I have been suffering from low back pain for a few weeks, and I have seen inversion tables advertised on television that claim to help low back pain. Do inversion tables help low back pain?
Low back pain (LBP) is one of the most common reasons for a visit to your physician, second only to the common cold. It can be caused by any number of reasons including poor sitting posture, heavy lifting, or frequent bending.
If you have had LBP, you might have realized that a lot of people have experiences with back pain just like you. That also means that many people have tried many different treatments and modalities to help decrease their LBP and improve their function.
An inversion table is a padded table that is connected to a metal frame with hinges. To use the inversion table, you strap yourself onto the table and slowly allow the table to flip over, thus inverting the body. Inversion tables typically range in cost from $100 to $400.
What Is an Inversion Table Supposed to Do?
The theory behind inversion table use is that by flipping your body over, you are able to unload the bones, joints and discs in the low back. This is thought to create a traction force through the spine, and it has been theorized that traction can decrease low back pain. Another name for inversion tables or inversion therapy is gravitational traction.
Are There Risks Assosciated with Inversion Tables?
The most common risks associated with inversion tables are an unsafe rise in blood pressure, a rise in pressure in the eyes (glaucoma), or a rise in heart rate. It is therefore recommended that if you have glaucoma, high blood pressure, or cardiovascular disease you check with your doctor before attempting inversion therapy.
Inversion Tables and Low Back Pain
Most studies indicate that inversion therapy does cause some traction force through the lumbar spine. One study found as much as a 3 mm separation between lumbar vertebrae during inversion therapy. So the question arises: Does lumbar traction help low back pain?
A review of available research was published in 1995 and found that most studies about the efficacy of traction for LBP were of poor quality. Those studies that were of high quality were not able to demonstrate that lumbar traction helps LBP. Conclusion: While lumbar traction did not seem detrimental to individuals with LBP, it also didn’t seem to help much.
A paper in the 2001 issue of Physical Therapy Journal examined published evidence for various treatment modalities for acute (< 4 weeks of pain), sub-acute (4-12 weeks), and chronic (> 12 weeks) non-specific LBP. In short, the findings indicate that traction for acute, sub-acute and chronic LBP received a grade of "C" (no benefit demonstrated). To date, no other high quality studies have been published to refute these findings.
What Does Help Low Back Pain?
The same paper in the 2001 Physical Therapy Journal that reviewed LBP concluded that the best treatment for non-specific acute low back pain is to remain as active as possible. For sub-acute and chronic low back pain, the evidence shows that exercise received a grade of “A” (benefit demonstrated). The paper concludes: “There is evidence to support and recommend the use of continued normal activities for acute non-specific LBP and therapeutic exercises for chronic, subacute, and postsurgery LBP.”
If you are suffering from low back pain or pain in the leg that is coming from the back (sciatica), the best treatment for you to engage in is continue normal routines and perhaps add exercise. The use of mechanical traction seems to offer little or no benefit for low back pain.
Comparing the risks associated with inversion tables (glaucoma, blood pressure changes, heart rate changes) with the benefits expected with using inversion for low back pain, it would seem that your time (and money) would be better spent exercising to help treat your pain.
A visit to your physical therapist is a reasonable plan of care for your low back. He or she can prescribe exercises for back pain and help you change your posture to help your condition. Your physical therapist can also teach you why your back is hurting and can help provide strategies to prevent future problems with your low back.
Albright, J. et al. Philadelphia panel evidence-based clinical practice guidelines on selected rehabilitation interventions for low back pain. Physical Therapy. 2001. Oct; 81(10): 1641-1674.
Souza, S. Cardioperipheral vascular effects of inversion on humans. Physical Therapy. 1987. May; 67(5): 680-687.
Tekeoglu, I. et al. Distraction of lumbar vertebrae in gravitational traction. Spine. 1998. May; 23(9): 1061-3.
van der Heijen, G. et al. The efficacy of traction for back and neck pain: A systematic, blinded review of randomized clinical trial methods. Physical Therapy. 1995. Feb; 75(2): 93-104.
Zito, M. Effects of two gravity inversion methods on heart rate, systolic brachial pressure, an opthalmic artery pressure. Physical Therapy. 1988. Jan; 68(1): 20-25.