Benefits and risks of inversion therapy for low back pain.
Patients presenting to the office with acute or chronic low back pain often ask questions about the potential benefits of using an inversion table to deliver inversion therapy, essentially head down. If you were to ask 10 different healthcare providers from different disciplines if inversion therapy is beneficial, you would probably get 10 different opinions. While inversion therapy in one form or another has been around for centuries, it only started gaining popularity in the West in the last 40 years. Modern interest began with a scene from the 1980 film American Gigolo.
Archaeological findings show that inversion therapy was practiced as early as 3000 BC.
In the 1980s, the original form of inversion therapy was performed in gravity boots and hung upside down from a pull-up bar. It was kind of an all-or-nothing method. If you were in appreciable pain or lacked the athleticism to put your feet on the bar and then control your descent, this really wasn't an option for you. Shortly after the release of the Gravity Boot system, the same company released a very bulky but useful type of table. This allowed him to lace up his boots while seated and then stand on the table. Then someone else would lower it to the desired level to develop the needed traction.
The most common form of inversion therapy today is using an inversion table where the boots are attached to the table itself. Teeter® inversion tables are the most popular inversion tables on the market today. Additionally, the United States 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 strain, degenerative disc disease, degenerative spinal joint disease, spinal stenosis, herniated disc, sciatica, muscle spasms, 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 reach a certain degree of inversion, the muscles, tendons, ligaments, and fascia stretch. Once they begin to lengthen, the spinal joints decompress and then the spinal discs stretch to increase the space between the vertebrae. Stretching the spinal discs creates a vacuum which, in theory, will help push material from the herniated disc into the disc, thereby decreasing the pressure on the outgoing spinal nerves.
Health care providers do not recommend full inversion (upside down) at the start of inversion therapy, especially if you have never done it before. Most experts recommend starting at a 20-45 degree inversion angle for 1-2 minutes repeated 4-5 times with the same recovery time between sessions. If you are partially inverting for one minute, you should return to the starting position for one minute before doing another minute of inversion.
The question remains, does it work? A number of scientific studies have been done. Unfortunately, they are of varying population sizes and there is no consensus on effectiveness. When studies narrow down the condition being treated, the results seem better. In particular, when inversion therapy is combined with physical therapy, the results seem more favorable. As the studies are often small, it is difficult to generalize the results. At present, most positive or negative results are largely anecdotal. If you have an isolated back injury or condition, you may be more likely to get relief with consistent inversion therapy. If you have several problems at the same time, the chances of relief or cure will be less. A small study of patients with isolated single-level disc herniation showed that more than 75% of those studied avoided surgery.
Although using an inversion table to help manage lower back pain sounds like a good idea, you should consider other aspects of your medical history before investing in an inversion table and starting to hang you upside down like a bat. According to the Mayo Clinic, your heart rate will slow and your blood pressure will increase when you stay in an inverted position for more than a few minutes, and the pressure in your eyes will increase significantly. The main medical reasons why you should not try inversion therapy are high blood pressure, heart disease, glaucoma, knee and hip degeneration, inguinal hernia, osteoporosis, spondylolisthesis/Spondylolysis, or if you are pregnant. Be sure to ask your health care provider if you are a good candidate for inversion therapy before investing the money in your own table.