Common, and usually ordinary back painStrong evidence
Back pain is the commonest ache in people who drive for a living. In 19 studies of 7,723 professional drivers (bus, lorry, taxi and others, mostly in Africa and Asia), 39% reported low back pain over a week and 53% over a year, and a larger pooling of 53 studies found 55.3% over a year. By job, it was about 54% of taxi drivers, 50% of bus drivers and 23% of lorry drivers. Almost all these studies looked at one point in time, and they varied a great deal.
There is no equivalent figure for people who drive a car to work. In a UK survey of car drivers, discomfort rose with annual mileage, and drivers of cars whose seat and controls adjusted more reported fewer troubles; in UK police officers, distance and hours driven went with low back trouble.
Sources 1, 2, 3, 4, 5, 6, 7, 8
Driving doesn't wear out your discsEmerging evidence
In 45 pairs of identical twins, the twin who drove for a living had no more disc degeneration on magnetic resonance imaging (MRI) than his brother; the authors concluded that driving may make back symptoms worse, but doesn't damage the disc.
Older studies found a link with disc problems: men who drove for half their working time or more were about three times as likely to have an acute herniated lumbar disc (New Haven, in 1970s cars), and in 841 French workers, driving over 2 hours on several days a week predicted sciatica, with wide uncertainty. Professional drivers were among the men most often admitted to hospital for a disc or sciatica in a Finnish cohort. The NHS lists sitting down or driving for long periods among the causes of a slipped disc. Our reading: long drives can bring on or aggravate disc-type pain and sciatica, without wearing the discs out.
Sources 9, 10, 11, 12, 13, 14
Sitting on its own isn't the causeStrong evidence
Reviews of sitting at work found strong, consistent evidence of no link with low back pain, and sitting on its own isn't a cause; in seated jobs, it was sitting combined with vibration and awkward postures that went with back pain. In a review of work exposures and long-lasting back pain, lifting and carrying had moderate evidence (odds ratio 1.7), while sitting and vibration had only weak, low-certainty links.
No driving posture has been proven to cause or prevent back pain: in a review of 7 studies of people who drive for work, the 4 that found a link used posture measures that hadn't been shown to be valid, and a review of 30 sources found no agreed set of best joint angles for driving.
Sources 15, 16, 17, 18, 19, 20
Vibration: a risk for heavy and off-road vehiclesEmerging evidence
In workers exposed to whole-body vibration, mainly drivers of tractors, forklifts, earth-moving machines, lorries and buses, the odds of low back pain were about doubled (pooled odds ratio 2.17) and of sciatica 1.92, higher with more exposure, though some studies may be missing. In 537 Italian professional drivers, a bigger vibration dose went with more severe pain and disability over 2 years. Vibration's effect is hard to separate from the lifting, posture and stress that go with these jobs.
The Health and Safety Executive (HSE) says most people who drive road-going vehicles at work aren't likely to have high vibration levels, that the risk for road transport drivers is likely to be low unless the vehicle lacks good suspension or goes off-road, and that poor posture, long periods in the same position and lifting should probably be considered first. That low risk for ordinary car drivers is our reading of this guidance and of the heavy-vehicle studies: no study has measured vibration in private cars.
Sources 21, 22, 23, 24, 25, 26
What goes with back pain in people who drive for workMixed evidence
In professional drivers, the factors with strong evidence were vibration, awkward postures, lifting and handling, job stress, job demands and previous pain; years of driving and hours at the wheel were inconclusive. An uncomfortable seat, no back support, days of over 10 hours and handling loads all went with back pain in a pooled analysis of studies at one point in time.
In 1,719 French sales reps who drove ordinary cars for work, 1,118 of them followed for a year, driving 10 hours a week or more, an uncomfortable seat and stress went with new back pain. In 436 British adults, men who had driven a car for more than 4 hours a day were about twice as likely to have back pain, yet lifting and driving together explained under 1 in 5 cases. The HSE lists stretching to reach the controls, sitting without changing position and repeated lifting among the reasons drivers get back pain.
Sources 24, 1, 27, 28, 25
Telling the causes apart, and when a scan mattersStrong evidence
Where it hurts and what eases it is the first clue (the map above). The NHS says sciatica usually affects your bottom and the back of one leg, often into the foot. The National Institute for Health and Care Excellence (NICE) says not to offer imaging routinely outside specialist care, and to consider it in specialist care only if the result is likely to change what happens. A scan doesn't explain driving back pain: in the twins, a working lifetime of driving left no extra disc wear on MRI.
Scans matter for the warning signs (an emergency MRI for possible cauda equina syndrome, an X-ray or scan after a crash or a suspected spinal fracture), and in specialist care for sciatica that isn't settling or a leg that is getting weaker.
Sources 29, 9, 30
How it usually goesStrong evidence
In 33 groups of 11,166 people with new low back pain, average pain fell from 52 out of 100 to 23 within 6 weeks and to 6 at a year; in persistent pain it fell from 51 to 33 at 6 weeks and 23 at a year. The NHS says back pain usually improves within a few weeks but can last longer or keep coming back, and sciatica usually gets better in a few weeks to a few months.
Even in professional drivers of machines and utility vehicles who started pain-free, 38.6% had low back pain over 2 years, but only 14.4% severe disability. No one can promise a date.
Sources 31, 32, 30, 33
