Yep, this is another one of the most common questions often asked of me, your local Kirkland chiropractor. I have my opinions about it, but I always like to temper my opinions with what research is telling us. Let’s take a dip. Har har.
How Do Inversion Tables Work?
Research has largely revolved around complex mechanical and computerized traction tables. Typically these tables are utilized on people with disc injuries- usually herniations. People are typically strapped in and are stretched at the injured region. The elongation of the ligaments, muscles, and spine is thought to reduce muscular tension and bulging of a blown disc, as well as open spaces for nerves that may be physically restricted.[2][4]
Naturally, inversion tables are assumed to work on the same principle as traction tables by using gravity to produce a general traction throughout the spine as opposed to using mechanical means to target a specific area or direction. However...
There Isn't a Lot of Research on Inversion Tables, But There is Some.
One study[1] split a group of adults with disc herniations between conventional traction and inversion traction over the course of 10 days to study the effects on pain, back and posterior leg flexibility, neurological deficit improvement (reflexes, strength, and sensation), and the amount of disc protrusion measured on advanced imaging. While the reporting of this study was not perfect, the authors found both forms of traction were able to produce improvements in reducing pain levels and increasing posterior leg flexibility in each of the groups. Surprisingly though, they found small but not significant increases in disc protrusion in the inversion group. Overall, they found both to be comparably effective, but patients found inversion tables less comfortable.
If Other Traction Tables Are More Studied, How Good Are Those?
Very mixed. Much like the type of low back pain injuries they treat.
One 2008 study[2] reviewed several randomized clinical trials that compared various forms of traction to treatments such as exercise, electrical stimulation, heat, ultrasound to manage chronic low back pain with and without leg pain and found no significant differences or equivocal results. The authors concluded there was not significant evidence to recommend traction to manage chronic low back pain.
A 2011 systematic review[3] on methods for chronic low back pain identified one lower quality study that compared traction with physiotherapy to physiotherapy only and found no significant difference in pain and disability at 3 months.
A 2013 Cochrane Review[4], which was a follow up review to one they did in 2006[5], investigated 32 randomized clinical trials that studied traction against various durations of low back pain with and without sciatica. They concluded that compared to shams, no treatment, placebos, various physio-therapies, and exercise, that no significant improvements could be found on pain intensity, functional status, and global improvement with traction therapies.
Just to be safe, the authors of a recent 2018 systematic review[5] decided to revisit the issue again as others before them have found them to be ineffective. Their study found that the types of back pain treated are as varied as the types of traction and protocols used to execute them. Because of this they find that it is difficult to draw any clear conclusions on efficacy on a population level and suggest that “negative conclusions about the overall clinical effectiveness of lumbar traction should be interpreted with caution.”
My .02 Cents on Whether Inversion Tables are Worth It
I know I might sound like a broken record, because I, and other Kirkland chiropractors, often say “it depends”. I generally agree with the 2018 researchers that research needs to be carefully interpreted.
Population statistics should be interpreted carefully in systematic reviews as there’s always going to be some people that get worse, some that have no change, and some that get better by some treatment. Often times the effect of the bad can move the needle against the effect of the good, making it seemingly neutral or equivocal.
Another simple way to think about this issue is like the GDP per capita, which provides a sense of wealth and productivity of a country. In the US it's currently about $60,000 per person. You could say, we are all doing “okay” in this country. However, most of you are aware we have a huge disparity where much wealth is concentrated toward the top and we clearly know that there’s a lot of people that are not doing “okay”.
Based on what I’ve seen from the research and what I've heard from patients over the years that use it, I would say that traction is probably effective at providing some short term relief for various types of low back pain for some individuals. Logically, there is some inherent sense about using an inversion table to draw a blown disc back a bit, but as we found in the one study above[1], the authors found it actually increased some amount of disc protrusion despite subjects feeling better. So much for logic.
Whichever form of traction you use, you’ll have to stand back up after your traction which means gravity will begin to compress your discs, joints, and maybe nerves again.
So it really comes down to a convenience/cost/safety analysis for me. Most traction protocols on the fancy machines require several sessions a week, which can add up in cost and time if you need to go to a chiropractic clinic in Kirkland, or anywhere else for that matter, to be buckled in. But it's also more comfortable and probably safer than the inversion table although not as convenient.
Because Inversion Tables Are Not For Everyone...
If you have decreased bone density, fractures, cardiovascular issues, eye disorders, are pregnant, are naturally lax in the joints[7]- these are just some health issues where you wouldn’t want to use inversion tables but the list isn’t exhaustive. Be sure to check with your medical doctors first before trying these out as there has been rare, but reported complications.
Are There Other Options for Treating Low Back Pain?
At Integrity Chiropractic we offer spinal manipulation, massage therapy, manual therapy, and exercise therapies to treat acute or chronic low back pain as they all have all been shown to help. While these methods can be found being offered by many other chiropractors in Kirkland, we offer a unique and comprehensive approach combined with generous treatment time to help our patients recover from acute low back pain quickly and find lasting relief from chronic low back pain.
Congratulations for reading all the way down! If you're ready to get some help for your low back pain, use code LOWBACK to receive 15% off your First Chiropractic Visit when you book online.
References
Güvenol K, Tüzün Ç, Peker Ö, Göktay Y. A comparison of inverted spinal traction and conventional traction in the treatment of lumbar disc herniations. Physiotherapy Theory & Practice. 2000;16(3):151-160.
Gay RE, Brault JS. Evidence-informed management of chronic low back pain with traction therapy. The Spine Journal. 2008;8(1):234-242.
van Middelkoop, M., Rubinstein, S. M., Kuijpers, T., Verhagen, A. P., Ostelo, R., Koes, B. W., & van Tulder, M. W. (2011). A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. European Spine Journal: Official Publication Of The European Spine Society, The European Spinal Deformity Society, And The European Section Of The Cervical Spine Research Society, 20(1), 19–39.
Wegner I, Widyahening IS, van Tulder MW, et al. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews. (8).
Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJMG, Bronfort G. Traction for low-back pain with or without sciatica. The Cochrane Database Of Systematic Reviews. 2005;(4):CD003010.
Alrwaily M, Almutiri M, Schneider M. Assessment of variability in traction interventions for patients with low back pain: a systematic review. Chiropractic & Manual Therapies. 2018;26:35.
Palmer E, Redavid L. Traction, Mechanical (Lumbar). Richman S, ed. CINAHL Rehabilitation Guide. January 2018.