Do Those Inversion Tables Work? A Physical Therapist's Perspective

Someone asked me this question the other day and I immediately wrote it down. That's because it was probably the 800th time I’ve been asked about inversion tables. And while I have answered this question many times, I've never done any formal research on it. I would always answer it based on what I had seen clinically. So the typical dialogue goes something like this...

PT:  “Have you used one before? Did it feel good? What happened when you became upright again?”

Client:  “No, but it looks like it would feel really great.” Or they'll say, “Yes, I’ve used one before and yeah it felt good; it calmed down my back pain.” Then they go on to describe how the pain eventually came back and they had to keep using it. The cycle repeats itself.

PT:  “Great, I’m glad that it feels good when you’re using it. Traction is definitely an effective way to decrease the effects of gravity on your spine and joints to give you some relief. I do something similar with my 'manual traction' techniques because it feels good, calms down pain, and relaxes muscle tension."

Client:  "Okay, then that’s all we have to do to make my back better?!?"

PT:  "Not so quickly." I continue the dialogue by asking, "How much of the day are you able to hang around upside down or have someone perform manual traction on your spine?"

Client:  "Well, not too much."

So here’s my real answer to this question.

Inversion tables, manual traction and even mechanical traction can feel good and provide pain relief, as long as it is performed correctly and not on someone where it would cause adverse effects. However, if all anyone ever did for back pain was traction or inversion, we would probably all end up hanging upside down and in mechanical traction machines or knocking the doors down to various practitioners' offices begging to get it for the rest of our lives. Right? But we aren’t. Why? Because there are many other options to treat the underlying reasons why someone would need an inversion table. And the treatment for these root causes of pain do not solely involve lying around having someone perform traction, using a mechanical traction machine, or purchasing an inversion table.

What are those other things? If I answered that question in it's entirety, I'd write a novel. So I will answer it generally. The location of the pain may not be the cause of the pain. In fact, more often than not it is coming from somewhere else. Something in your body is telling you it's had enough if it is hurting. It needs a change.

Your spine has many vertebrae: 7 in your neck, 12 in your thoracic spine (mid back), and 5 in your lumbar spine. All of these segments move and have muscles that move them. Those muscles and joints can be influenced by active flexibility exercises as well as muscle activation and strengthening exercises. Exercise and movement are proven to reduce low back pain significantly; and I’ve even treated people that report complete elimination of back pain without mechanical traction or inversion tables.

If your body is upright or horizontal most of the time, then we need to be influencing and retraining the active components of the structures whose job is to keep us upright. There may be a much more efficient way than laying upside down for an extended period of time day in and day out to treat back pain.

There’s definitely a place for passive treatments. I’m a huge advocate for manual treatment techniques, but I would love to teach anyone (who is dependent upon an inversion table or years of passive treatments for back or neck pain) a way for them to more efficiently eliminate those symptoms, and allow them to return to activities beyond what they thought possible. Keeping up with a passive modality indefinitely may eventually reduce their pain, but if you spend the remaining 98% of the time doing the exact same thing you always do, then you'll likely be dependent on it for life.

Inversion research

I looked up some research on inversion tables and found this out. They do work in decreasing pain, increasing lumbar flexibility, and even improving trunk extensor strength. The study I looked at had people inverting over an 8-week period to varying degrees for 9 minutes a day, 4 days a week. It found that the most improvements were at 60 degrees of inversion. So yeah, it works. But 8 weeks? How much did their pain relief, flexibility gains, and strength improvement actually translate into functional use? I could go on and on, but hopefully you get the point.

So I still hold to my same answer and wouldn’t change it. Passive modalities can be great and can really help to calm down symptoms and better prepare you for activity, but they must be combined with more active measures that address the source of your symptoms.

There are so many ways that I’ve seen and helped people get better a lot faster than 8 weeks who have had chronic low back pain. If all you do is something passive, you may be spending more time in pain than necessary.

Disclaimer:  The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.

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Kim, Jae-Deung et al. ‘The Effect of Inversion Traction on Pain Sensation, Lumbar Flexibility and Trunk Muscles Strength in Patients with Chronic Low Back Pain’. 1 Jan. 2013: 237–246.

Dr. Adrienne Jensen

Center Director | Physical Therapist | Doctor of Physical Therapy
Adrienne Jensen is a Doctor of Physical Therapy (DPT) and Certified Strength & Conditioning Specialist (CSCS). She works at Activcore in Princeton, New Jersey, located just 2 miles from Princeton University. Besides athletics, Adrienne has a special interest in orthopedics and breast cancer rehabilitation.
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