Upside Down for Back Pain
Do inversion tables work?
Q. What do you think about using inversion tables to relieve back pain?
A. Inversion tables are one type of "inversion therapy," which involves adopting an upside-down posture to reverse the effects of gravity on the spine. The head is tilted downward on a table, allegedly to relieve pressure on the discs and nerve roots in the spine and increase the space between vertebrae. Proponents claim that inversion table therapy not only relieves back pain but also improves posture, preserves height, increases flexibility, stimulates blood flow to the brain and scalp, corrects the position of abdominal organs, and relieves varicose veins. None of these assertions has any scientific basis.
Experts regard inversion tables as a form of spinal traction. Instead of increasing disk space, traction is more likely to stretch the muscles and ligaments around the spine and temporarily relieve muscle spasm. That may be why some people get short-term relief from back pain after lying on an inversion table. But spinal traction doesn't provide long-term relief. A 2006 Cochrane Review (a summary of evidence from randomized trials) concluded that there was no evidence to recommend traction for the treatment of low back pain.
Using an inversion table is not without risk: it raises blood pressure, lowers heart rate, and increases pressure in the eye. In some users, it has caused bleeding into the retina. It's also been associated with headache and blurred vision. Don't use an inversion table if you're pregnant or if you have high blood pressure, heart disease, or glaucoma or any other eye disease.
Some physical therapists may incorporate short-term inversion table therapy, under supervision, in a comprehensive program for back pain. That's the only setting in which I would consider use of an inversion table.
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Yes, inversion is a form of spinal traction, but it utilizes ones own body weight in combination with gravity for natural decompression. One should not assume that the therapeutic results are exactly the same as those reported with traditional, mechanical spinal traction. Mechanical traction equipment provides uncertain loads of strength, making it difficult to perfectly calibrate a meaningful load. Also, most designs require the use of complicated traction components that can be difficult to adjust and can cause patient discomfort, and patients may have difficulty relaxing, preventing distraction of tissue. All of these factors, combined with the fact that patients cannot accomplish this kind of therapy routinely on their own, contribute to the poor overall results reported with mechanical traction.
A number of studies HAVE shown that inversion can increase disc space, temporarily widening the space between the vertebrae. This claim is backed by FDA review. Though the benefits are temporary, the use of an inversion table as directed can be a useful maintenance tool that can help with the health of the discs and other weight-bearing joints of the body. The nature of the inversion table, a piece of equipment that can easily be utilized at home to stretch and elongate the body in just a few minutes, is ideal for accomplishing short term relief that quickly turns into a longer term solution for managing back pain and the health of the joints.
As for the risks involved, there are a few contraindications for inversion that people should be aware of and discuss with their own health advisors, most importantly glaucoma and uncontrolled high blood pressure. A few of the risks mentioned by Dr. Robb-Nicholson are assertions without scientific basis.
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