Does Flying Have to Hurt?

by Liz Savage, Guest Blogger Perhaps during a cross-country flight, boredom gets the best of you, and you reach in the seat back pocket for the SkyMall catalog. Flipping through pages jammed with products you didn’t know you needed, you are presented with options for back pain relief—from standard lumbar cushions and back supports to extravagant massage chairs to the downright wacky—a Swedish nail bed, anyone? It’s not for me to say whether these are a waste of money or a godsend, but can we for a minute contemplate the irony of shopping for back pain alleviation while crammed into what many coach travelers would call a torture chamber?

The plight of the air traveler has been thoroughly discussed—rows are shrinking, legroom is nonexistent, and seats have narrowed to a measly 17 inches (the standard size of the first aluminum seats from the 1950s). But what is merely a nuisance to the healthy traveler can be a day of purgatory to those with back pain.

“It’s almost as if commercial airline travel were designed to trigger low back episodes,” writes Dr. Vijay Vad in his book Back Rx. As Vad explains, cabin pressure and lower oxygen levels can leave back pain patients wishing they had missed their flights. The changes in air pressure while flying can trigger an inflammatory response that causes pain in already damaged joints. Also, since the cabin pressure is lower than the air pressure at sea level, gases—sometimes trapped in degenerated discs—expand, causing more back pain. Meanwhile, the plane’s low-oxygen environment means the disc is not getting enough nutrition. Vad recommends taking two or three Advil or other anti-inflammatory before the flight, as well as staying hydrated.

Of course, let’s not forget that some of the blame belongs to the seat itself. Prolonged sitting of any kind can worsen back pain, but airplane seats are particularly bad due to their lack of lumbar support, headrests that can’t be adjusted, and of course the cramped quarters. The concave seat back puts pressure on the spinal discs and forces you into a curled-shrimp posture that flattens the lumbar spine.

The natural curve of the lumbar spine is best achieved by positioning yourself with a 135-degree angle between the thigh and torso, back experts say. This deep recline is not something you’ll find outside of first class, but even the minimal tilt of most airline seats (typically about 5 inches) may ease your discomfort—a little (unless you are flying with Spirit Airlines, which offers fixed, non-reclining—excuse me, “pre-reclined”—seats).

Airplane seats have not changed much in the last few decades, but recently several major airlines have upgraded their interiors with new slimline seats that are lighter weight with a narrower seat back. The lightweight seats were installed to reduce fuel costs, but they also allow more rows to be crammed into coach. This isn’t supposed to impact your legroom, however, because the slender seat back means the entire seat takes up less room.

You may have heard these seats advertised as “roomier”, but so far the reviews have been mixed.

New slimline seats on United’s A320
New slimline seats on United’s A320

According to a recent TripAdvisor survey of nearly 1,400 air travelers, about 50% of respondents weren’t sure if they’d ever sat in a slimline seat. Of those who noticed the difference, 83% said they were less comfortable than traditional seats. United, Alaska, Delta, Southwest and Spirit have installed slimline seats in at least some of their planes.

There is still hope for the back-pain stricken, if you’re willing to shell out a little bit. The tighter quarters in coach are making way for some downright luxurious (in comparison, at least) seats in premium economy and business classes—and a great opportunity to up-sell desperate coach passengers. Last year, the airline industry pulled in $23.9 billion in à la carte fees—for extra legroom, Wi-Fi, meals, and other services.

If you are willing and able to upgrade to a more comfortable seat, here are some standouts:

  • Air New Zealand’s Spaceseat and Skycouch:
    • Spaceseat: The two-seat configuration has a center console that adjusts in height to act as an armrest, table or, when lowered to seat height, makes room to stretch out your legs (but you can’t comfortably lie flat). Other perks: a slide-and-tilt feature that gives the equivalent of nine inches of recline and a beanbag foot support. 
    • Skycouch: A row of three coach seats that convert into a futon for two when the leg rests are raised to a 90-degree angle. Other perks: taller seatbacks, armrests that fully retract, leg rests that adjust from 60 to 90 degrees, and plush headrests with adjustable “ears”.
  • JetBlue’s “Even More Space”:
    • JetBlue offers “Even More Space” seating areas on all of their planes, with as much as 41 inches of seat pitch—the distance from one row to the next (typical seat pitch is 30-32 inches). Other perks: early boarding with early access to overhead bins, and expedited security in certain cities. Be careful though—some of these seats are located in front of an exit row, which means they don’t recline.
  • Virgin Atlantic
    • Upper Class passengers can enjoy a Back in the Clouds inflight massage. If you can’t wait until boarding to get your massage, most airport terminals offer massage and other spa services. XpresSpa operates 56 airport locations throughout the world.

Even if you can’t spring for the posh seats, you can still maximize your experience. On any given airplane, there are bad seats and better seats (we won’t call them “good”). SeatGuru helps you pick the best seat for you with detailed descriptions and comparison charts of nearly every airline and every plane in the sky. Deciding between 11A and 25D? Users share reviews for individual seats. You might find out that one seat has more legroom, but it’s close to the restrooms and the armrests don’t move.

A few more tips to survive your next flight:

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  • Roll up a sweater, blanket or towel, and place it behind your lower back for lumbar support.
  • Bring aboard a slightly inflated playground ball, and place it between your spine and the back seat cushion.  Or try two tennis ball taped together, and set your aching spine between them.
  • Of the SkyMall offerings, the BackJoy has a loyal following. The BackJoy Posture+, a portable seat enhancer, corrects your posture and engages core muscles, making prolonged sitting more comfortable.
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          • Fly at off-peak times. You’ll be more like to get an empty seat next to you.
          • Select exit rows for more legroom and an aisle seat so you can get up and walk every 30 minutes (I have no tips on avoiding the frowns you’ll get from the flight attendants).
          • Maximize what little legroom you have. Stow bags in the overhead bin rather than at your feet.
          • Try some inflight yoga. The aptly named Airplane Yoga iPhone app guides you through a series of 24 sitting and standing poses that are customized for air travel.

Flying may never be an orthopedic experience, but by taking a few measures, you can at least read your SkyMall in relative comfort.