Low back pain (LBP) is one of the most common reasons for a visit to your physician, second only to the common cold. It can be caused by any number of reasons including poor sitting posture, heavy lifting, or frequent bending. If you have had LBP, you might have realized that a lot of people have experiences with back pain just like you. That also means that many people have tried many different treatments and modalities to help decrease their LBP and improve their function. An inversion table is a padded table that is connected to a metal frame with hinges. To use the inversion table, you strap yourself onto the table and slowly allow the table to flip over, thus inverting the body. Inversion tables typically range in cost from $100 to $400. The similiar device, called “Gravity boots”, was popular in the 1980s. Another name for inversion tables or inversion therapy is gravitational traction. DEFINITION

The theory behind inversion table use is that when the body's weight is suspended from the lower body – rather than borne on the hands as in handstands or headstands or hanging from a bar with arms at sides, which are also forms of inversion – the pull of gravity may decompress the joints of the body below the anchor. Hanging by the feet, as with gravity boots or inversion tables, causes each joint in the body to be loaded in an equal and opposite manner to standing in an identical position of joint alignment. This is thought to create a traction force through the spine, and it has been commercially advertised as a relief for back pain CLAIMS

RISKS People who have heart disease, high blood pressure, eye diseases (such as glaucoma), or are pregnant are at higher risk for the dangers related to inversion therapy and should consult their doctors about it first. The first time anyone tries inversion therapy with gravity, they should be sure to have someone standing by, in case assistance is required to get out of the apparatus, or if health problems are experienced. People with Gstroesophageal reflux disease (GERD) are also at risk. During an episode of acid reflux, small amounts of stomach acid manage to escape out the stomach's doorway and into the esophagus. Fortunately, gravity keeps much of the stomach acid away from this doorway. However, in an inverted position, gravity cannot do its job. Combining an inversion table and acid reflux can be a painful, nauseating and potentially dangerous combination.

Most studies indicate that inversion therapy does cause some traction force through the lumbar spine. One study found as much as a 3 mm separation between lumbar vertebrae during inversion therapy. So the question arises: Does lumbar traction help low back pain? A review of available research was published in 1995 and found that most studies about the efficacy of traction for low back pain were of poor quality. Those studies that were of high quality were not able to demonstrate that lumbar traction helps LBP. Conclusion: While lumbar traction did not seem detrimental to individuals with LBP, it also didn’t seem to help much.low back pain A paper in the 2001 issue of Physical Therapy Journal examined published evidence for various treatment modalities for acute ( 12 weeks) non-specific LBP. In short, the findings indicate that traction for acute, sub-acute and chronic LBP received a grade of "C" (no benefit demonstrated). To date, no other high quality studies have been published to refute these findings. The same paper in the 2001 Physical Therapy Journal that reviewed LBP concluded that the best treatment for non-specific acute low back pain is to remain as active as possible. For sub-acute and chronic low back pain, the evidence shows that exercise received a grade of “A” (benefit demonstrated). The paper concludes: “There is evidence to support and recommend the use of continued normal activities for acute non-specific LBP and therapeutic exercises for chronic, subacute, and postsurgery LBP.”1 EFFECTIVNESS

Comparing the risks associated with inversion tables (glaucoma, blood pressure changes, heart rate changes) with the benefits expected with using inversion for low back pain, it would seem that your time (and money) would be better spent exercising to help treat your pain. A visit to your physical therapist is a reasonable plan of care for your low back. He or she can prescribe exercises for back pain and help you change your posture to help your condition. Your physical therapist can also teach you why your back is hurting and can help provide strategies to prevent future problems with your low back. CONCLUSION There are no clear indications, however, that traction is an ineffective therapy for back and neck pain. Further trials may prove othervise. But if you are suffering from low back pain or pain in the leg that is coming from the back (sciatica), the best treatment for you to engage in is continue normal routines and perhaps add exercise. The use of mechanical traction seems to offer little or no benefit for low back pain.