What are the health benefits of using inversion tables for back pain?

Health Benefits of Inversion Tables for Back Pain

Inversion tables have limited evidence supporting their use for back pain and carry significant risks that outweigh potential benefits for most patients. 1

Current Evidence on Inversion Tables

Inversion table therapy (ITT) is a form of spinal traction that theoretically works by using gravity to create separation between vertebrae. However, clinical practice guidelines from reputable organizations do not recommend inversion therapy as a first-line or even secondary treatment for back pain.

Potential Benefits:

• May provide temporary lumbar distraction (0.3 to 4.0 mm of intervertebral space separation) 2
• Some patients report subjective improvement in back symptoms (13 out of 16 symptomatic patients in one small study) 2

Significant Risks:

• Increases in blood pressure (average increase of 17.2 systolic and 16.4 diastolic) 2
• Decreases in heart rate (average decrease of 16.4 beats per minute) 2
• Significant changes in intracranial pressure and cerebral blood flow 3
• FDA has documented serious injuries including spinal cord injury, fractures, lacerations, and even death 1
• Side effects including periorbital and pharyngeal petechiae, persistent headaches, persistent blurred vision, and contact lens discomfort 2

Evidence-Based Alternatives for Back Pain

The American College of Physicians and American Pain Society clinical practice guidelines recommend several evidence-based approaches for back pain management:

For Acute Low Back Pain:

• Superficial heat (good evidence for moderate benefits) 4
• Spinal manipulation (fair evidence for small to moderate benefits) 4

For Chronic Low Back Pain:

• Exercise therapy (good evidence, moderately effective) 4, 5
• Cognitive-behavioral therapy (good evidence, moderately effective) 4
• Spinal manipulation (good evidence, moderately effective) 4
• Interdisciplinary rehabilitation (good evidence, moderately effective) 4
• Acupuncture (fair evidence) 4
• Massage (fair evidence) 4
• Yoga (fair evidence, particularly Viniyoga style) 4

Clinical Decision Algorithm

1. First-line approaches for chronic back pain:

   • Structured exercise programs that incorporate individual tailoring, supervision, stretching, and strengthening 4
   • Consider cognitive-behavioral therapy for patients with psychosocial factors 4

2. Second-line approaches:

   • Spinal manipulation by trained providers 4
   • Massage therapy 4
   • Yoga (particularly Viniyoga style) 4
   • Acupuncture 4

3. For patients not responding to first and second-line treatments:

   • Consider interdisciplinary rehabilitation programs 4

Important Cautions

Inversion therapy should be avoided in patients with:

• Hypertension 6
• History of elevated intracranial pressure 3
• Cardiovascular disease
• Glaucoma or other eye conditions
• Pregnancy

Summary

While inversion tables may provide temporary relief for some individuals with back pain through spinal distraction, the significant cardiovascular and neurological risks, combined with the lack of endorsement in clinical practice guidelines, make them a poor choice compared to evidence-based alternatives. Exercise therapy, cognitive-behavioral therapy, spinal manipulation, and interdisciplinary rehabilitation all have stronger evidence supporting their effectiveness and safety for back pain management.