No matter what the cause, back pain can seem relentless.
The frustration and sense of caution when you have or have had back pain can be life changing. It is common to be fearful of getting reinjured and can lead to avoiding common tasks like picking up your children or pets, working out, driving, and even walking.
You don’t have to just live with your pain. We see many patients will severe back pain and injuries who are able to alleviate their pain and get back to doing the things they most enjoy doing.
It is important to know you are not alone, and there is help.
What is an inversion table and why did we start to include it as a physiotherapy treatment?
The premise is to gently and carefully pull the discs apart, allowing more blood flow between the discs in a very controlled and progressive way. Inversion also allows for a gentle stretching of the muscles and tendons which is beneficial to increase strength and flexibility as well as achieving deeper breathing. While inverted, your body weight acts as a natural form of traction, lengthening your spine. Benefits can include relief from disc pressure as well as alleviating stress on the ligaments and nerve roots.
Why is it better to work with a physiotherapist for inversion especially if you have back pain?
For centuries yoga practitioners have recognized the concept of turning the body upside down to find relaxation. The headstand position is a form of “postural exchange” (reversing the direction of gravity). It is important to recognize that not everyone wants to learn the intricate skill required for bodyweight inversion, so inversion therapy, especially for those who have back pain is an alternative way to reap the benefits without having to focus on the long process of learning the proper skill and technique needed for safe and effective bodyweight inversion. It is also important to note that using an inversion table with a physiotherapist you also have the added benefit of joint decompression versus compression.
Using a table, as opposed to body weight postures, allows for the inversion to happen while under the guidance of a trained professional who can assess and then progress your inversion at a speed and level that is right for your body. Also, inversion is fantastic for the body but if done too quickly or with compressive load (ie. in a headstand) it can actually cause more damage and increase the risk for injury or re-injury.
What does the research say on inversion? How does it work?
Clinical studies show that when inverted the separation between the vertebrae increases, allowing for better absorption of moisture into the soft tissue of the discs, increasing the nutrient content as well as plumping the discs for better shock absorption and flexibility.
When you are sitting, standing, exercising, or doing other weight-bearing activities, fluid is squeezed out of your discs and into adjacent soft tissue, just as moisture can be squeezed out of a sponge. As a result, your discs lose some of their height. To prove this fact, measure yourself in the morning and then again at night. You will lose half-an-inch to three-fourths-of-an-inch in height by the end of the day.
When you are lying down the compression in the spine is reduced enough to allow the discs to slowly reabsorb moisture and nutrition over the many hours you sleep. However, the discs may not always maintain their full height capacity, creating a total accumulation of height loss of up to two inches in a lifetime.
How does inversion help alleviate back pain and pressure?
The only time in your life when you are giving your discs a break is when you are inverted. The Nachemson study provides some insight: A number of volunteers permitted a pressure sensor to be surgically implanted inside the third lumbar disc. The pressure inside the disc in the standing position was set at a baseline of 100% and all other body positions compared to it. Interestingly one of the most compressive activities for the discs is sitting (although not really surprising). The muscles in the stomach and back relax, but the pressure in the spine increases.
If you are sitting in poor posture the pressure in the lumbar can climb as high as 250%. The real surprise occurred while lying down. The pressure inside the disc only lost 75% of standing body weight – it never went below 25%! This residual compression seems to be due to the hundreds of ligaments and muscles that encase the spine, holding it in compression like a mass of rubber bands. This study further indicated that the amount of traction force required to overcome the compression was a large number, approximately 60% of your body weight. Inversion to an angle of about 60 degrees is the only practical way to offset that much gravity force while remaining relaxed.
Nerve pain is a leading cause of back pain. How can it be treated?
The height of the discs relates to the size of the passageway for the nerve roots to exit from the spinal column, so a plump hydrated disc creates maximum clearance, helping to alleviate any pressure or pinching of the nerve root.
A bundle of nerves called the spinal cord run through the spinal column; these nerves control communication from the brain to the rest of the body. Nerve roots exit between the vertebrae along the length of the spine in the passageway created by the discs. Damage to the discs or de-hydration/degeneration of the discs can result in nerve root entrapment, or what is commonly known as ‘a pinched nerve’. Since the nerves extend into the body there can be pain that radiates into your other extremities.
Through the increased hydration to the discs during inversion the discs plump in height, effectively increasing the separation between the vertebra and reducing the pressure and pinching on nerve roots.
Let’s Talk about your Posture
So many of our daily activities lend themselves to misalignment and possible permanent postural changes:
- Sitting at your computer/laptop
- Carrying your purse or laptop bag on one side
- Wearing High Heels
- Improper fitness training on machines
- Carrying uneven loads like laundry baskets, kids and pets
- Certain physical jobs like construction, painting
- Rotational sports like golf, squash and tennis
While these activities can’t be avoided in most cases, it speaks to the importance of working on our strength and alignment.
Muscles adapt to bad posture. For example, with slouching shoulders, the muscles in the chest shorten and those in the back lengthen. At some point, it feels strange to stand properly. Inversion helps realign the spine and stretch the shortened muscles, many users report that they stand ‘taller’ and straighter after just one short inversion session.
Misalignment to Alignment
Before we talk about alignment let’s talk about misalignment. Misalignment means that your body weight is no longer supported by an alignment of your bones, and therefore the soft tissue of the body must resist gravity. Misalignment is not always felt on the inside but left alone it can cause visual changes to your posture, and those changes can be degenerative.
If you want to test this at home, take an empty aluminum can and place pressure on the top. The can will be able to maintain its shape even with great force applied because the sides are in alignment, but add a small dent to the can and it will crumble under half the amount of pressure.
When a vertebra is bumped out of alignment the ligaments and muscles that support the spine can hold it in misalignment through the compression that they generate. Since these ligaments and muscles are engaged even when lying down, creating pressure as much as 25% compared to 100% standing, it can be difficult for the spine to naturally come back into alignment. When inverted to 60 degrees the pressure in the spine drops to zero, as shown in the Nachemson medical study, with the pressure off of the vertebrae and with some gentle stretching the vertebra has the opportunity to move back into alignment.
What does stress do to your body?
Stress and tension can cause pain and muscle spasms in the back, neck, and shoulders, as well as headaches and other problems. Tense muscles can be attributed to misalignments of the spine, overstimulation of nerves, or poor removal of toxins by the lymphatic system and a lack of oxygen-rich circulation.
A study conducted by physiotherapist L.J. Nosse found that EMG activity (a measure of muscle tension), declined over 35% within 10-seconds of inversion, the effect was found to start at the very shallow angle of 25 degrees. It is suggested that the stretch to the muscles while inverted allowed the circulation to enter the sore muscle, bringing oxygen-rich blood inversion therapy also stimulated the lymph system to clear the muscle of the toxin build-up. Patients therefore, feel a decrease in pain and stiffness.
Dr. John E. Sarno, of the New York Institute for Rehabilitation Medicine, claims that in more than 90% of the patients that he sees for back pain either there is no structural abnormality or the ‘abnormal’ x-ray does not really explain the nature or location of the pain. He calls the disorder the ‘tension myositis syndrome’ and describes how the tension causes muscle pain in this way: The muscle tenses and this reduces blood flow in the muscles of the neck, shoulders, back, or the buttocks. This produces pain by allowing the accumulation of waste chemicals, much the same process that causes leg muscle fatigue after a long run because of lactic acid build up. When the muscles go into spasm in the lower back, it often leads you to believe (mistakenly) you have a disc problem. Our Taylored Training Physiotherapist Cassie Dionne MSc PT has also written on this topic – Should you get an x-ray or image?
What can you do if you have back pain?
It’s important for you to know, you don’t have to live with back pain. You don’t have to just deal with your pain. Inversion, physiotherapy and getting your body moving better is the key to enjoying all the things you love to do!
- The Nachemson Study: https://www.ncbi.nlm.nih.gov/pubmed/7209680Johns Hopkins White Papers, The Johns Hopkins Medical Institutions, Baltimore, MD, 2003.
- Jensen M, Brant-Zawadzki M, Obuchowski N, et al. Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain. N Engl J Med 1994; 331: 69-116.
- Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98.