Air travel can be hellish on the best days. But the only thing more obnoxious than a cranky TSA agent or seatmate with bare feet is flying with a bad back. Unfortunately, that’s one thing you can’t leave at home.

Vanessa Francis Gray, 43, has chronic back pain and says the things that might feel mildly annoying or uncomfortable for the average traveler—like hauling a heavy suitcase off a luggage carousel, standing in an endless TSA line, or sitting in a cramped seat for hours on end—might be excruciating for her. But as someone who flies at least once a month, Gray has a plan. After years of trial and error, she knows what to pack for a (mostly) pain-free flight. “At this point in my life, it feels like a routine,” she tells SELF.

If you have chronic back problems, a few simple pre-travel steps can make a huge difference when it comes to your comfort. Here’s exactly how to plan your next getaway, according to experts.

1. Choose back-friendly luggage.

Even when you pack light, you still have to carry, pull, or drag your stuff through an airport. That can put a lot of strain on your back,¹ Mallory Behenna, PT, DPT, an orthopedic physical therapist at Brooks Rehabilitation in Jacksonville, Florida, tells SELF. If you can, opt for luggage with four spinner wheels so you can swivel it in multiple directions, Rodrigo Cayme, MD, a physiatrist at OrthoArkansas in Little Rock, tells SELF. Also, try to roll it at your side or in front of you versus behind you—this ensures you’re pushing, rather than pulling, it, which keeps pressure off your spine, Behenna says.

If you need to lift your bag off the floor, always bend at your hips and knees to pick it up and avoid twisting your torso, Dr. Cayme says. If you don’t feel comfortable doing this, you might politely ask a fellow traveler if they could help you hoist it into an overhead compartment or onto the conveyor belt in the security line. (You can talk to the airline ahead of time, too—more on that in a sec!) Dr. Cayme also avoids carrying a backpack when traveling and advises folks he treats with lower back pain not to use one either, as they can sometimes lead to muscle or neck strains.²

2. Make a plan when you book your seat.

Try to get an aisle spot—a.k.a. ensure you have convenient access to a walkway— when scheduling your flight, Behenna says. You can avoid having to ask a fellow passenger to let you out, a super awkward moment that can leave you sitting for too long. These prolonged periods in one place can put a lot of pressure on your spine, which often worsens back issues.

If it’s in your budget, consider paying for a spot with extra legroom so you can stretch and make yourself even more comfortable, she adds.³ Gray always books aisle seats so she can easily walk around, as she finds that being sedentary for too long makes her symptoms worse.

If you’re worried that you will be unable to do basic travel tasks (say, making a 30-minute connection in another terminal), contact your airline a few weeks before your departure. They’re required to help folks who need assistance with moving around the airport, going through security, getting on and off the plane, navigating baggage claim, and handling luggage, according to the US Department of Transportation.

3. Pack a plane survival kit.

If your symptoms flare up mid-flight, you’ll want to be prepared with your go-to pain medication. OTC non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, can reduce inflammation and help in the moment, Sean Sanderson, MD, an interventional spine and sports physiatrist, at Atlantic Health System in Kinnelon, New Jersey, tells SELF. NSAIDs are generally safe for most people to take, but if you have a medical condition like acid reflux or kidney disease, check with your doctor first, as they can sometimes make your symptoms worse, Dr. Cayme says.

You can also try OTC topical products that contain inflammation-fighting or numbing ingredients like Aspercreme Back Patches. Your doctor also might recommend a more heavy-duty medication, like a muscle relaxer, if you’ve got a huge travel day ahead of you or your pain is super intense. Just be sure to take it exactly as prescribed, Behenna says.

You can also use a lumbar pillow to help your lower back, Dr. Sanderson says. Airplane seats famously have a shape that doesn’t adhere to the natural curvature of your spine. (So when you’re in one, your muscles in that area have to work harder to keep you in alignment.)⁴ While you can find travel back pillows on sites like Amazon, Gray gets support from a rolled-up scarf. Another option? Pack a cold gel pack or an empty hot water bottle (you can politely ask the attendant to fill it for you and hope for the best) if those things tend to ease your aching.

4. Move around before and during your flight.

Since you’ll likely be sitting a long time on the plane, try to keep active in the hours and even minutes before you board, Dr. Sanderson says. Go for a walk or do some gentle stretches prior to calling your Uber—extra flexibility in your hips and core can help minimize pain. (Here are 15 yoga poses that can help with back pain.) When you get to the airport, “walk a bit, go to the gift shop, get some food,” he suggests. Movement keeps your muscles warm and loose, which can cut back on discomfort. Gray also makes sure to do planks and cat-cow stretches on travel days.

If you’re able to, try to sneak in a few lunges or walk with long, exaggerated strides when pre-boarding starts, Behenna suggests. “You might get some funny looks,” she says, but these movements in particular can help keep your hip flexors limber and get your blood flowing.⁵

As soon as the seatbelt sign goes off, get up and walk around, and then repeat that every 30 minutes if you can, Dr. Cayme suggests. When you’re sitting again, touch your toes, shift your weight from one hip to the other, or squeeze your shoulder blades together periodically, Dr. Sanderson suggests—anything you can do to not remain totally rigid for long periods.

5. Pay attention to how you sit. 

You may be tempted to curl up to get cozy in-flight, but Dr. Cayme says that can wreck your back. Instead, keep your feet planted firmly on the ground (no crossing!) with your knees at right angles, he suggests. This position takes the pressure off your pelvis, Behenna adds, which minimizes straining and helps it stay aligned.⁶ If your feet don’t touch the ground, prop them up with your carry-on, if possible. And don’t forget the lumbar support pillow!

6. Plan for your arrival.

You’ll probably be fairly stiff upon landing, so try to keep moving once you’re on the ground too, Behenna says. Try those hip-focused moves we mentioned earlier at the baggage claim, or do a few trunk rotations.⁷ One of Behenna’s favorite is one you can do in your hotel room: Lie on your back with your knees bent into your chest, and then rotate them from side to side.

Dr. Sanderson notes that making a self-care plan in advance can help ensure your vacation or work trip goes smoothly at your destination. Massages can help loosen tight muscles that contribute to back aches, Dr. Cayme says, so it might be worth scheduling one at your destination (if you can swing it). If you have chronic pain caused by a muscle tear or a chronic condition, like rheumatoid arthritis, check with your doctor first. As for Gray, she occasionally books an appointment when she arrives, but also relies on the heating pad that she packs into her carry-on bag.

After years of dealing with back issues and having to travel so much, Gray now knows what products and exercises help keep her symptoms from flaring up. Rest assured that if you map a game plan ahead of time (and, perhaps, give yourself some grace when things go awry, which tends to be 75% of air travel)—your poor spine will thank you.

Related:

• 7 Small but Effective Ways to Relieve Back Pain
• How to Get a Good Night’s Sleep When You Have Chronic Back Pain
• 8 Excellent Posture Exercises to Add to Your Routine

Sources:

1. Occupational and Environmental Medicine, The Effect of Lifting During Work on Low Back Pain: A Health Impact Assessment Based on a Meta-Analysis
2. Journal of Education and Health Promotion, Backpack Improper Use Causes Musculoskeletal Injuries in Adolescents: A Systematic Review
3. Healthcare, A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain
4. Chiropractic and Manual Therapies, The Effect of a Lumbar Support Pillow on Lumbar Posture and Comfort During a Prolonged Seated Task
5. Physical Activity and Nutrition, Effects of Combined Hip Exercise and Passive Stretching on Muscle Stiffness, Pain Perception, and Pain-Related Disability, and Physical Function in Older Adults With Low Back Pain
6. International Journal of Environmental Research and Public Health, The Effects of Cross-Legged Sitting on the Trunk and Pelvic Angles and Gluteal Pressure in People With and Without Low Back Pain
7. Environmental Research and Public Health, Effects of Different Trunk Training Methods for Chronic Low Back Pain: A Meta-Analysis