Driving a car if you have ankylosing spondylitis (AS) can present a number of potential challenges. From getting in and out of cars, to turning your head and body to check for other cars while on the road, to sitting for long periods of time, there’s a good chance that some part of the process may cause anxiety or discomfort. And, as a study from 2022 reported, driving challenges for people with AS can affect their overall productivity, especially at work.
But for all the potential pitfalls of driving, there are a number of steps you can take to make the process easier when you have ankylosing spondylitis. Indeed, with some adjustments, most people with AS can continue to drive, notes the National Axial Spondyloarthritis Society.
Try these tips the next time you get behind the wheel to ensure a safer, more comfortable, and more enjoyable trip.
1. Use Good Technique for Entering and Exiting the Vehicle.
Getting in and out of your car is often difficult for people with AS, especially if your car is lower to the ground, says Tara Perry, OTD, an occupational therapist at Keck Hospital of the University of Southern California in Los Angeles.
To reduce the need to twist your torso or bend over too much, Perry recommends getting into your car by first sitting down, with your legs still outside of the vehicle. Once you’re seated, you can then pivot your body and bring your legs into the vehicle with minimal effort, she says.
To get out of your car, go through the same process in reverse — pivot your body to bring your legs out of the door, then stand up to exit the vehicle, Perry adds.
2. Practice Good Driving Posture.
It’s important to sit in a way that doesn’t put too much stress on your back or neck, says Charla R. Fischer, MD, an orthopedic surgeon at NYU Langone’s Spine Center in New York City. In practice, this means that “for most people, the ergonomics are better when you’re more upright,” she adds.
When you get in the car, take a few minutes to make sure the seat is the correct distance from the pedals, the seat back is at an appropriate angle, and the steering wheel is at a position to allow this alignment, she advises. The closer you stick to this position while driving, the more likely you’ll avoid fatigue due to muscle strain, she adds.
But Dr. Fischer notes that this isn’t a hard and fast rule. “Everyone’s ideal alignment is slightly different,” she says, and you may even find that different positions become more comfortable as your spinal alignment changes over time.
3. Try a Lumbar Pillow for Support.
An extra pillow behind your lower back can make a big difference in your comfort level when you’re driving, says Perry. This may be a pillow specifically designed for lower-back support, or it can just be a small decorative or throw pillow — anything, Perry says, that can easily be moved around and adjusted for the optimal position.
“The way car seats are designed is not for comfort, but for safety,” adds Fischer. For this reason, it’s often up to you to use aids that make the experience more comfortable, she explains.
4. Consider Using a Neck Pillow.
Because of how car headrests are built, Fischer says, your head may be pushed forward in an uncomfortable way if your seat is in the proper position to support your back.
A lumbar pillow may help reduce this effect, but if you find that the upper part of your head is still pushed forward too much, a neck pillow can help even out the pressure and reduce strain on your neck.
Perry notes, though, that it’s important not to restrict the range of motion in your neck, since it’s vital for driving safety to be able to turn your head. For this reason, she says, a U-shaped pillow is probably not a good idea. Instead, try a narrow cylinder-shaped pillow, or a rectangular throw pillow similar to those used for lumbar support, she recommends.
5. Experiment With Heat (and Cold).
If you experience back pain while driving, try using a heating pad. Many heating pads have the extra benefit of functioning as support pillows as well, whether for your neck or your lower back.
Another option for some people, of course, is to use heated seats. “Some of my patients say that their ‘happy place’ is sitting in their car with the seat and back warmer on,” says Perry.
But some types of pain, Perry notes — particularly radiculopathy, or nerve pain in the spine — respond better to cold than to heat. In these cases, she says, it’s probably best to ice the affected area ahead of time, rather than trying to do this while you drive.
6. Explore Using Extra Mirrors.
Sometimes, the stock mirrors in your car don’t offer as wide a view as they ideally would for someone with ankylosing spondylitis, since moving your head into the optimal position to see something often means moving not just your neck, but also your torso.
If the complaint is restricted range of motion because of stiffness, Perry often recommends snap-on mirror extensions for both the rear-view and side mirrors.
Another option that’s especially good for parents of young children, she says, is a special mirror mounted above the back seat at an angle that lets the driver see what’s happening there in the rear-view mirror.
7. Take Breaks and Move Around.
Even if your posture is excellent, sitting in the driver’s seat for too long can still cause pain and stiffness. “Maintaining static positions for long periods of time can increase inflammation and pain sensations,” says Perry.
Perry notes that for many people with AS, sitting still for longer than 30 or 40 minutes may cause significant discomfort and isn’t advisable. Other people can go slightly longer, she says, but it’s generally not good to go above 50 or 60 minutes.
If you’re going on a long trip or have a long commute, says Fischer, take breaks to help reduce stiffness-related pain. “Do some stretches, walk a little bit, loosen things up — and then you can get back to driving,” she says.