Neck pain while driving usually comes from holding one position for a long time with the head drifting forward, the arms reaching too far for the wheel, and the shoulders braced. Setting the seat so your back and head are supported, bringing the wheel close enough that your elbows stay bent, and taking a break every 30 to 60 minutes often reduces it. Drive only when you can turn your head to check your blind spot without a jolt of pain.
The car is a small space you sit in for long stretches. Small changes to how it fits you add up over a commute, and they cost nothing.
Key takeaways
- Common cause: long, still sitting with the head forward of the shoulders and the arms reaching.
- Seat first: hips about level with or slightly above the knees, backrest slightly reclined, upper back resting on the seat.
- Wheel: close enough that your elbows stay softly bent, and the center of the wheel at least 10 inches (25 cm) from your breastbone.
- Headrest: top level with the top of your head, or at least the top of your ears, and close behind your head.
- Breaks: stop every 30 to 60 minutes while your neck or shoulder is sore.
- Safe to drive: you can turn your head to check over your shoulder, grip with both hands and brake hard without pain stopping you.
How to set up the car
Adjust in this order, because each step changes the next.
Seat height and distance
- Height: raise the seat until your hips are level with or a little higher than your knees and you can see clearly over the wheel.
- Distance: move the seat so you can press the brake fully with your knee still slightly bent.
- Backrest: recline it a little, roughly 100 to 110 degrees, so your shoulder blades rest against it. A very upright seat tips the head forward. A very reclined one makes you crane your neck to see the road.
- Lower back support: if the seat has adjustable lumbar support, set it so it fills the curve of your lower back. A rolled towel does the same job.
Headrest
- Height: the top of the headrest should be level with the top of your head, or at least the top of your ears.
- Gap: the back of your head should sit close to it, ideally about 2 to 4 inches (5 to 10 cm) away. This matters most in a rear impact.
Steering wheel
- Reach: with your shoulders against the seat, your wrists should rest on top of the wheel. If you have to lift your shoulders off the seat to reach, it is too far.
- Distance: keep at least 10 inches (25 cm) between your breastbone and the center of the wheel, for airbag safety.
- Hands: hold at about 9 and 3 o’clock with a relaxed grip. Holding the top of the wheel with one straight arm loads the shoulder for the whole trip.
Mirrors
Set your mirrors after the seat, sitting the way you normally drive. You should see each mirror by moving your eyes, without leaning or turning your head. If you start leaning forward to use them on a long drive, your posture has slumped. Mirrors do not replace a head check before changing lanes.
If you cannot turn your head far enough to see your blind spot, you are not ready to drive.
When it is safe to drive
Before driving with neck or shoulder pain, sit in the parked car and check that you can:
- Turn your head: far enough to look over each shoulder into your blind spot, without a sharp jolt of pain.
- Steer: hold and turn the wheel with both hands, including a quick turn.
- Brake: press the brake hard, as you would in an emergency stop.
- Stay alert: you are not taking medicines that cause drowsiness, such as some strong painkillers, muscle relaxants or nerve pain medicines.
Do not drive wearing a soft neck collar, as it stops you turning your head. Do not drive with your arm in a sling. After neck or shoulder surgery, your surgeon decides when you can drive. Some insurers also expect you to be fit to control the car, so check your policy if you are unsure.
Common mistakes
- Leaning forward: sitting with your shoulders off the seat, head pushed toward the windshield.
- One-handed driving: a straight arm on top of the wheel or an elbow on the window ledge for the whole trip.
- Headrest too low: set for someone shorter, so it supports the base of your neck instead of your head.
- No stops: driving for two or three hours without getting out of the car.
- Shrugged shoulders: gripping hard in traffic. Check every so often that your shoulders have dropped.
How long changes take to help
Most people notice whether a new setup helps within a few drives. If your pain comes from a recent strain, a better setup makes the drive more comfortable while the strain settles, which often takes 1 to 6 weeks. If driving still brings on pain after about 2 weeks of a good setup and regular breaks, something other than the car may be driving it.
Where else this could be coming from
- A pinched nerve in the neck: pain, tingling or numbness that runs down the arm, sometimes worse looking up or turning toward the painful side. It tends to follow a line into the hand.
- Rotator cuff problems: an ache at the outer upper arm, worse lifting the arm or reaching behind into the back seat, and often at night.
- Upper back joints and ribs: a sharp spot between the shoulder blades, worse twisting to reverse or with a deep breath.
- Headache from the neck: a one-sided headache starting at the base of the skull after a long drive.
- Tingling in the elbow, wrist or hand: if the symptoms sit only in the forearm or hand and the neck feels fine, the cause may be lower down the arm.
Get it checked if
- Emergency: call your local emergency number if neck or left shoulder pain comes with chest pain, breathlessness, sweating or feeling faint, or if you have new neck pain after a collision with numbness, weakness or severe pain.
- Today: see a doctor today if you have arm weakness that is getting worse, clumsy hands, unsteady walking, or loss of bladder or bowel control.
- Soon: get it checked if you still cannot turn your head enough to drive after a week, if pain wakes you most nights, or if tingling in the arm is not easing after 2 to 4 weeks.
More on this area: desk and sleep guides.
Fit the car to you first, then check you can turn your head before you set off.
Written by Louise Yow, Neck & Shoulder Physio.