Getting into a car the right way: the back‑saving move most people get wrong

The back‑friendly way to get into a car is simple: sit down on the seat bottom‑first, facing out, then swing both legs in together while keeping your spine in line — instead of stepping one leg in and dropping into the seat as you twist. Physiotherapists and spine and hip surgeons give exactly this advice to people with back pain, sciatica, or recovering from surgery ¹²³⁴. It costs nothing, takes two seconds, and sidesteps one of the most common everyday triggers of low‑back pain.

Why “legs‑first” is a classic back trigger

Watch most people get into a low car: they plant one foot inside, then let the trunk fold forward and rotate as they drop onto the seat. That combines the three things the lumbar spine likes least, all at once — forward bending (flexion), twisting (axial rotation), and load (your body weight).

This is the highest‑risk movement pattern for the low back in the research. In a landmark prospective study of more than 400 industrial jobs, the strongest predictors of back injury were trunk flexion angle plus twisting velocity plus side‑bending velocity — together they separated high‑risk from low‑risk work with an odds ratio above ten ⁶. A three‑year cohort of workers found that sustained trunk flexion and rotation each independently raised the risk of new back pain ⁷.

The disc is the weak link. In human spine‑segment experiments, adding torsion to flexion sharply lowered the pressure needed to tear the annulus — the tough outer ring of the disc — and pushed the tear toward the back, where the nerves are ⁸. Repeated flexion, especially with a twist, is enough to make the disc’s inner gel track backwards and herniate ⁹¹⁰. And the disc is most vulnerable precisely when the spine is bent forward under load ¹¹.

Getting into a car is a small, brief version of this — but it is also the moment people are tired, distracted, carrying a bag, or stepping down to a low seat, so the load can arrive faster than the muscles brace for it. Unexpected, off‑guard loading raises spinal forces further ¹². That is why a twist into a car seat is such a famous way to “put your back out”.

The right way to get in — step by step

1. Back up to the car until you feel the seat against the backs of your legs.
2. Put a hand on the door frame or seat for support and lower yourself down bottom‑first, sitting on the edge of the seat facing out of the car.
3. Shuffle your bottom back into the seat.
4. Keeping your knees together, swing both legs into the footwell as one unit, turning your whole body to face forward. Move your shoulders and hips together, in one piece — don’t leave your feet planted and twist your back to follow them.

…and the right way to get out

1. Turn your whole body and bring both legs out of the car together, feet flat on the ground.
2. Shuffle to the edge of the seat.
3. Use your hands and legs — not a twist of the back — to stand up.
4. If your back is sore, breathe out and gently tighten your stomach as you move, and avoid holding your breath.

Who should pay the most attention

• Anyone with current low‑back pain or sciatica
• People with a known disc bulge or herniation
• Anyone in the first weeks after spinal, hip or knee surgery ¹²³
• Older adults, who naturally shift to a “both legs together” strategy for stability ¹⁴
• And honestly, everyone during an acute flare‑up — it is the cheapest insurance there is

How strong is the evidence, really?

We think it is important to be straight about this. The sit‑first technique is genuinely recommended by NHS hospital physiotherapy departments, spine units and orthopaedic surgeons — but as a mechanistic, common‑sense precaution, not because anyone has proven it in a controlled experiment ¹²³⁴. Studies that filmed people getting into cars describe many different natural strategies and have not tested which one is kinder to the spine ⁵. So: strong biomechanical rationale, strong clinical consensus, no direct trial. For a healthy back the difference on any single day is probably small; when your back is fragile, it is the sensible default.

While you’re at it: the other everyday ambushes

• Getting out of bed: roll onto your side, drop your legs over the edge and push up with your arms — don’t sit straight up and twist.
• Lifting: hinge at the hips and knees, keep the load close, and never bend and twist at the same time.
• Sneezing or coughing with a sore back: stand up and lean slightly back rather than folding forward.

Travellers feel this most: a long flight or overnight ferry, a hire car that sits low, and a back that is already stiff. If you have arrived in Olbia or on the Costa Smeralda and tweaked your back getting in or out of the car, a single assessment usually makes clear what is going on and what to do. Marco treats residents and visitors alike, in English and Italian.

References

1. Fiona Stanley Fremantle Hospitals Group (WA Health). Resuming activities after spinal surgery (reviewed 2025).
2. University Hospitals Plymouth NHS Trust. Your back after surgery — physiotherapy patient leaflet (2021).
3. Royal Berkshire NHS Foundation Trust. Advice and exercises after a total hip replacement (2023).
4. Nebraska Spine Hospital. Safely entering a vehicle with back pain (2024).
5. Fong CJ, et al. Identifying car ingress movement strategies before and after total knee replacement. International Biomechanics, 2020.
6. Marras WS, et al. The role of dynamic three‑dimensional trunk motion in occupationally‑related low back disorders. Spine, 1993;18(5):617–628.
7. Hoogendoorn WE, et al. Flexion and rotation of the trunk and lifting at work are risk factors for low back pain: a prospective cohort study. Spine, 2000;25(23):3087–3092.
8. Veres SP, Robertson PA, Broom ND. The influence of torsion on disc herniation when combined with flexion. European Spine Journal, 2010;19(9):1468–1478.
9. Callaghan JP, McGill SM. Intervertebral disc herniation: a porcine model exposed to highly repetitive flexion/extension with compressive force. Clinical Biomechanics, 2001;16(1):28–37.
10. Marshall LW, McGill SM. The role of axial torque in disc herniation. Clinical Biomechanics, 2010;25(1):6–9.
11. Adams MA, McNally DS, Chinn H, Dolan P. Posture and the compressive strength of the lumbar spine. Clinical Biomechanics, 1994;9(1):5–14.
12. Magnusson ML, et al. Unexpected load and asymmetric posture as etiologic factors in low back pain. European Spine Journal, 1996;5:23–35.
13. American Academy of Orthopaedic Surgeons (OrthoInfo). Activities after total hip replacement.
14. Chateauroux E, Wang X. Car egress analysis of younger and older drivers for motion simulation. Applied Ergonomics, 2010;42(1):169–177.