“I think men who have a pierced ear are better prepared for marriage. They’ve experienced pain and bought jewelry.”
– Rita Rudner

Inversion Therapy

 

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Definitions and Terms Related to Pain

 

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What Is an Inversion Table Supposed to Do?

The theory behind traction of the spine is to unload the bones, joints and discs in the low back to decrease low back pain. In patients with lumbar disc protrusions, mechanical (hoizontal) lumbar traction has been shown to be effective at improving pain. However, systematic reviews and meta-analysis evaluating the effect of mechanical traction showed only a significant short-term benefit but no long-term benefits.

Inversion Therapy has been practiced for thousands of years in different cultures. Inversion uses gravity to produce a traction force that is much larger than that which can be achieved on conventional horizontal traction tables. Inversion therapy was first (?) published as an effective treatment in 1964 and since then numerous studies have evaluated inversion to produce lumbar disc distraction of up to 4 mm at each disc space, mainly at L3/4 and L4/5..

 

Are There Risks Associated 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. That being said, there is little research to guide one in assessing the safety of inversion therapy in these conditions and therefore it would probably best to avoid inversion therapy if one has these conditions.

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. 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 indicated that traction for acute, sub-acute and chronic LBP received a grade of “C” (no benefit demonstrated).

A 2012 study evaluating inversion therapy hypothesized that inversion therapy would reduce the need for a surgical procedure in subjects with sciatica due to single level disc protrusion. The results of this study do support this:

“Surgery was avoided in 77% in the inversion group while it was averted in only 22% in the non-inversion group. Previous trials of traction have not reported on avoidance of surgery as an outcome measure and this trial has addressed that issue.”

In 2014 a survey performed to review the benefits of lumbar traction in LBP concluded:

“Several biases can be introduced by limited quality evidence from the included studies. Lumbar traction seems to produce positive results in nerve root compression symptoms. Data in degenerative and discogenic pain are debatable. To date, the use of lumbar traction therapy alone in LBP management is not recommended by the best available evidence.”

A 2021 study published by The Society of Physical Therapy Science evaluated patients with LBP and sciatica:

The study measured symptoms and compared surgery rates following inversion therapy for 85 participants with low back pain and MRI-proven disc protrusion with sciatica. The study concluded that inversion therapy relieved symptoms and there were improvements in the 2 year surgery rate (21% in the inversion participants, significantly lower than in the matched control group with 39% at two years and 43% at four years).

Teeter inversion tables were used in the study with a minimum of two minutes inversion repeated up to six times over a 30-minute period. Patients were inverted to the maximum tolerated angle for each patient (45 to 90 degrees head down from the horizontal).  They participants were advised to self-invert at least two or three times per day. Six and twelve months after starting, follow-up self-assessment questionnaires were provided by the patients.

Conclusion:

While lumbar traction and inversion therapy may help LBP and reduce the need for surgery, definitive studies are lacking to establish the true benefits. Safety concerns are present for those with high blood pressure, glaucoma and heart disease and inversion therapy is not recommended in these populations.

 

References

Inversion Therapy – Overviews

  1. DEVELOPMENT OF INSTRUMENT TO COMBINE INVERSION THERAPY & ZERO GRAVITY CONCEPT – 2013
  2. The Design of a Novel Tilt Seat for Inversion Therapy – 2013

Inversion Therapy – Low Back Pain

  1. Inversion therapy in patients with pure single level lumbar discogenic disease – a pilot randomized trial – 2012
  2. Lumbar Traction in the Management of Low Back Pain – A Survey of Latest Results – 2014
  3. Lumbar disc disease: the effect of inversion on clinical symptoms and a comparison of the rate of surgery after inversion therapy with the rate of surgery in neurosurgery controls – 2021

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Emphasis on Education

 

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