On the road again – driving comfortably with axial SpA (AS)

Now more of us are on the road again, osteopath Zoë Clark explains how to drive comfortably when you have axial SpA (AS).

First thing’s first

Getting in and out of a car comfortably can be really difficult when your back is stiff and painful. Here’s a simple technique that may help:

To get in, open the door wide and stand with your back to sit seat
Slowly sit down onto the seat (making sure to duck your head if you need to)
Once seated, pivot on the spot to swing your legs into the footwell (rather than twisting your back)

To get out of the car, you simply do the same technique in reverse:

Pivot on the spot to swing your legs out of the car.
Plant your feet down, ensuring you have good support and balance.
Push up with your legs (while minding your head) to stand upright.

If you need support during this, holding onto the dashboard will give you more stability than the door. If you use a stick as a mobility aid, you can get that into a comfortable position and use that to push up as well. One of my patients taught me that once you’re sat on the car seat, you could slip a plastic bag underneath you, so that you pivot more easily on the seat. Remove the bag before driving, so that you’re safe and not moving around on the seat. You can use the bag when getting out of the car, too.

Explore different cars

It’s worth exploring different cars to find one that works well for you. When shopping around:

Try getting in and out so check the height and door frame size.
Adjust the seat to ensure that you can get it into a comfortable position.
Try maneuvers on a test drive, such as reversing and parallel parking, to ensure that the car is comfortable and you have good visibility.
If you have lots of hip or shoulder problems, automatic cars can be more comfortable.
Look for power steering and braking.
Parking sensors can help reduce the amount you need to turn.

Positioning yourself when driving

When sitting in the drivers seat, there are some simple adjustments you can make to ensure you’re supported.

The seat should be close enough so that you have a slight relaxed bend in your knees when the peddle is fully depressed.
The chair should be upright and supporting you, but without pushing your body forwards.
You don’t want your arms overstretching, there should be a slight bend in your elbows when holding onto the steering wheel (but ensure the wheel isn’t too close so that it’s safe if the air bag goes off).
The head restraint should be just behind your head, so that in the event of an accident it will stop your head moving backwards (but ensure that when you’re relaxed into the seat, it’s not pushing your head forwards).
Adjust the wing mirrors and rear view mirror so that you can see them without having to twist or strain.

Positioning yourself when you’re a passenger

As a passenger, you have a little more flexibility with your seating position.

The back of the seat should be upright, but without pushing you forwards.
You can push your seat back so that you can either stretch out your legs or bend your knees to plant your feet on the floor.

Consider using cushions

You can place a small lumbar support cushion behind your low back, but ensure it has a strap around it to secure it to the seat. If you experience lots of rib or mid-back pain, try a foam cover for the seat belt to reduce the pressure across your chest. Passengers can also use a neck pillow to support their head and neck.

Heat can be soothing

Many people with axial SpA (AS) find heat really soothing. You can use your car journey to your advantage by investing in a heated seat cover that plugs into your car, allowing you to use heat safely while sitting still.

Does ice help you more?

Ice is a little trickier to apply on the move! To get around this, you could:

Ice the area for 10-minutes before you drive.
Take single-use ice packs or ice packs in a cooler if you’re going on a long journey. You can use these on rest breaks or when you reach your destination.

We don’t advise applying ice while you drive – both for the obvious safety risk, but also because you may accidentally leave it on a lot longer than you should. When applying ice, always wrap it in a towel to protect your skin from ice burns.

Take regular breaks

As always, the best thing to reduce axial SpA (AS) pain and stiffness building up is to move regularly. On longer car journeys, try to stop and walk around or stretch every 45-60 minutes. Sometimes your back can feel fine at the time, but then be very painful when you try to get out of the car, so planning in particular rest stops will reduce the likelihood of this happening. Regular rests are important for your concentration too, so it’s a win-win!

Exercises

All of these exercise suggestions should be comfortable. If you’re unsure if they’re suitable for you, chat with your doctor or physiotherapist before trying them.

As a passenger, you have more options to move around and exercise during a journey. Always ensure you keep your seatbelt on even when exercising. Try out these simple movements to reduce your joint stiffness, performing the movements slowly and gently:

Gently turn your head and neck to look to the left as far as comfortable, then repeat to the right.
While looking forwards, slowly tilt your left ear towards your left shoulder as far as comfortable, then repeat to the right.
Gently tilt your chin down towards your chest, then return to the centre.
If you don’t have any neck problems or nerve pain, slowly look up as far as comfortable, before returning to the centre.
Shrug your shoulders up towards your ears, then roll them forwards in circles three times.
Roll your shoulders backwards in circles three times, then relax your shoulders down.
As far as possible while keeping your seatbelt secure, you can gently twist your body to the left to get a slight twist in your spine. Then repeat to the right.
Push into the floor with your feet and shift your weight to the right side, to lift the left hip off the seat slightly. Repeat to the opposite side. This gently bends your low back and you can repeat it a few times slowly and rhythmically.
Gently arch your low back and then slump into the seat slightly. Return to a comfortable, upright seated position.
Stretch your legs out in front of you and place your feet together. Slowly let your hips relax, so your legs turn out and your knees fall away from each other. If this is comfortable, you can relax in this position for a few seconds.
Separate your feet to about hip width, then keep your feet on the floor as you relax your hips so your knees relax into each other.
Point the toes on your left foot towards the floor, while you point the toes on your right foot up towards you. Alternate these movements in a foot pumping action to loosen your ankles and boost your circulation.

The driver can do the exercises above when you stop for rest breaks (and the car engine is switched off). It can be helpful to do them in the passenger seat or back of the car, so you have more room in the foot well.

At rest breaks, walking is one of the best activities you can do to help loosen up before continuing the journey.

These standing exercises can also be really effective for loosening up your joints and stretching your muscles:

Stand with your feet hip width apart, then take your hands overhead to stretch your spine upwards.
Place your hands on your waist and gently move your hips side to side (this will loosen your back, as well as your hip joints).
Relax your arms beside you and gently roll your shoulders forwards and backwards.
If comfortable, you can look down towards the floor and then roll your spine down to reach towards the ground (only go as far as comfortable). You can hold this for one breath, before slowly coming back up to standing.
Standing comfortably, place the palms of your hands on your low back to provide some support. Then, gentle arch your back and lift for your chest bone towards the ceiling as far as comfortable, before returning to the starting position.
Stand beside the car, so you can use it for balance and support if you need. Step your right leg behind you and bend gently bend your left knee to do a lunge. You should feel a stretch in your right thigh and possibly both calf muscles. Repeat this on the other side.
Also using the car for support, stand on your left leg and swing your right leg forwards and backwards in a slow and controlled movement. Repeat on the other side.
Open the car door and place the heel of your right leg on the edge of the doorframe. Stand up nice and tall, holding onto the car for balance if needed. You should feel a gentle stretch at the back of your right thigh.

You can download these exercise sheets to take with you on journeys as reminders to keep moving regularly.

Things to be aware of

Remember, you shouldn’t drive if:

Your flare is significantly affecting your mobility.
Your flare is causing pain that will affect your concentration.
Your medication is making you drowsy.
You’re experiencing a lot of fatigue.

If you feel your axial SpA (AS) is affecting your ability to drive safely or comfortably, then do speak to your doctor. Your doctor or pharmacist can also discuss medication side effects if you’re experiencing drowsiness or difficulty concentrating.

It can also be helpful to speak to the charity Driving Mobility. This charity can help with car adaptations to keep you driving, for example fitting larger wing and rear view mirrors. The service is free if you’re referred by the DVLA and there is a small charge if you self-refer. Please remember to check with the DVLA when considering car adaptations, because they may need to be notified of your axial SpA (AS) before making these changes.

Visit our website to find out more about when you need to contact the DVLA and how to do so. You can also read Government advice about driving and axial SpA (AS).

The link above to our website also has information on the Motability Scheme and the Blue Badge Scheme. There is a lot of help and support out there to keep you driving safely and comfortably, so do get in touch if you would like any advice.

Summary

Shop around for the best car for you and test it out thoroughly.
Take care on getting in and out of the car comfortably.
Use all the features in the car to adjust the seat, steering wheel and mirrors to set it up well.
Take regular breaks to move, exercise or apply ice and heat.
Speak to your doctor about driving for more specific advice.
Check our website to understand whether the DVLA need to be informed of your axial SpA (AS).
Look into the Motability Scheme, Blue Badge Scheme and the charity Driving Mobility.

Zoë Clark is our Self Management Programme Officer. You may have seen her blog posts previously written for NASS and she spoke at the latest parliamentary meeting in January and appeared on Channel 5 News.

Zoë is available on the Helpline, so if you’d like to have a chat then please get in touch and we can arrange a call. She’ll also be sharing some of her top tips and answering any common questions, so please let us know in the comments if there’s any particular advice you’d like.

The Helpline is open 1000-1600 Monday to Friday on 020 8741 1515 or you can email zoe@nass.co.uk