Literature review: back pain driving & driving ergonomics

Strong evidence from more than 69 research studies links back pain and driving.

Driving→Back Pain

Two meta analyses totalling 69 studies published by the International Archives of Occupational and Environmental Health by Bovenzi 1998 and Ling 2000 (1 & 2), shows ‘a clear correlation between driving and the incidence of low back pain (LBP), sciatic pain, degenerative spinal conditions and intervertebral disc pathology.’

Many of these studies also focussed on the effect of whole body vibration (WBV) when sitting in a moving vehicle.

The research shows that the major factors influencing back pain when driving are:

  • WBV
  • ergonomic setup
  • sufficient lumbar support.

Chronic pain impairs cognitive function.

Chronic Pain→Impaired Cognitive Function

Numerous studies have shown a relationship between chronic pain and cognitive function.

Melkumova (2010) looked specifically at spinal pain with similar results. Complaints of difficulty with mental concentration were present in 17.3% of patients and problems with remembering information in 20.2%. They showed mild neurodynamic impairments (the ability of the nervous system to communicate between different parts of itself), as compared with healthy subjects. ‘They had significantly worse performances in tests assessing memory (delayed reproduction in the 12-word test), attention, visuomotor co-ordination and mental flexibility’ (3).

Chronic lower back pain leads to reduced Neuropsychological Performance (NP)¹ and reduced Physical Function (PF)

Pain→ reduced neuropsychological performance + reduced physical function.

The Weiner et al (2006) looked at osteoarthritis (OA) pain and LBP. Their study group found an impairment in NP and PF (4).

¹ ‘Neuropsychological tests are designed to examine a variety of cognitive abilities, including speed of information processing, attention, memory, language, and executive functions, which are necessary for goal-directed behaviour.’

To find out more:

A clear correlation between depression and lower back pain.

Lower back pain→ depression.

The link between chronic pain and depression has been well established over the past 40+years. Currie and Wang (2004) looked specifically at LBP and depression in a massive study looking at 118,000 Canadians. They found a clear correlation between rates of depression and LBP.  The rate of major depression increased in a linear fashion with greater pain severity.’(5)

Brown et al (2002) found that people with constant pain (using Rheumatoid arthritis patients) show impairment of cognitive function and then can lead to depression. There is evidence that this gets worse with age. (6)

2. Literature review – vehicle ergonomics

Driving ergonomics has not been a high priority for vehicle manufacturers.

Historically, the motor vehicle industry did not start its design process with a person in mind. Generally, it did the opposite. A vehicle was designed and then the needs of drivers were considered almost as an afterthought.

This led to numerous idiosyncrasies and produced some of the quirks found in certain classic cars.

In the past this probably didn’t have too much impact on drivers, as the time spent driving was significantly less than it is today.

With the recent improvements in our understanding of ergonomics, you’d expect these quirks to have disappeared by now. However, research has shown this is not the case. Many blogs highlight this. A couple of recent examples show that very few car manufacturers come out unscathed.

Most cars are still built asymmetrically.

If you were designing a go-kart for a child, you would:

  • put the steering wheel in the mid-line of the seat
  • have the steering wheel parallel to the front of the seat
  • have the pedals equally spaced from the midline of the seat

Analysis of modern vehicles by McIlwraith (car models from1995-2005) shows that less than 20% of cars attain these basic requirements. (7)

See McIlwraith-Bryan car seat analysis results (PDF)

A quote from this article

“To recap so far; the driver is likely to be sitting with the cervicodorsal spine flexed and rotated, the lumbar spine flexed and the right thigh abducted and externally rotated, and the right foot inverted. Bearing in mind that this position may be held for hours at a stretch this begins to look like a recipe for disaster and certainly nothing like the ‘ergonomic design’ so frequently quoted in advertising material.”

A worst-case scenario in which the wheel offset (4), wheel angle (5) and pedal offset (6) are shown. The pelvis and the shoulder girdle are set at an angle to each other. The right foot has come across to the mid line and the right leg has been forced into external rotation. Source: An Analysis of the Driving Position in the Modern Motor Car, BRYAN MCILWRAITH Bsc (Hons) Ost. Med. DO.,  Reprinted and edited from British Osteopathic Journal Vol XI pp27-34 1993 (PDF).

References

(1) An updated review of epidemiologic studies on the relationship between exposure to whole-body vibration and low back pain (1986–1997)

Bovenzi, M. & Hulshof, C T 1998

Int Arch Occup Environ Health. 1999 Sep;72(6):351-65.

(2) Whole-body vibration and low back pain: a systematic, critical review of the epidemiological literature 1992-1999.

Lings, S & Leboeuf-Yde, C  2000

Int Arch Occup Environ Health. 2000 Jul;73(5):290-7.

(3) Characteristics of Cognitive Functions in Patients with Chronic Spinal Pain

Neuroscience and Behavioral Physiology 2011

A. Melkumova . E. V. Podchufarova. N. N. Yakhno

(4) The Relationship Between Pain, Neuropsychological Performance, and Physical Function in Community-Dwelling Older Adults with Chronic Low Back Pain

Debra K. Weiner MD, Thomas E. Rudy PhD, Lisa Morrow PhD, Jill Slaboda MS, Susan Lieber MS,

Pain Medicine – Vol 7, issue1 – 2006

(5) Chronic back pain and major depression in the general Canadian population

Currie & Wang

Pain – 2004

(6) The relationship of pain and depression to cognitive function in rheumatoid arthritis patients

Brown,  Glass & Park

Pain – 2002

(7) An Analysis of the Driving Position in the Modern Motor Car.

BRYAN MCILWRAITH Bsc (Hons) Ost. Med. DO.

British Osteopathic Journal Vol XI pp27-34 1993.

(8) Int J Occup Saf Ergon. 2009;15(3):295-307.

The effect of an active lumbar system on the seating comfort of officers in

police fleet vehicles.

Donnelly CJ, Callaghan JP, Durkin JL.

Scand J Work Environ Health. 2005 Aug;31(4):258-65.

(9) Seat inclination, use of lumbar support and low-back pain of taxi drivers.

Chen JC, Dennerlein JT, Chang CC, Chang WR, Christiani DC.

Occupational Health Program, Department of Environmental Health, Harvard School

of Public Health, Boston, Massachusetts 02115, USA.

2018-11-15T11:26:07+00:00