Been using this for a few years now on the tatl flights, along with the self inflatable seat cushion (magellans). It is true you have to scoot up a bit on your seat but the final results on my part are no more aches/pains on my shoulder blade areas and lower back area. You have to keep it underinflated enough to fit your back-usually about less than half inflated. The tedious part is deflating it and trying to fold it back to fit into that small plastic case just right. For flights within the US, the neck pillow and seat cushion work fine.