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Showing posts with label traction spine. Show all posts
Showing posts with label traction spine. Show all posts

Thursday, March 19, 2015

Inversion Tables

I am constantly asked by patients what my professional opinion is regarding inversion tables. In most cases I share my cursory exploration of the subject and advise that they do their homework before buying one. Having been asked this question again only three days ago I felt it only right to review what research literature I could find on the subject so as to provide people with a more detailed point of reference.

My search for credible, unbiased literature revealed a surprisingly scant wealth of resources on the subject. There are plenty of sites with opinion pieces, organizational advocacy, and even consumer testimonials regarding personal experience with inversion (i.e. Spine-Health) but very little medical evidence for or against its use. In fact I could only find two websites where the authors cited medical research to substantiate their advocacy, or lack thereof, for inversion table use in the treatment of musculoskeletal pain.

Edward R. Laskowski, M.D., co-director of the Mayo Clinic Sports Medicine Center and a professor at College of Medicine, Mayo Clinic, published a brief article regarding the subject where he opened his commentary by stating, “Inversion therapy doesn't provide lasting relief from back pain, and it's not safe for everyone”. He went on to describe the effects of inversion and ended by citing its contraindications for use.[1]

Kevin Macpherson, M.Ed., ATC, currently employed by Pivotal Health Solutions, published an article where he cites eight relevant publications and ends his commentary by stating, “If more health-care providers were educated on the benefits of inversion, many patients could receive the lifelong benefits of this therapy and the cost savings to both patients and practitioner can be substantial, as we start to equalize gravity’s negative effects one patient at a time”.[2]

However, several of the research studies cited are more than twenty (20) years old and the sample sizes were small (60 subjects or less) which isn't a true random sampling of the general population. This in no way means the findings of these researchers is not legitimate but is dated and cannot accurately formulate a conclusive argument for or against the use of inversion tables.[3], [4], [5], [6], [7], [8], [9], [10], [11] Dr. Laskowski’s article did however include two literature reviews in which the authors searched medical databases for studies involving treatment methods for low back pain.

The first, published in 2006 in Spine, examined traction therapy for low back pain with or without sciatica. In this review the authors selected studies regarding “randomized controlled trials (RCTs) involving any type of traction”, albeit inversion tables ARE a form of traction this was not the solitary focus of this review. The authors ultimately concluded that “intermittent or continuous traction” is not a recommended standalone treatment for low back pain but that “the literature allows no firm negative conclusion that traction, in a generalized sense, is not an effective treatment for patients with LBP”.

The second, published in 2007 in the Annals of Internal Medicine, examined treatment methods that ranged from acupuncture to yoga but did not primarily examine the benefits and/or risks involved with inversion tables. The authors conclude that cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation exhibited moderate clinical effectiveness for the treatment of chronic or subacute low back pain. [12]

Ultimately I did find one [unbiased][13] research article that exclusively examined the use of inversion therapy in the treatment of low back pain. Although cited in Mr. Macpherson’s article 2 it must have been an ad hoc addition by the website because this study was conducted three (3) years after the publication of his commentary. This was a pilot randomized trial conducted at the Regional Neurosciences Centre, Newcastle Upon Tyne in the United Kingdom that examined “the effect of inversion therapy in patients with single level lumbar discogenic disease, who had been listed for surgery”. Although only a small sample size (24 participants) was observed it examined the use of physiotherapy in the treatment of sciatica with and without the use of an inversion device. From a clinical standpoint the outcome measures used in this trial are right on the mark as well as their use of surgery avoidance as a sign of treatment success. The authors concluded that a larger multi-center randomized trial needs to be conducted because it was shown that “intermittent traction with an inversion device [plus physiotherapy] resulted in a significant reduction in the need for surgery”.[14]

So what does all of this mean for you, the consumer? Before commencing any form of treatment due to a spine related disorder you should first consult a licensed medical professional who is specifically trained to differentially diagnosis your symptoms. Internet websites and anecdotal advice from friends and family is not a proper substitute for professional determination of your pain and effective treatment protocol(s). In fact when it comes to inversion therapy there are several contraindications to its use such as deconditioned musculature (spinal instability, spinal injury), eye conditions (detached retina, glaucoma, infection), circulatory problems (clotting issues, heart condition, high blood pressure, atrial fibrillation), fracture, hernia, implanted device(s), middle ear infection, osteoporosis, or pregnancy and only a professional medical consult will help determine if this form of treatment is right for you.[15] You should also keep in mind that no solitary intervention, as stated in the research presented here, is an effective form of treatment for musculoskeletal pain and dysfunction.

“Inversion tables are more or less like traction. I tell patients that want to try an inversion table to make sure they have another person in attendance to help them on and off the table. The same is true with traction. It may help, it may not. Generally, you will know the first time it is used.”[16]
Center for Spine Health, Cleveland Clinic



[1] Laskowski, Edward R. "Diseases and Conditions - Back Pain." Inversion Therapy: Can It Relieve Back Pain? Mayo Foundation for Medical Education and Research, 09 June 2014. Web. 17 Mar. 2015. <http://www.mayoclinic.org/diseases-conditions/back-pain/expert-answers/inversion-therapy/faq-20057951>.
[2] Macpherson, Kevin. "Inversion Therapy." Canadian Chiropractor. Annex Business Media, 30 Apr. 2009. Web. 17 Mar. 2015. <http://www.canadianchiropractor.ca/techniques/inversion-therapy-1461>.
[3] Haskvitz EM, et al. Blood pressure response to inversion traction. Physical Therapy. 1986;66:1364.
[4] Lamarr JD, et al. Intraocular pressure response to inversion. American Journal of Optometry & Physiological Optics. 1984;61:679.
[5] Klatz RM; Goldman RM; Pinchuk BG; Nelson KE; Tarr RS: The effects of gravity inversion procedures on systemic blood pressure, intraocular pressure and anteriol retinal pressure. J Am Osteopathic Assoc. 1983 Jul; 82(11) 853-857.
[6] Goldman RM; Tarr RS; Pinchuk BG; Kappler RE: The Physician and Sports Medicine. March 1985.
[7] Nachemson A and Elfstrom G: Intravital Dynamic Pressure Measurements in Lumbar Discs. Scandinavian Journal of Rehab Medicine, supplement, 1970.
[8] Kane M, et al.: Effects of Gravity-facilitated Traction on Intervertebral Dimensions of the Lumbar Spine. Journal of Orthopedic and Sports Phys Ther. 281-288, Mar 85.
[9] Nosse L.: Inverted Spinal Traction. Arch Phys Med Rehabil 59: 367-370, Aug 78.
[10] Dimberg L, et al: Effects of gravity-facilitated traction of the lumbar spine in persons with chronic low back pain at the workplace.
[11] Sheffield F.: Adaptation of Tilt Table for Lumbar Traction. Arch Phys Med Rehabil 45: 469-472, 1964.
[12] Chou R. Nonpharmacologic therapies for acute and chronic low back pain: A review of the evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline. Annals of Internal Medicine. 2007;147:492.
[13] I did find another study published in the Journal of the Canadian Chiropractic Association but found it hard to believe no outcome bias existed when the study was funded by the manufacturer of the inversion device being used in the research.
[14] Prasad KS, et al. Inversion therapy in patients with pure single level lumbar discogenic disease: a pilot randomized trial. Disability and Rehabilitation. 2012;34(17):1473-80
[15] Spinasanta, Susan. "Low Back Pain and Sciatica Treatment | Inversion Therapy." SpineUniverse. Vertical Health, LLC, 17 Apr. 2014. Web. 17 Mar. 2015. <http://www.spineuniverse.com/conditions/back-pain/low-back-pain/turning-back-pain-sciatica-upside-down>.
[16] Wilson, Fredrick. "Osteopathic Manipulation for Back&Pelvic Pain." My.clevelandclinic.org. Cleveland Clinic, 14 Jan. 2011. Web. 18 Mar. 2015. . This is was taken from "Online Health Chat" hosted by the Cleveland Clinic where members of the general public were able to have a Q&A session with Fredrick Wilson, DO.