Does using an inversion table increase the risk of a herniated disc?

Inversion Table Use and Herniated Disc Risk

Inversion tables do not increase the risk of developing a herniated disc, but they pose significant risks of catastrophic spinal cord injury from falls, particularly in older adults with pre-existing cervical spine degeneration.

Primary Safety Concerns

The main danger is not disc herniation but rather severe spinal cord injury from falls while inverted. Multiple case reports document devastating cervical spinal cord injuries, including central cord syndrome and tetraplegia, occurring when patients fall from inversion tables 1, 2. These injuries are particularly catastrophic because the inverted position combined with a fall creates high-energy trauma to the cervical spine 1.

Fall-Related Spinal Cord Injury Risk

• Central cord syndrome is the most common incomplete spinal cord injury pattern seen with inversion table falls, especially in adults over 60 years 2
• Age-related cervical spine changes (stenosis, spondylosis, ligamentous laxity) predispose older adults to spinal cord compression during falls or cervical extension 2
• The inverted position during a fall creates a mechanism of injury that frequently results in tetraplegia 1
• These injuries have become increasingly common but remain underreported in the literature 1

Physiological Effects During Inversion

Inversion causes significant increases in intracranial pressure and alterations in cerebral blood flow that may contribute to fall risk 3:

• Optic nerve sheath diameter (a proxy for intracranial pressure) increases significantly during inversion 3
• Internal carotid and middle cerebral artery blood flow velocity, resistance, and pulsatility all change substantially 3
• These hemodynamic changes could theoretically increase complications in patients with pre-existing elevated intracranial pressure 3

Evidence on Disc Herniation Risk

There is no evidence that inversion therapy causes or increases the risk of disc herniation. In fact, limited research suggests potential benefits:

• A randomized controlled trial showed inversion therapy combined with physiotherapy reduced the need for surgery in patients with existing lumbar disc protrusions (77% avoided surgery versus 22% in controls) 4
• A registry study of 85 patients demonstrated symptom improvement and lower surgery rates (21% at 2 years) compared to matched controls (39-43%) 5
• No studies report increased disc herniation as a complication of inversion therapy 5, 4

Clinical Recommendations

Inversion therapy should be avoided or used with extreme caution, particularly in:

• Adults over 60 years of age due to increased risk of central cord syndrome from falls 2
• Patients with cervical spine stenosis, spondylosis, or degenerative changes 2
• Patients with history of elevated intracranial pressure or cerebrovascular disease 3
• Anyone with balance impairment or fall risk 1

Key Safety Considerations

The primary concern is catastrophic spinal cord injury from falls, not disc herniation 1, 2. When counseling patients:

• Emphasize that the evidence for lumbar traction effectiveness is limited 2
• Discuss the specific risk of cervical spinal cord injury if a fall occurs while inverted 1, 2
• Consider that age-related cervical spine changes dramatically increase injury risk during falls 2
• Note that safer alternatives for back pain management exist with stronger evidence bases 6

The risk-benefit ratio for inversion tables is unfavorable given the catastrophic nature of potential complications versus limited evidence of benefit.