Driving with AxSpA: Shifting Gears on Stiffness and Pain

Editor’s Note: At a recent SAA Los Angeles Educational Support Group meeting, discussion on air travel with spondyloarthritis expanded to driving, with participants sharing challenges and practical tips. These types of support group exchanges regularly inform SAA programs and content across seminars, workshops, podcasts, and Spondylitis Plus. Below, Dr. Andrew Lui outlines strategies to make driving more comfortable for people living with spondyloarthritis.

For many people, driving is one of summer’s great pleasures—windows down, music playing, and sunlit roads ahead evoke a strong sense of freedom. For people living with axial spondyloarthritis (axSpA), however, this experience is sometimes different, limited by stiffness and pain.

Driving requires sitting in one position for extended periods, turning the neck and trunk to monitor traffic, and reaching for pedals and controls. For some people with axSpA, these demands can cause problems. Fortunately, understanding these challenges and making simple adjustments can help improve comfort and reduce strain while driving.

Common Challenges of Driving with AxSpA

One of the most common issues people experience while driving is neck, mid-back, and/or lower back pain. This may be related to positioning while driving that increases stress on the spine. People with axSpA may be more sensitive to this stress than individuals without the condition, especially during a flare.

Mobility limitations can also contribute to discomfort. If spinal mobility is reduced, particularly rotation of the neck, turning to check blind spots or navigate lane changes may become painful and/or difficult.

In some cases, limitations in other joints—such as reduced hip flexion (the ability to bring the thigh toward the chest) or shoulder motion—can lead to compensatory changes in posture that increase strain on the spine. Over time, this may contribute to pain or fatigue.

General joint stiffness is another common challenge. Prolonged time in one position tends to worsen this typical feature of axSpA.

Reduced spinal mobility can also affect the ability to visualize the environment. Difficulty turning the neck or trunk may make routine driving tasks such as changing lanes, backing up, or

parallel parking more challenging.

Adjust Your Car, Protect Your Spine

An important first step in improving comfort involves adjusting the car to support a neutral position of the spine. In this position, the natural curves of the low back, mid-back, and neck are

preserved and this posture typically feels most comfortable over time.

Because spinal anatomy varies from person to person, identifying an individual “neutral position” can be helpful, often with guidance from a physical therapist or other clinician.

Once this position is identified, the goal becomes simple: adjust the car to fit the person, not the person to fit the car.

Seat

Start with the seat. Sit with your buttocks fully back in the seat, then adjust your distance from the pedals so that your right foot can easily reach the pedals and you can use your left leg to

support your lower body. Be sure that the distance from the steering wheel allows your shoulders to stay relaxed with your elbows slightly bent without straining or changing your posture.

If possible, adjust the seat height and tilt so your lower back feels comfortably supported. Fine-tune the lower back support so that it matches the natural curve of your lower back. Set the backrest angle so you can comfortably reach the steering wheel while keeping a relaxed hip position, often around 100 to 110 degrees between your thighs and trunk.

Steering Wheel

Adjust the tilt and distance of the steering wheel so that controls are easy to reach while maintaining a safe distance from the airbag.

Mirrors

Adjust mirrors after the seat and steering wheel are positioned. This helps ensure the car is adapted to your best posture, not the other way around.

Stretching and Movement Strategies

Gentle movement before and during driving can help reduce stiffness and pain. Stretching should focus on areas that commonly feel tight in axSpA, as well as muscles that shorten during prolonged sitting. These include the neck, chest, abdominal muscles, hip flexors, and hamstrings.

Simple movements may include:

• Neck rotations: slowly turning the head from side to side to maintain gentle mobility
• Shoulder rolls: gently rolling the shoulders forward and backward in a circular motion to reduce upper back and shoulder tension
• Thoracic extension: standing tall and gently arching the upper back to open the chest and mid-spine

For longer drives, stopping periodically to repeat gentle movements, stretch, and/or stand and walk for a few minutes can be helpful.SAA member Martha Wittler says, “I take a minimum of three trips per year, [each] over 5 hours by car. I have to stop every 1.5 to 2 hours for a walk. Otherwise, I literally couldn’t do it.”

Heat-based strategies can also play an important supportive role. Heat does not improve flexibility in the same way that stretching does, but it can reduce pain, stiffness, and muscle tension, making driving more tolerable.

SAA member Carly Vester notes, “If heated seats aren’t possible, you can also find heat pads that plug directly into your car’s outlet. I have a heat pad and a heated blanket that plug right into the car.”

For many people, heat is most helpful before or during driving to reduce baseline stiffness, while stretching provides a more active way to maintain mobility over time.

Driving Breaks and Trip Planning

Driving strategies often depend on trip length. For short commutes, maintaining good posture and performing brief stretches before and after driving may help reduce stiffness.

For longer trips, planning becomes more important. It can be helpful to identify a personal comfort threshold and take breaks before pain begins. For many people, this means stopping every 30 to 60 minutes.

During breaks, standing, walking, and light stretching such as trunk rotations or back extensions may help reduce stiffness.

Alternating drivers when possible and staying well hydrated can also help on longer trips.

Staying Independent: Driving Supports and Adaptations

Practical adaptations vary widely between individuals and often come directly from lived experience.

James H. relies on a combination of in-car supports. 

“I’ve used a cushion I travel with for years called a G Seat Lite or Junior,” he says. “I can’t ride in a car without one. A neck pillow that fits between the headrest and seat back can also help.”

Martha Wittler suggests a simple, if unconventional, support item. “Squishmallows. They come in all sizes and are supported by all fandoms. They squish a lot, so they’re not as sturdy as foam, but they do position well because of how much they compress.”

Beyond physical supports, technology can also provide added assistance, particularly for drivers with limited spinal mobility. Features such as multiple cameras, blind-spot monitoring, and adjustable seating systems may make driving safer and easier.

If driving remains difficult despite these adjustments, consultation with a rheumatologist, physical therapist, or occupational therapist can help identify individualized solutions.

Driving isn’t just a summer pastime. It’s an important part of independence for many people. With thoughtful adjustments, regular movement, and awareness of individual limits, people living with axial spondyloarthritis can often make time behind the wheel more manageable and sustainable.

Because individual needs vary, stretching routines should ideally be guided by a rheumatologist or physical therapist.

Andrew Lui, DPT, is a physical therapist and Clinical Professor in the Department of Physical Therapy and Rehabilitation Science at the University of California, San Francisco. He specializes in exercise-based rehabilitation for people with rheumatologic and chronic musculoskeletal conditions, focusing on mobility, function, and quality of life.