My Recommendations for Inversion Therapy

By | February 18, 2015

My personal inversion routine is a little different than what I recommend to the patients at Schlesinger Pain Centers.  I feel like I get a better stretch at 60 degrees than at 30 or 45, but I have worked up to this angle slowly over a couple of years.  Since I use the machine at the Burbank office I invert 5 days a week instead of 7.  My hang time is also a little longer at 15 minutes instead of the 10 I recommend to patients because I often find it difficult to get back to the machine in the afternoon.

My personal inversion routine is a little different than what I recommend to the patients at Schlesinger Pain Centers. I feel like I get a better stretch at 60 degrees than at 30 or 45, but I have worked up to this angle slowly over a couple of years. Since I use the machine at the Burbank office I invert 5 days a week instead of 7. My hang time is also a little longer at 15 minutes instead of the 10 I recommend to patients because I often find it difficult to get back to the machine in the afternoon.

At Schlesinger Pain Centers inversion therapy is usually the first step in the back rehabilitation plan. It is prescribed once the patient is nearly pain free. I have found that inversion is perceived as unpleasant by patients with more than a little remaining back pain. In addition it can induce reflex spasm. The starting “dose” of inversion is usually 30° for 5 minutes once a day, progressing as tolerated to 30° to 45° for 5 to 10 minutes once or twice a day, every day, for a total of 1 to 2 hours a week. Patients often complain of soreness in their lower and mid back as well as shoulders after the first few sessions. If soreness is severe of persist they are told to cut back on the degree and length of inversion or to invert every other day until they get used to the therapy.

My personal regimen is a bit different. I use the table at Schlesinger Pain Center weekdays only and invert for 15 minutes in the morning before I start my day, because I am often unable to return for an afternoon session. I average about an hour and a half per week, but this is not a rigid value. Depending on the amount of strength work I do I may need to increase the amount of inversion usually in conjunction with an increase in the amount of time devoted to yoga. Short interruptions of this inversion regimen are usually well tolerated, but when I return from more than a week’s vacation the first couple of inversion sessions are usually accompanied by mild soreness especially in the latissimus dorsi muscles.

Inversion & Empiricism

By | February 17, 2015

Francis Bacon is widely considered to be the father of the scientific method and an unwavering advocate of empiricism. "Pourbus Francis Bacon" by Frans Pourbus the younger - www.lazienki-krolewskie.pl. Licensed under Public Domain via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Pourbus_Francis_Bacon.jpg#mediaviewer/File:Pourbus_Francis_Bacon.jpg

Francis Bacon is widely considered to be the father of the scientific method and an unwavering advocate of empiricism.
“Pourbus Francis Bacon” by Frans Pourbus the younger – www.lazienki-krolewskie.pl. Licensed under Public Domain via Wikimedia Commons – http://commons.wikimedia.org/wiki/File:Pourbus_Francis_Bacon.jpg#mediaviewer/File:Pourbus_Francis_Bacon.jpg

At this point I would like to use inversion therapy to discuss a philosophical point related to different types of knowledge and their implications for medical practice. I know from my own experience at Schlesinger Pain Centers that patients who regularly practice inversion therapy for a variety of lower back pains come back to see me approximately 50% less often than those who do not. When I share this information with the patients they are intrigued and many will offer an explanation such as the effect of distractive forces in reducing the size of disc protrusion, for the phenomenon expecting me to either confirm or refute their mechanistic analysis. They often seem perturbed when I refuse to do so. It is at this point that I begin the discussion of phenomenology or empiricism. An empirical fact is something that you know to be true because you observe it repeatedly under a given set of conditions. It is important to remember that an empirical fact continues to be true despite the fact that you may not be able to explain why it occurs. All medical knowledge begins as empirical facts and only after an often-lengthy series of experiments varying one condition or another, is a mechanism sometimes elucidated. Is inversion therapy effective in reducing subsequent attacks of lower back pain by reducing the size of disc protrusions, decreasing the size of spondylolisthesis, reducing facet joint arthritis, stretching out tight paraspinal ligaments or is it because patients who invert are also more likely to engage in yoga therapy and do their back exercises. Perhaps it is something completely different that I haven’t even thought of. I don’t know and frankly I don’t care as long as they get better. The empirical fact of their improvement remains true.

Presidents Day

By | February 16, 2015

Since it is now called Presidents Day, this year I choose to celebrate a president more reminiscent of modern times.  I will celebrate Millard Fillmore a do nothing fool who stood idly by as the country slipped closer and closer to civil war.

Since it is now called Presidents Day, this year I choose to celebrate a president more reminiscent of modern times. I will celebrate Millard Fillmore a do nothing fool who stood idly by as the country slipped closer and closer to the disaster of civil war.

In the course of the seven years that the clinic has been open I have blogged on almost every conceivable topic from back pain to the life of cavemen, but to the best of my knowledge I have never blogged on Presidents Day. When I was I child growing up in New Jersey we used to celebrate both Washington’s Birthday and Lincoln’s Birthday, which was great. Then some killjoy decided that we had too many holidays in February and since the southern states did not like the idea of celebrating anything having to do with Lincoln, one holiday simply disappeared and the new blander and more politically correct term President’s Day was introduced. I didn’t like it then and I don’t like it now. The ski industry certainly doesn’t like it. The shopping malls don’t like it. Stand up for your rights America. Email your congressperson and demand that the return the second February holiday.   But alas it probably will make little difference to me since my boss here at Schlesinger Pain Centers turned down my request to have the day off on the first holiday and would probably make me work the second one as well.

Inversion Tables

By | February 15, 2015

I invert daily and several of the staff members here at Schlesinger Pain Centers invert as well.  Most see it as a form of relaxation even if their back are not bothering them.

I invert daily and several of the staff members here at Schlesinger Pain Centers invert as well. Most see it as a form of relaxation even if their back are not bothering them.

By far the most commonly recommend form of spinal distraction therapy at Schlesinger Pain Centers is the modern inversion table. They are easy to use and with a price point of around $300 they are accessible to most patients for home use. Invented over 30 years ago by Roger Teeter an engineer with a bad back, these devises are easy to use and allow for an easily adjustable amount of inversion. Patients step into the device in the upright position and after locking their ankles in are able to invert simply by raising their arms above their heads. Properly adjusted the patients are able to return to the upright position simply by bringing their arms down to their sides. At Schlesinger Pain Centers we strongly suggest that the patients try out our machine before buying their own for both economic and safety reasons. The biggest drawback to theses devices is that some patients are intolerant of the inverted position. The base model Teeter 560 is adequate for nearly all of our patients. It is available on-line from Teeter Hang Ups for $325 and comes with free shipping and a money back guarantee.

Valentine’s Day 2015

By | February 14, 2015

On Valentine's Day the gestures should be heartfelt and not reflexive.    It is a day to say, "“Jody, I love you as much now as the day I married you.”

On Valentine’s Day the gestures should be heartfelt and not reflexive. It is a day to say, ““Jody, I love you as much now as the day I married you.”

You hear a lot of complaining about Valentine’s Day being a Hallmark holiday and it is true that a substantial industry has grown up around the day. Others complain that $100 roses and $50 chocolates are meaningless gestures that do not make up for a year of abuse or neglect, but I think that this misses the point. Valentine’s Day is as much for the donor as the recipient. It is my chance to break free from the rat race of modern life here at Schlesinger Pain Centers and celebrate the person who gives life meaning in the first place. It is a day on which the word will not be left unsaid, a day on which the gestures will be heartfelt and not reflexive. Valentine’s Day is a chance for me to say, “Jody, I love you as much now as the day I married you.”

Slant Boards

By | February 13, 2015

Although designed for doing inverted sit ups, devices such as the Marcy Slant Board, available at Sears can also be used to stretch your back out.

Although designed for doing inverted sit ups, devices such as the Marcy Slant Board, available at Sears can also be used to stretch your back out.

Slant boards, originally designed for doing inverted sit ups are an effective and in my opinion under utilized form of spinal distraction therapy. They are simple, cheap and available in most gyms and health clubs. The biggest drawback to their use is that as the degree of inversion increases they become less stable and harder to get into and out of. At Schlesinger Pain Centers we discourage the use of slant boards beyond thirty degrees and we believe that they are unsafe beyond forty-five degrees.

Donut Distraction Devices

By | February 12, 2015

The Back Bubble Spinal Decompression Pain Relief Device available through Amazon.com is an example of an upright gravitational distraction device.

The Back Bubble Spinal Decompression Pain Relief Device available through Amazon.com is an example of an upright gravitational distraction device.U

I have only had a couple of patients at Schlesinger Pain Centers who have used these devices. In each case the patients could not tolerate and inverted position. The patients reported that the devices, both home made and store bought were comfortable and relatively easy to use. They were not however, highly effective I believe due to the limited distractive forces generated in the lumbar spine from the weight of the lower extremities and pelvis. Again since these devices are used in the vertical position the amount of distractive force is not easily modified.

Gravity Boots

By | February 11, 2015

Several companies including Teeter Hang Ups make Gravity Boots.

Several companies including Teeter Hang Ups make Gravity Boots.

The last use of a chinning bar to produce spinal distraction is with “Gravity Boots”, as made famous by Richard Gere in the 1980 film American Gigolo. Several companies including Teeter Hang Ups currently make these boots. In addition large numbers can still be found in closets and garage sales.  Unfortunately none of these boots either new or used come with Lauren Hutton or even Nina van Pallandt for that matter. “C’est dommage.”

I have been told that the boots are quite comfortable and patients are able to invert for significant periods of time, but as with other uses of the chinning bar gravity boots offer only one strength of inversion/distraction and require a degree of upper body strength not possessed by the average patient at Schlesinger Pain Centers.

Chinning Bars

By | February 10, 2015

It is extremely unlikely that any of the Marines taking part in this pull up contest have any significant back problems, but if they did simply hanging from the bar would help to stretch out their back and relieve the pain.

It is extremely unlikely that any of the Marines taking part in this pull up contest have any significant back problems, but if they did simply hanging from the bar would help to stretch out their back and relieve the pain.

This little girl knows that the best way to treat back problems is to prevent them.  By hanging upside down from her knees she is using gravity to stretch out her back.  She obviously likes the way it feels.

This little girl knows that the best way to treat back problems is to prevent them. By hanging upside down from her knees she is using gravity to stretch out her back. She obviously likes the way it feels.

Chinning bars are refreshingly simple and can be used in a variety of ways. In the upright position they expose the back to mild to moderate distractive forces. In addition to simple hanging the addition of a chin up or a pull up will contribute to increased upper body strength. One drawback to the upright position is that a greater distractive force is applied to the thoracic spine than to the lumbar spine, which is the opposite the usually desired effect. In the inverted position with the knees hooked around the bar one gets excellent distraction forces applied to the lumbar spine but the position is relatively uncomfortable and can only be maintained for short periods of time by most people. In either case the use of a chinning bar requires a fair amount of upper body strength, something not possessed by the average patient at Schlesinger Pain Centers.

Gravitational Distraction Therapy

By | February 9, 2015

Gravity is usually our enemy compressing the spine.  There are however an number of ways to use gravity to our advantage.

Gravity is usually our enemy compressing the spine. There are however an number of ways to use gravity to our advantage.

All forms of gravitational traction therapy utilize the body’s own weight to generate the distractive force. The advantages of this are significant. Not only are the devices simpler to construct the use of the body’s own weight minimizes the risk of excessive loading.   Devices fall into two basic groups upright and inverting devices. The simplest gravitational distraction device is the basic chinning bar, with or without the use of “Gravity Boots”. I have seen a number of upright “donut” suspension devices both homemade out of an old truck tire as well as complex store bought models. Slant boards, which are available in most gyms and health clubs, are cheap and effective way to mild to moderate amounts of inverted gravitational distraction. Finally, inversion tables allow for upright entry and controlled degrees of inversion. At Schlesinger Pain Centers we have patients who practice each of the above types of gravitational distraction therapy and all appear to be equally effective. The choice is often driven by patient preference and convenience.