Hanging upside down from your feet may look like a special form of torture — but for some people, it’s an important form of back pain relief.

Based on the concept of distraction traction, inversion therapy uses your body weight and gravity to help pull the spinal bones apart, allowing for increased space and movement between the vertebrae, which may decrease pain caused by pressure on the nerves. Traction is also thought to help straighten spinal curves and stretch the muscles surrounding the spine.

Inversion tables, or tilt tables, are long tables that have a hinge in the center with a place at one end to anchor your feet or legs. The user safely fastens their feet in the device and slowly tilts it into a head down position until they reach the desired angle.

Gravity-assisted traction can be a convenient and efficient means of applying force to the spine. The concept behind its use is simple: When issues arise due to spinal compression, you use mechanical energy to help pull them apart. You may find an inversion table in a health club or physical therapy clinic. They can also be purchased for home use.

Some doctors and physical therapists use traction for patients with chronic low back or neck pain. It may also be beneficial for patients with a disk herniation or nerve pain due to compression of a nerve root, often known as radiculopathy.

It’s used for people with abnormal spinal curves, like those with scoliosis and hyperlordosis, as well. Lastly, it can be beneficial to those with tight muscles of the trunk and spine.

There are several benefits of using the inversion table.

Decreased Pain

One study looked at the effect of inversion traction on pain, low back flexibility, and muscle strength in patients with chronic low back pain.

The authors found that inversion traction at an angle of 60 degrees reduced back pain and improved low back flexibility and trunk extensor muscle strength in patients following an eight-week program.

Improved Flexibility

Flexibility of the spine is important to allow joints to move through their full range of motion and to maintain good posture, balance, and prevent injuries.

The previously mentioned study also found a significant change in trunk flexibility after an eight-week inversion program.

Muscle Relaxation

When the body is placed in an upside down position, the muscles of the trunk and back are pulled by the weight of the body, allowing for them to stretch and lengthen, which may contribute to increased relaxation.

There is little high-quality evidence to support physical changes due to traction. It may temporarily take the pressure off compressed nerves and help stretch the muscles, but without functional restoration through physical therapy and chiropractic care, results may be temporary.

Conservative Treatment to Avoid Surgery

A 2012 study looked at the effects of intermittent extreme traction with an inversion device in patients with pain and disability due to low back disc compression.

Surgical intervention was avoided in 10 patients (76.9 percent) in the inversion group and avoided in only two patients (22.2 percent) in the noninversion group. Therefore, inversion therapy may help avoid surgery in a safe and economical way.

Inversion Table Exercises

Most inversion tables are designed to simply stretch the back. The user can choose if they want to be partially inverted or completely upside down, and they may remain inverted for short periods of time, or stay inverted for longer sessions.

Some people choose to do exercises such as torso rotations, ab crunches, or inverted squats, but there is no evidence to support that exercises while done inverted on the table are better than similar exercises in standing or lying positions.

Inversion therapy increases the pressure and blood flow to the head and upper body. People that are advised against the use of inversion tables include those with:

  • heart or circulatory disorders
  • high blood pressure
  • glaucoma
  • retinal detachment
  • swelling
  • unhealed fractures
  • joint problems
  • pregnancy

Although there is some evidence to support the use of gravity-assisted traction, a 2013 Cochrane review concludes that there is not enough high-quality evidence to say that traction helps patients with low back pain with or without sciatica.

The Cochrane review evaluated 32 randomized controlled trials and found that “traction, either alone or in combination with other treatments, has little or no impact on pain intensity, functional status, global improvement or return to work among people with low back pain.”

That being said, if you are safe to engage in activities upside down, it may be something fun to try before you consider more invasive treatments.