Many adults suffer from lower back pain, and some people may consider inversion tables a potential therapy. Alternative treatments may prevent the need for invasive surgery or unwanted medication, so they have a lot of interest. The idea of lying upside down for a few minutes a day for pain relief is very inviting. But does it work?
Are inversion tables good for lower back pain? In this article, we look at the science behind inversion therapy, its drawbacks, and its benefits.
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Inversion therapy is a type of treatment where you’re suspended upside down. It can relieve back pain as lying upside down ‘decompresses’ the spine. Gravity normally works against us, creating a build-up of pressure in the back, but it helps stretch the spine when you’re inverted.
Here are three different types of inversion therapy equipment:
Gravity boots are strong ankle boots that allow you to hang upside down
Inversion chairs, which some believe are better because they cause less strain on the legs
Inversion tables, which we’ll be looking at in further detail here.
An inversion table is a machine with a platform allowing you to lie on your back, strap in at your ankles, and hang upside down. This table can tilt at certain angles to stretch and decompress the spine. The closer the head is to the floor, the greater the stretch on the back. However, most people won’t go past 60 degrees because of the pressure in the head.
Over time, gravity affects our bodies by compressing our spine and back muscles. The theory of inversion therapy is that it can take away stress from the back by stretching and reducing the weight on your back. The constant pressure on your spine from daily sitting, standing, and bending can take a toll on your back.
Inversion tables can also improve your mobility and flexibility, making it easier to reach, bend, and twist. Having greater mobility is important for reducing back injuries, and it’s vital as we age. It keeps us active, independent and decreases the risk of falls and broken bones.
A study from 2013 discovered an increase in muscle mass and lower back strength.¹ Muscle plays a vital role in stabilizing the back and core, reducing lower back pain and the chance of injury.
Another study discovered that inversion therapy reduced the need for spinal surgery,⁴ but it’s best to consult your doctor about whether this treatment is appropriate. Back pain and its causes are very complex, so there’s no guarantee that inversion therapy would alleviate your back pain. There are also risk factors you need to consider, which we’ve listed below.
As well as short-term relief for non-specific and chronic back pain, inversion tables can help relieve a few other issues:
Degenerative disc disease
Degenerative disc disease is where the disc between the vertebrae begins to dry out and shrink, so there’s less cushioning and support for your spine. This condition causes inflammation, muscle spasms, and pain. Inversion therapy can help by creating more space between the discs and easing the constant pressure on the spine.
Scoliosis is an abnormal curvature of the back that can compress the spine and the surrounding nerves and muscles. While the research is limited, the gravity-defying effects of inversion therapy may help relieve discomfort and the uneven pressure on the spine.
Evidence for the benefit of inversion therapy on sciatica is limited,⁴ but some people may find the anti-gravity effects of inversion helps their symptoms. The only study showing a significant reduction in participants suffering from sciatica was a 2021 study sponsored by Teeter, an inversion equipment company.⁷ We need to consider this conflict of interest when assessing the quality of the study.
Muscle tightness can occur when muscles begin to tire. Studies have demonstrated that inversion can prevent muscles from overworking.² Scientists discovered that inversion therapy reduced muscle activity after three minutes of treatment in 52.5% of people.
Kidney stones can be hard to clear from the body. Currently, doctors use shockwave lithotripsy to blast them and help them escape the kidney. However, new evidence from a 2015 study shows that inversion therapy can improve the clearance of stones using the effects of gravity alongside diuresis (urinating a lot).³
Inversion therapy can also improve flexibility and build muscle mass.
It depends on the exact model of the table, but some general advice involves:
Firstly, consult your doctor to ensure it’s safe for you to use an inversion table
Secure your inversion table on a flat, stable surface
Familiarize yourself with the operating manual
Wear athletic shoes with a good grip; never use an inversion table in bare feet
For your first time inverting, have someone with you. You may feel dizzy, so it’s helpful to have someone with you to keep an eye on you
With your back toward the table, place each foot into the straps, one at a time
With a straight back, lean forward to pull the lever and lock your feet in place
Secure yourself with any straps or bars on the table
Grasping onto the side, you can now slowly tilt yourself to your preferred degree
It’s best to stick to short sessions when you first start, so 30 seconds could be a good idea for beginners
Pull yourself up slowly to return to your starting position and repeat if desired
When you’ve finished, unclip yourself to get out. You may benefit from lying flat on the machine for a moment if you haven’t got used to the blood rushing sensation
You can choose from various angles, from a very slight inversion at -15 degrees to a full -180 tilt. However, studies have shown that -60 degrees are beneficial, so a full inversion may not be necessary. Trial and error will help you identify which works best for you.
A 2012 study⁴ focused on 26 participants awaiting lumbar disc surgery. The researchers split the group into two. One group used inversion therapy and physiotherapy, while the control group used physiotherapy alone. Only 22% of the participants avoided surgery in the control group, while 77% of the other group had the same outcome. However, there were no significant diagnostic test differences between the two groups.
There was a follow-up to the above study with 85 participants in 2021.⁵ It showed promising results: 21% of participants underwent surgery compared to the group not using inversion therapy, where 39% opted for surgery after two years. However, there is a conflict of interest: Teeter supported the study and supplied the inversion tables. Also, the study wasn’t randomized.
A 1985 study² discovered the ability to bend forward increased by 25%, a decrease in EMG levels (muscles relaxed, less pain), and a flattening of lumbar lordosis, an inward curve of the spine. Again, a manufacturer of inversion equipment funded this study.
When it comes to the best angle for treatment, a 2013¹ study compared three positions: supine (flat), -30 degrees, or -60 degrees. After eight weeks of treatment in 47 women with lower back pain, researchers found that the -60 degrees position led to significant decreases in pain and increased muscle gain. However, more research is needed as this was only a small study.
While the studies are positive, they’re all very small and not definitive. Generally, more research is needed as this is a growing area. The Annals of Internal Medicine⁶ stated that only low-quality studies supported the idea of inversion therapy.
Consult your doctor before trying inversion therapy as they may deem it unsafe for you. There could be different treatments to target the root cause of your issue.
If you have certain conditions, inversion therapy might be unsafe. As you’re upside down during inversion therapy, it puts immense pressure on your eyeballs, increases your blood pressure, and decreases your heart rate.
Your doctor may advise avoiding inversion tables if you have:
Cardiovascular disorders, including stroke, heart disease, or high blood pressure
Issues including glaucoma, conjunctivitis (pink eye), retinal detachment, ear infections, or cerebral sclerosis
Bone and joint disorders, including osteoporosis, fractures, spinal injuries
Blood clotting medication, acid reflux, hernias, slipped discs, pregnancy, and obesity can cause complications, so consult your doctor if any of these apply to you.
It’s a good idea to take it slow when you first start using inversion tables. Short, 30-second sets are an appropriate starting point, which you can slowly increase to three to five minutes. Starting slow allows your body to adapt to the therapy, and you’re less likely to have side effects like a muscle strain or dizziness.
If you have any side effects, slowly come back up and reduce how long you invert for next time. Hanging upside down for too long is dangerous, as it can cause blood to pool in the head.
Inversion therapy is where you hang upside down to defy gravity and its effects on your body, particularly your spine and back.
While inversion therapies have performed well in studies as short-term pain relief, better quality research with more participants is needed. Additionally, manufacturers of inversion products have supported or sponsored studies.² ⁵ ⁷ Despite results showing its potential for muscle-building and decreasing pain, other safer treatments have a similar effect (e.g., pilates, yoga, etc.)
If you want to try inversion therapy, consult your doctor to ensure it’s safe for you. They may suggest other treatments you can try alongside inversion therapy. Inversion may not be the answer for your specific case of back pain, but your doctor will be able to guide you in the right direction.