I am often asked whether Inversion Tables can help relieve back pain symptoms. You may have seen this treatment in the movies.  It really came into vogue after Richard Gere used Inversion boots in the old movie, American Gigolo.  The concept is that the table tips you upside down and gravity pulls on the weight of your trunk, head and arms.  This stretches your spine to counter the compression created when we are upright. By stretching (“tractioning”) the spine you can reduce the compression on the discs, joints and nerves, with the expectation that back pain can be alleviated.

Although it is a little different in a clinical setting as it is often applied  with a machine on a horizontal table, my early experience with traction was mixed.   At times it was very effective, at others there was no difference and occasionally it could aggravate low back pain. I suspect that if a clinical trial of inversion table treatment was done, you would see similar results.

If you are going to try inversion its important to balance the safety (risk) with the effectiveness, (benefit).  Using an Inversion Table to tip yourself from a slight incline to fully “upside down” is quite unique and unusual for most adults. Although you may benefit from the stretch to the spinal tissues, it can also have negative, potentially harmful effects.

Here are some of the pros and cons of inversion:

Benefits of inversion

  • Relief of low back pain
  • Applying traction type forces to the spine can be helpful in alleviating low back pain symptoms in the short term particularly if done as part of a more comprehensive program of exercise and education.

Risks of inversion

  • Inversion can make your back pain worse. 
  • If the traction-type force created as you suspend yourself “upside down” is excessive you can aggravate the “straight”/extension position of your spine. This may not be tolerated if you have conditions such as spinal stenosis (narrowing of the spinal canal).  You may get more pain if your core muscles are too weak to take the stretch.

Inversion can affect your heart

Another consideration is the effect that tipping will have on other body systems. For example, in the Mayo Clinic newsletter an article on Inversion Tables/Therapy mayoclinicpain@everydayhealth.com  highlighted the cardiovascular risks if you have a slower heart rate or high blood pressure.  They recommend that if you have a cardiac condition such as an abnormal heart beat or hypertension or if there is a history of stroke or future risk of a stroke that you should not use an inversion table. If you are seeing a cardiologist you should ask what your risks are for this type of treatment.

Other reasons to avoid inversion treatments

  • Any condition where there is increased pressure within the eye i.e. Glaucoma or Retinal disease . Tipping upside down will increase this pressure and put you at risk for damage to the optic nerve.
  • Inner ear problems such as vertigo, dizziness or infections
  • Obesity can be an issue if you have cardiovascular issues as well as from the increased load on your spine and legs
  • Pregnancy
  • Osteoporosis or bone weakening conditions and history of spinal fracture
  • Hernias
  • Taking blood thinning types of medication
  • Gastric issues, such as acid reflux
  • Presence of orthopaedic implants, total hips/total knee replacements

It is strongly recommended that before using an Inversion Table to treat your back pain you discuss any medical issues with your Doctor.  Your physiotherapist can provide you with guidance on whether this is a good treatment option for your back.

The bottom line on inversion tables and low back pain

If you are healthy, with no risk of any of the above conditions, “traction” type forces such as produced by an Inversion Table may be beneficial as part of a more comprehensive program of exercise. A trial of horizontal traction with your therapist can be the first step in deciding if this is the right treatment for you.  If you have back pain and would like to discuss this further or receive other treatment strategies to take control of your pain, please contact me at gsneath@orthophysio.com or 416-925-4687.

References

https://www.mayoclinic.org/diseases-conditions/…/inversion-therapy/faq-20057951

Author E. Laskowski MD June 30 2017