite fit the ladies or men outside the average build. I’ll explain why as we go.

This post is about setting up your car seat for optimal comfort as well as preventing sacroiliac (SI) pain or any low back and hip discomfort. If you commute to work, spend a lot of time shuttling kids or other family members to events or appointments, are planning a road trip, or otherwise just drive a lot, please read. If the only adjustability your car seat has is moving the seat forward or back, please read. Maybe you never drive but are a passenger in a car, please read.

This post is NOT about car safety. I am not suggesting anything unsafe, but there are specific suggestions about distance from your steering wheel or how the headrest should be set for optimal safety in a crash. This will not give you that information. Search further for that information in your owner’s manual. This is also not about kids. This is for adults, but the ideas can be generalized to kids and teens.

Having All the Bells and Whistles Isn’t Enough to Avoid Pain

New cars offer some pretty amazing bells and whistles, many of which are right under our bottoms. A recent client was heading out soon on a road trip with her husband. She has some low back problems, so I suggested we look at setting up her car seat and asked her what kind of adjustability features her car seat had available. Several weeks ago, she purchased a new car and knew it had some adjustability but hadn’t played with it to know what to tell me. After I explained some common issues with car seats and back pain, she agreed that we should save some of our session to check out the features and set it up for her.

When we went outside, she hopped in the passenger seat because her husband does most of the driving. When she sat down, the position of her seat was far less than ideal and could have contributed to her persistent back pain. Her new car had all the adjustability features an occupational therapist like me dreams of, including:

• The seat pan moved forward and backward.
• The seat pan moved up and down.
• The seat pan tilted.
• There was a feature that raised the forward part of the seat, near the knees only. (This was very cool.)
• The back of the seat tilted separately from the seat pan.
• There was a lumbar support option.
• The headrest was in a completely vertical position, so I did not check the adjustability options.

Common Problems When Sitting in Car Seats

Unfortunately, we did not take photos the day we did the assessment, so I’m recreating some common problems experienced when driving or as a passenger in a car.  I had two clients recently who were willing to pose for photos, and I was able to catch some issues and give them some suggestions. Thank you, Stacy and John!

Before I dig into the problems, let me first say that no position is bad. Problems arise when we choose a less-than-ideal position most of the time. I later discuss choosing a healthy home base and varying from that often. The positions I’ll discuss next are only problematic when they are chosen the most often.

Problem One: Knees Higher Than Hips

Why is having the knees higher than the hips is not ideal for you? If you were sitting in an office chair rather than a car seat, no ergonomic specialist would ever (in a million years) tell you to have your knees higher than your hips.

When the knees are higher than the hips, the force of gravity is taken entirely through the lower hip bones, often called the sit bones. When riding in a car, the forces are not just gravity and the weight of the upper body. Every bump you feel is a force the body must deal with. Even though John’s car is a super smooth ride, there are still forces the body must deal with. If the forces are excessive, the fascia will determine this is a trauma that it must protect you from and lay down extra structural support (in other words, get thicker and tighter).

Notice that John’s right knee is higher than the left. This is his preferred position when driving. He is very tall with very long legs and doesn’t have a lot of options with his driving leg. He prefers to have his left leg stretched out, which brings this leg more horizontally in line with the hip. This is good. Why? When the knee is horizontally in line with the hip, the thigh can accept more of the forces of gravity and the normal bumps from driving. This is good.

Another problem arises when one knee is high, and the other is low. This will potentially twist the hip. I hope John doesn’t mind me sharing that his irritation is primarily on one side of his hip/low back. If I didn’t already know John, this picture would tell me where he might be having issues.

Optimal Knee Placement while Driving

What is the fix? Bringing both knees in line with the hips. Unfortunately, John is so tall, this isn’t possible in this car. I guess we’ll see what he decides to do!

Our next model is Stacy. She is the opposite of John. She is much shorter and has a much larger vehicle. In the top left photo, her knees are higher than her hips, and the part of her thigh closer to the knee is not in contact with the seat. In the photo on the right, she has adjusted both the seat and her foot position to bring the thigh fully in contact with the seat. The knee is still a little higher than her hips, but this position is better than the position in the left picture.

The good news is that she is not asymmetrical. Unlike John, her low back issues are on both sides of her body. Both models’ issues align with their habits. Both John and Stacy drive a lot. John takes long road trips and Stacy is in and out of the car, shuttling kids and commuting to work.

Problem Two: Tucked Pelvis

The picture above shows the proper alignment of the pelvis on the left. You can find these landmarks in your own body by feeling them with your fingers. You actually have two ASIS landmarks. One on each side about where the pockets of your pants would be. You have one pubic bone, which you can feel if you find your belly button and then move straight down until you feel bone.

The picture shows a standing position, but the same position applies when sitting. When standing or sitting, if your pubic bone is further forward than your ASIS or top of the hips, your pelvis is tucked as in the drawing on the right. You can also see by the blue lines how the tailbone goes from a normal slanted position on the left to a more vertical and not a normal position when the hips are tucked. Sitting with your pelvis or tailbone tucked is not a good choice; many people do it unknowingly. The tucked position puts excess pressure into your tailbone and flattens your lumbar curve, which we’ll discuss next.

Problem Three: Lumbar Support Missing or in the Wrong Spot

Your lumbar or low back curve is normal, and you should feel a gentle curve in your lower spine when standing and sitting. The picture above shows how the curve disappears when the pubic bone is forward from the ASIS. When the lumbar curve is flattened, the discs in the spine have more opportunity to become displaced. See the picture below. The blue stuff between the bones represents the disc bulging out and putting pressure on the nerve. A disc bulge scenario can go from slightly annoying to excruciatingly painful.

I do not have a lumbar option in my car, so I keep a small folded towel and use it in my lumbar space to help keep my pelvis in a good position while driving. If you have a lumbar option in your car and use it, be sure it is not pressing on your tailbone. This can be very irritating over time, causing sacroiliac or SI pain.

In the photo below, you can see how high above the seat I need the towel to be to fit comfortably in my lumbar curve. This is much higher than most lumbar supports embedded within the seat.

Problem Four: Head Rest Too Far Forward

The headrests in newer cars are far too forward. I’m sure this is done for safety reasons. And car manufacturers are adapting to the anthropometrics of the modern-day body. Unfortunately, too many people have forward head posture, and to protect them in case of a crash, the headrests are being placed further forward. However, for those of us with our heads in good alignment, a forward headrest feels like it continually pushes me forward, and I find it very irritating to my neck. To create a more comfortable position, I have to lean my backrest a little further back and bolster my low back support a bit more

Problem Five: Asymmetrical Postures

This is just a reminder that no position is bad. It is only when we choose one less-than-ideal position most of the time. Another common problem I see is that asymmetrical positions are preferred positions. This may be one knee higher than the other, as seen in John’s picture. It may be leaning an elbow on the center console. Below, I am demonstrating an asymmetrical driving posture, which I sometimes find myself in during a long drive. Again, this is OK for some of the time but not most of the time. Observe some of the issues in this photo:

• Leaning on my right elbow.
• Right arm outstretched.
• The left knee is higher than my hips, with the right in line. Likely twisting my hips.
• Pelvis tiled (pubic bone forward).
• No lumbar support (flattened low back).

If I drove in this position all or most of the time, no doubt I would have back pain and maybe some shoulder pain. If I get lazy or I’m too busy thinking to pay attention to my body, I tend to get pain in my tailbone if I stay in this position too long.

An Example of Asymmetrical Driving Posture

Many years ago, a family member who drove a semi-truck for a living told me about a pain in his left elbow. When we went to his truck to look at his position, he sat down, immediately placed his left elbow on the window ledge, and held the steering wheel with the same hand. When I asked how often he drove like this, he responded, “Most of the time.” The constant pressure of the window ledge is called contact stress and can irritate the tissues over time, causing localized inflammation. The constant leaning to the left was also shifting weight onto the left hip, contributing to his low back pain. Once he understood all this, he chose more variety in his positions.

Create a Home Base, Then Add Variety

The human body loves variety. The body gets very stiff when sitting, standing, or lying down in one position for too long. Car trips tend to make us very stiff, especially when you are traveling with that person who makes it their mission to get to the destination quickly and minimize stops. I recommend that my clients think about their posture in the car in the same way they should think about their posture when standing or sitting at a desk. It is important to have a good, solid home base posture.

You don’t have to spend all your time in the home base posture, but it is important to regularly return to your home base during your time in the car. Remember that your fascia will shape itself in the positions you choose most often. What you should be thinking now is this… but Amy, I don’t want to be in the shape of a car seat! Good! You are starting to get this fascia thing! Let me give you an example.

I have clients who love to tuck one leg under their bottom when sitting in a chair, on the couch, or in the car. This feels very comfortable to them. The problem comes when they are always tucking the same leg under. This creates unbalanced tension that can really throw the whole body off. When you tuck one leg under, one hip gets high and tight, then something above and below the hips must compensate. This can be extremely hard to correct and rebalance. If you must tuck, tuck both legs equally. Switch back and forth. Still coming back to the home base regularly. I do not recommend tucking one leg under if you are the driver! Passengers, have at it.

Home Base Posture

Here is what a good home base looks like.

• Fully supported thighs.
• Knees no higher than the hips.
• Uncrossed and symmetrical legs.
• Hips in good vertical and horizontal alignment.
• Good lumbar support.
• Upright spine, with a little recline.
• Head stacked on the spine.
• Upper arms along the rib cage.
• Relaxed muscles.

Wrap Up

When I’m working with a client and do not see the progress I might expect, especially when they are working hard at their good posture and movement habits, we dissect other aspects of life. We drive so much that this is an area where, if you are not translating your good habit to driving or riding, if you are a passenger, this could be the culprit in your slow progression to healing.

Want to learn more about the details of good posture and body alignment? Check out my posture course Posture, Fascia and Your Health here: Homepage | Mayer Fascia Wellness (teachable.com)

Want to work with me to assess your posture? Book an Appointment – Mayer Wellness & Myofascial Release

It’s your move!

Amy Mayer OTD, OTR/L, RYT

Updated June 11, 2024