Inversion Therapy: How It Works, What the Evidence Shows, and Who Should Avoid It

What Is Inversion Therapy?

Inversion therapy is a way of using gravity as a traction force. A 2023 paper on the topic in the journal Disability and Rehabilitation calls inversion table therapy “a form of spinal traction which is thought to have a role in relieving low back pain due to the gravity-facilitated traction of the spine which distracts the lumbar vertebrae” (Kassay, 2023). The wording matters: “is thought to” describes a proposed mechanism, and that paper is an opinion and regulatory piece, not a trial.

The Main Types of Equipment

Five kinds of device are sold for inversion therapy:

• Inversion tables have a padded bed that pivots on a frame. You lie on it, secure your ankles and tilt back.
• Gravity boots clamp around the ankles so you can hang from a bar.
• Inversion chairs keep you seated and tilt the whole seat backward.
• Mini inversion tables are small, seated devices that tilt you part of the way back.
• Yoga trapezes are fabric swings that support you in head-down positions.

The table comparison near the end of this guide sets out what each maker says about its design.

Inversion Therapy Versus Other Traction

Traction is any method that applies a pulling force to the spine, whether by a therapist, a machine or your own weight. Inversion therapy is the version where your body weight does the pulling. That is why the strongest summary of traction research, covered below, applies to inversion only by extension.

Does Inversion Therapy Work?

For pain and function, the honest answer is that it has not been shown to work reliably, and it has not been ruled out for everyone either. Three pieces of evidence matter most.

What the Cochrane Review Found

A Cochrane review published in 2013 included 32 randomized trials with 2,762 participants on traction for low back pain, with or without sciatica. The authors concluded that traction, alone or combined with other treatments, has little or no impact on pain intensity, function, global improvement or return to work, and that the effects seen were small and not clinically relevant (Wegner, 2013). Seven of the 32 trials reported adverse effects, including more pain, worse neurological signs and subsequent surgery, while four reported none (Wegner, 2013).

Two limits apply. The review covers manual and machine traction in general, not inversion tables specifically. And the authors rated the evidence as limited in quality, from small studies with moderate to high risk of bias.

The Small Trials That Look Better

Two groups of studies look more favorable, and both are small.

• The Newcastle pilot trial. Prasad and colleagues randomized 24 patients already listed for lumbar disc surgery. Surgery was avoided in 10 of 13 who added inversion to physiotherapy, against two patients in the physiotherapy-only group. Pain, disability and MRI scores did not differ significantly between the groups, and the authors describe it as a pilot (Prasad, 2012).
• The Güvenol comparison. In 29 people with a herniated lumbar disc and sciatica, ten sessions of inversion traction and ten of conventional mechanical traction were both clinically effective, with no significant difference between them. CT findings tended to favor conventional traction (Güvenol, 2000). There was no group that received no traction, so the result cannot separate the treatment from the natural course of sciatica.

The Registry Teeter Advertises

The same Newcastle team later published a registry of people who used inversion. In 85 inversion users the two-year surgery rate was 21 percent, against 39 percent in a matched control group (Mendelow, 2021). That registry was not randomized. Teeter supplied the tables and funded the study administrator, and the authors state the analysis was independent of the sponsor (Mendelow, 2021). Fewer operations in a self-selected group is a finding worth following up. It is not proof that inversion prevents surgery, and you should not read it as a promise.

What About Claims Beyond Back Pain?

The studies above measured spinal length, muscle activity, blood pressure, eye pressure and, in the trials, pain and surgery. They did not measure mood, sleep, brain function or immunity. Claims in those areas have nothing in this evidence to rest on. Our guide to hanging upside down benefits checks those wider claims one by one. For a fuller breakdown of the claimed benefits and what each one rests on, see our guide to inversion table benefits.

How to Try Inversion Therapy at Home

If you have no condition on those lists and your clinician agrees, here is what the manufacturers’ own manuals say. These are instructions from makers, not clinical protocols.

Setting Up and Getting On

Teeter says to set the main shaft to your height with the locking pin, noting that this is only a guide that can differ by several inches depending on how your weight is distributed (Teeter, 2020). Innova’s ITX9600 manual says smooth inversion depends on finding your center of gravity with three settings: the height tube, the headrest pad and the foot position, and it tells users to wear athletic shoes with top laces to help secure the ankles (Innova). Innova’s FAQ adds that you should invert by slowly raising one arm and then the other, start at a low angle and have a spotter nearby (Innova).

Starting Slowly and Coming Back Up

Innova says most people begin with one to two minutes a session and that frequency is typically more important than duration (Innova). Teeter says there is no predetermined time limit and that users should listen to their body (Teeter, 2020). Neither cites a trial, and the fall-injury authors suggested under one minute (Jung, 2021). Returning matters as much as going down. Teeter tells users to let the body settle at 60 degrees, bring the arms to the sides, and, if they do not come upright, bend the knees rather than lift the head (Teeter, 2020). Innova’s manual says to pause at horizontal to prevent dizziness and not to sit up or rely only on the handlebars (Innova). Our step-by-step guide to using an inversion table covers the process in more detail.

Can It Replace Seeing a Clinician?

No. None of the research above tested inversion as a substitute for diagnosis or care, and the Cochrane authors found no reliable benefit from traction alone. If you try it, do so alongside your clinician’s advice, and report any new or worsening symptoms to them.