I have chronic back pain. Over-the-counter painkillers help, but I’d like to cut back. I’ve heard that hanging upside down can help. Should I try it?


You’re referring to inversion therapy—a form of traction that uses the force of gravity to stretch the spine. Your feet and ankles are securely strapped to a special table or chair, which you then tilt backward until your head is lower than the rest of your body. While inversion therapy hasn’t been shown to provide long-term relief for back pain, many people do feel better for a short time while they are doing it and immediately afterward. That brief respite may be enough to allow a long pain-free walk or give you a break from the over-the-counter pain meds that you’re taking. The first thing you should know, though, is that you don’t need to literally hang upside down with the soles of your feet pointing toward the ceiling! That’s not necessary and isn’t even a good idea for most people…at least not when you first try inversion therapy. I’ll explain a safer approach below. First, though, let’s look at the potential benefits—and risks.


Inversion therapy can work in two very different ways… • Mechanical relief. If pain is being cause by a compressed disc, removing stress on the disc by lying or sitting in an inverted position can reduce the pain. • Gravity creates a traction force to muscles and ligaments around the spine, which temporarily releases muscle spasms. When that tightness disappears, you will feel more relaxed. Relaxation isn’t just a nice extra—it’s an integral part of treatment. That’s especially true if you have back pain that has lasted 12 or more weeks. Here’s why: Living with pain for so long can make you frustrated and anxious, feelings that can become so ingrained that they form new pain pathways. Even after the original source of the pain—say, a pulled muscle—has dissipated, the new pathway still continues to sends pain signals. Inversion therapy can relieve your pain so that as you relax, you can begin to “unwind” this nervous system response and break this painful pattern. While short-term pain relief and relaxation can go a long way, though, they are rarely enough. Treating chronic pain is like fighting a forest fire—it must be attacked from all angles. Staying active is the top recommendation. Getting enough good-quality sleep is key. Nondrug treatments such as yoga, Pilates, tai chi and hypnosis can help. By itself, then, a few minutes on the inversion table won’t help much if you’re not also staying active and getting your best sleep. On the positive side, combining inversion therapy with other nonpharmacologic treatments can further reduce pain. For example, hypnosis by itself, or inversion therapy by itself, may each provide only a modest amount of relief, but when you try them both, you may see big improvements in your back pain—without drugs.


Inversion therapy is not for everybody. When your head is lower than the rest of your body, your heart rate slows but your blood pressure rises—and so does the pressure inside your eyes. If you have heart disease or any cardiovascular problem, including high blood pressure…or glaucoma, retinal detachment or any other eye condition…do not try inversion therapy. Pregnant women and people with hiatal hernia should also avoid it. (If you have any questions about whether it’s safe for you, talk to your health-care provider.) Even if you don’t have any of these conditions, you could hurt yourself by being too gung-ho in your approach. If you hang upside down the first time out, you might hurt your ankles or knees. If you stay inverted too long, you might even pull a muscle, which will just make your pain worse. That’s why I recommend a go-slow approach. If you’re healthy and you’re interested in inversion therapy, speak with your health-care provider about first trying it under supervision at a physical therapist’s office. You will most likely start gently and slowly by reclining at a slight angle (15 degrees below horizontal is a good start) for just a few minutes. If you feel better, periodically increase the angle and duration of the treatment (be careful not to overdo it). If you find it’s really helping you after several sessions at the physical therapist’s office, you might want to consider purchasing an inversion table—or an inversion chair, which provides a gentler angle for your body. To learn more about my back-pain approach, see Bottom Line’s article “Stop Chronic Back Pain Without Surgery.”