Benefits and risks of Inversion therapy for lower back pain.
Original publication date – February 2020
Patients that present to the office with acute or chronic lower back pain commonly inquire as to the potential benefit of using an Inversion Table to apply Inversion Therapy – essentially hanging upside down. If you asked 10 different healthcare providers of different disciplines if inversion therapy is beneficial, you would probably get ten different opinions. While inversion therapy in some form has been around for centuries, it has only begun to increase in western popularity in the last 40-years. The modern interest began with a scene in the 1980 movie American Gigolo. Archeological discoveries show inversion therapy performed as early as 3000 B.C.
In 1980, the original form of inversion therapy was performed wearing Gravity Boots and hanging upside down from a chin up bar. This was kind of an all-or-nothing method. If you were in appreciable pain or did not have the athleticism to swing your feet up to the bar and then control your descent, it really wasn’t an option for you. Shortly after the Gravity Boot system came out, the same company released a very cumbersome but useful type of table. This allowed you to strap into the boots in a seated position and then get positioned on the table standing. Someone else would then lower you to the desired level to develop the necessary traction.
The most common form of inversion therapy today is through the use of an Inversion Table where the boots are actually attached to the table itself. Teeter® Inversion Tables are the most popular inversion table on the market today. Also, the U.S. Food and Drug Administration (FDA) has approved the Teeter® Inversion Table as a medical device. It is the only inversion table on the market approved as a medical device. The FDA has also provided the following list of conditions for which Teeter® Inversion Tables are approved for use; they include back pain, muscle tension, degenerative disc disease, spinal degenerative joint disease, spinal stenosis, herniated disc, sciatica, muscle spasm, and facet syndrome.
The accepted mechanism of inversion therapy is to reverse the effects of gravity. Since gravity is compressive in nature, inversion therapy is used to decompress the spine and surrounding structures. When you achieve a particular degree of inversion, the muscles, tendons, ligaments, and fascia will stretch. Once they have begun to lengthen, the spinal joints will decompress and then the spinal discs will stretch to increase the space between the vertebrae. Stretching of the spinal discs creates a vacuum, in theory, will help to pull herniated disc material back into the disc thus decreasing pressure on the exiting spinal nerves.
Healthcare providers do not recommend complete inversion (hanging upside down) when you begin inversion therapy, especially if you have never done it before. Most experts recommend starting at an angle of between 20 and 45 degrees of inversion for 1-2 minutes repeated 4-5 times with an equal amount of recover time between sessions. If you are partially inverted for one minute, you should return to the starting position for a minute before performing another minute of the inversion.
The question remains, does it work? There have been a number of scientific studies performed. Unfortunately they are of a variety of population sizes and there is no consensus on effectiveness. When the studies narrow down the condition that is being treated, the results seem to be better. In particular, when the inversion therapy is combined with physical therapy, the results seem to be more favorable. Because the studies are typically small in size, it is hard to generalize the results. Right now most of the positive or negative results are largely anecdotal. If you have an isolated lesion or condition in your back, you are more likely to get relief from consistent inversion therapy. If you have multiple problems going on at the same time then the chances of relief or recovery will be less. One small study of patients with single level isolated disc herniation showed greater than 75% of those studied avoided surgery.
While using an inversion table to help manage your lower back pain sounds like a good idea, you have to consider other aspects of your health history before you invest in an inversion table and start hanging upside down like a bat. According to the Mayo Clinic, your heart rate will slow down and your blood pressure will rise when you remain in an inverted position for more than a couple of minutes, and the pressure in your eyes will increase dramatically. The primary medical reasons you should not try inversion therapy include high blood pressure, heart disease, glaucoma, knee and hip degeneration, inguinal hernia, osteoporosis, spondylolisthesis/spondylolysis, or if you are pregnant. Remember to ask your healthcare provider if you are a good candidate for inversion therapy before you invest the money in a table of your own.
Dr. Buchberger is a licensed chiropractor, physical therapist, certified strength and conditioning specialist and Diplomate of the American Chiropractic Board of Sports Physicians with 31 years of clinical sports injury experience. Dr. Buchberger can be contacted at 315-515-3117, www.activeptsolutions.com or www.shouldermadesimple.com