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.
