Common, and usually ordinary neck painStrong evidence
Neck pain is common in people who drive for a living. In a review of 56 studies of 18,882 professional drivers, 26 studies (3,480 drivers) gave a pooled figure of 42.4% with neck pain, which the authors compare with a 12-month figure of 37.2% for everyone. By job, it was 25.8% of lorry drivers, 38.2% of taxi drivers and 39.9% of bus drivers. These are professional drivers in studies that looked at one point in time and varied a great deal; there is no figure for ordinary car drivers. In the general population, 30% to 50% have neck pain over a year.
Driving hasn't been shown to cause neck pain. In a survey of 12,907 British adults, there was no link with professional driving, and a review of work driving lists long hours sitting, years in the job, the vehicle's set-up and vibration as risk factors from studies that can't show cause. In 1,615 hospital staff, commutes over 50 minutes by any means went with more neck and shoulder pain, again in a study that looked at one point in time.
Sources 1, 2, 3, 4, 5, 6, 7, 8
Why a long drive builds the acheEmerging evidence
In 21 pain-free volunteers who each drove about 3 hours on the same route in three different seats, discomfort rose with driving time in every seat, and the neck and lower back were where it built most. Over 150 minutes in a car seat, discomfort rose while recordings of the neck muscles showed no sign of fatigue, and in a simulator, people shifted in their seats more as discomfort rose.
Holding your hands up on the wheel keeps the upper trapezius muscles working: in 10 volunteers, their activity was lower with the arms resting on armrests. The Chartered Society of Physiotherapy says what contributes to neck pain is holding the body in sustained positions for long periods, rather than poor posture as such. In 160 car drivers who drove at least 2 hours a day, those with neck pain had less neck movement and a more forward head, but that study looked at one point in time and has reporting errors, so it can't show which came first.
Sources 9, 10, 11, 12, 13, 14, 15
The headrest is there for a crashEmerging evidence
The Highway Code asks that "head restraints are properly adjusted to reduce the risk of neck and spine injuries in the event of a collision". In insurance claims from rear-end crashes, head restraints that sat behind drivers' heads went with lower neck injury rates; active head restraints, which move up and forward in a crash, went with about 43% fewer whiplash claims (55% fewer in women); seats rated good had 11.2% fewer injury claims than seats rated poor; and in Victoria, Australia, whiplash-reducing head restraints went with 11.6% lower odds of whiplash. An expert review called this evidence preliminary.
In 14 drivers measured on ordinary roads, the head sat on average 78 mm in front of the head restraint, more than US guidance in 12 of them. A computer model suggests keeping the gap under 60 mm, and a crash-test procedure rates a head restraint by its height and its distance behind the head. No study has linked the headrest with everyday neck pain, so the set-up in this guide is for crash protection.
Sources 16, 17, 18, 19, 20, 21, 22, 23, 24
Looking over your shoulder takes a big turnEmerging evidence
Ordinary driving needs little neck turning: in a pilot on-road study, the neck spent 87% of the time within 15 degrees of straight ahead, with peaks of about 36 degrees left and 43 degrees right. Shoulder checks are the exception. In 20 volunteers driving about 68 minutes on public roads, there were a median of 15 left and 12.5 right shoulder checks, turning the head about 81 to 84 degrees relative to the car, with the trunk turning too. In 60 adults, reversing a car used 92% of the neck's turning range, more than any of 15 everyday tasks.
When the seat or controls stop the trunk turning, the neck has to turn further, as a study of work-vehicle drivers found. In a blind-spot task, older drivers turned their trunks about 10 degrees against 18 in younger drivers, and saw less. Letting the shoulders and trunk share the turn is our reading of these studies, not a tested treatment.
Sources 25, 26, 27, 28, 29
After a crash: whiplashStrong evidence
Whiplash causes neck pain, stiffness and difficulty moving your head, headaches and shoulder and arm pain, and the NHS says "It can take several hours for the symptoms to start after you injure your neck". About half of people still report some neck pain a year later; most of the recovery comes in the first 3 months, and about 3 in 10 report moderate to severe pain at a year. Our whiplash guide covers it.
In 33 people with long-lasting whiplash, the hardest driving tasks were checking blind spots, long drives and reversing, and 75% said they turned the trunk more. Driving difficulty tracked pain and stress more than measured stiffness, and in a simulator, people with long-lasting whiplash drove close to normal over short drives.
Sources 30, 31, 32, 33, 34, 35, 36, 37
When a scan mattersStrong evidence
Not for neck pain from driving. In 1,211 people aged 20 to 70 with no neck symptoms, 87.6% had disc bulges on a magnetic resonance imaging (MRI) scan. After a crash or a fall, doctors use a clinical rule, tested in 8,924 adults, to decide who needs neck imaging: high-risk features such as being 65 or over, a dangerous mechanism or tingling in the limbs, and whether you can turn your head 45 degrees each way. New weakness, clumsy hands or any warning sign needs a doctor, who decides on a scan.
Sources 38, 39
How it usually goesStrong evidence
The NHS says most neck pain lasts a few weeks, and NHS inform expects new neck problems to begin to settle within 8 weeks. It often comes back: half to three quarters of people with neck pain report it again 1 to 5 years later, which is why the plan keeps going after the pain settles. No one can promise a date.
Sources 40, 41, 42
