For those who have experienced lower back pain in the past or for those currently managing it, you know it is no easy feat to deal with on a regular basis. Chronic low back pain ranks as one of the top reasons for physician consultations for Canadians less than 60 years old. Four out of five adults will experience at least one episode of back pain in their lives and it is the predominant reason patients seek physiotherapy at my clinic in Coquitlam, B.C.

Many experience pain even on the best of days. Now, imagine taking a three-plus hour flight and you’re left asking why you put yourself through the torture to get to your destination.

While the following tips may not completely resolve your pain during a flight, they can certainly help to ease it.

  Train your body

Pre-Flight: train your body

While I definitely recommend moving around and stretching during the flight itself (to be discussed shortly), the weeks leading up to a flight can have a big impact on how your back handles the trip. Despite some beliefs to the contrary, in most cases activity is the best thing for your back. Even short daily walks - as brief as 10 minutes - can make a difference in your mobility.

Along with maintaining an active lifestyle, strengthening your core will give your back the flexibility and support it needs to endure long flights. Your core muscles help to support and stabilize your spine and are necessary for everyday movements of bending, twisting, and lifting heavy objects. While the rectus abdominis (our six-pack muscle) is part of our core, the other core muscles that we tend to forget about are especially important for low back pain. They include the deeper core - the inner unit musculature. The inner unit is made up of four muscles including our pelvic floor, multifidus, our diaphragm (breathing muscle) and transverse abdominus (TA). When these muscles are weak or unbalanced, the body naturally begins to compensate, increasing the strain put on your low back.

When delivering physiotherapy at our Coquitlam Wellness Centre, the most common core exercises we prescribe for the low back include side planks, dead bugs, bird dogs, and TA activation. Videos of these can be found below. These exercises will target the aforementioned muscles that are necessary to properly support your spine.

Pre-Flight Exercise Examples

Bird Dog

Dead Bug

Side Plank

Pre-flight: carefully consider your flight itinerary

While cost and duration are usually top priorities when selecting flights, consider taking a route with more legs. For example, splitting one long 14-hour flight into two seven-hour flights. This will allow you to move around and sleep in between, loosening muscles and increasing blood flow to keep back pain at bay.

Also, if you are able to book a flight during off-peak times, the likelihood of scoring empty neighbouring seats is much greater, giving you more room to stretch out during the flight.

Similarly, taking the extra step to book an aisle seat will give you the freedom to stand up and move around without annoying your seat mates.


During flight: apply heat

Although it is not as easy to accomplish in the air, heat is a great option for back pain relief. Applying heat helps relieve pain by overriding the pain signals being sent from your back to your brain by stimulating your skin receptors. Heat also causes the blood vessels to dilate which increases blood flow to the area. Applying heat will help your tight muscles relax, calming down your muscle spasms mid-flight.

The best option during a flight is to bring single-use heat wraps which provide heat for up to eight hours. There are USB heating pads on the market but it is best to check with the airline beforehand to determine if they are permitted on board.

Keep in mind that heat is best suited for post-acute injuries. If there is acute inflammation, heat can heighten your symptoms and a cold wrap or ice may be a better alternative.


During flight: be posture smart

Flying involves prolonged periods of sitting, which the body does not like. Our spine becomes compressed and the muscles that support it are not as active. When we have good posture our body can sit and stand in positions with reduced stress on the ligaments and muscles supporting our spine. Good posture helps prevent muscular aches and pains.

Unless you’re flying in a private jet, airplane seats are widely recognized as uncomfortable. We want to prevent the back from rounding, especially while sitting for hours on end. A physiotherapy lumbar pillow is a good tool to prevent this, placing it behind your lower back to create a curvature. A sweater or rolled-up blanket can also do the trick. This will help to reduce the severity of the aching and tightness you experience.

Another more common tool is a neck pillow which is especially helpful when trying to catch some shut-eye. If you end up getting the window seat, place the pillow around your neck, but also place another pillow or rolled-up sweater under your head to prevent your neck from collapsing.

When leaning against the wall in this seated position, the upper back is moving one way and the lower body is moving the other which will result in increased pain and tightness. Try putting a pillow under the opposite hip. This will help decrease the amount of strain on your lower back, keeping the pelvis in line with the spine.

Finally, don’t forget the feet. If your feet are not placed on a stable surface while sitting, additional pressure will be transferred to your low back. If the plane seat is too high, rest your feet on a footrest or something that can act as one, keeping your knees at a right angle. Similarly, if the seat is too low, place a pillow beneath your buttocks.


Get your move on

As mentioned, with prolonged periods of sitting the back stiffens and we start to experience more aches and pains. Unsurprisingly, the best solution for this is to move!

Movement stimulates blood flow which brings oxygen and nutrients to the structures of our back. Our options for movement are more limited during a flight but there are still plenty to choose from. Try some of these out:


4 exercises to do while seated on a plane

1) Adduction squeezes: With both feet flat on the floor, place a physio pillow or rolled-up sweater between your knees. Squeeze your knees together for 3 - 5 seconds, pushing into the pillow with both legs evenly. Repeat 8 - 10 times.

2) Sit-to-stand squats: Simply stand in your seat and sit back down. Repeat 8 - 10 times every 20 minutes.

3) Seated press-up: Push down with your hands, into the chair's armrests and extend your arms straight. Make sure your hips lift off of the chair. Allow your spine to be suspended, letting it lengthen for some self-traction.  Pause at the top for 5 seconds and slowly lower back down. Repeat four times. 

4) Pelvic tilts: Place your feet flat on the floor. Place your hands on your hips and roll them forwards (belly button moving forwards), and then roll them back (back rounded). Repeat.


In-flight exercises to do while standing

1) Calf raises: Holding onto a nearby seat or wall, raise the heels up off of the ground and slowly lower back down. Repeat.

2) Lunges down the aisle: While engaging your core, step forward with one leg, lowering your hips until both knees are bent at about a 90-degree angle. Repeat.


If I can leave you with one last thought, it’s that of pain-free movement. Ideally all the movement you produce should be relatively pain free. I hope these tips help make your next flight more enjoyable!