Episode 24 - Using an Inversion Table for Back Pain: Is It Safe?
Select tabs below to read the show notes or the full transcript of this episode.
Episode Summary
In the world of back pain, there are a variety of vendors in the marketplace offering purported solutions. And, with patients searching for alternatives to injections, physical therapy, surgery, and traditionally prescribed medications, the market for these alternatives treatments is booming. With these solutions ranging in efficacy from widely accepted remedies to ineffective and potentially harmful, how do you know what is and isn’t safe? Welcome to Back Talk Doc.
In this episode, Dr. Sanjiv Lakhia is taking on gravity-assisted devices, more commonly known as inversion tables. Dr. Lakhia reveals his personal experience and research with inversion tables and addresses the most common questions he receives from patients: “When I tilt on [the inversion table], it helps. But, is that safe? Is this something that's effective? Something that I should use?"
Dr. Lakhia presents two studies on inversion therapy, explaining the methodology of the studies, and the conclusions presented. Dr. Lakhia then provides examples of how to perform common gravity-assisted interventions for low back pain.
Highlights from the episode:
Resources mentioned on this episode:
For more information on Dr. Sanjiv Lakhia’s practice, visit backtalk.com
If you enjoyed this episode of Back Talk Doc, check out our episode Worth a Shot? Spinal Injections with Dr. Andrew Sumich.
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
In the world of back pain, there are a variety of vendors in the marketplace offering purported solutions. And, with patients searching for alternatives to injections, physical therapy, surgery, and traditionally prescribed medications, the market for these alternatives treatments is booming. With these solutions ranging in efficacy from widely accepted remedies to ineffective and potentially harmful, how do you know what is and isn’t safe? Welcome to Back Talk Doc.
In this episode, Dr. Sanjiv Lakhia is taking on gravity-assisted devices, more commonly known as inversion tables. Dr. Lakhia reveals his personal experience and research with inversion tables and addresses the most common questions he receives from patients: “When I tilt on [the inversion table], it helps. But, is that safe? Is this something that's effective? Something that I should use?"
Dr. Lakhia presents two studies on inversion therapy, explaining the methodology of the studies, and the conclusions presented. Dr. Lakhia then provides examples of how to perform common gravity-assisted interventions for low back pain.
Highlights from the episode:
- Inversion Therapy in Patients with Pure Single-Level Lumbar Discogenic Disease: A Pilot Randomized Trial (02:16)
- What is an inversion table? (04:14)
- Lumbar decompression (5:08)
- Warnings about using gravity-assisted devices (9:47)
- The Effects of Aquatic Exercise Programs on Low Back Pain Disability in Obese women. (11:17)
- Summary of the two research articles (16:56)
Resources mentioned on this episode:
- Inversion Therapy in Patients with Pure Single-Level Lumbar Discogenic Disease: A Pilot Randomized Trial by Prasad KS, Gregson BA, Hargreaves G, Byrnes T, Winburn P, Mendelow AD.
- The Effect of Aquatic Exercise Program on Low Back Pain Disability in Obese women. by Abadi, F. H., Sankaravel, M., Zainuddin, F. F., Elumalai, G., & Razli, A. I.
For more information on Dr. Sanjiv Lakhia’s practice, visit backtalk.com
If you enjoyed this episode of Back Talk Doc, check out our episode Worth a Shot? Spinal Injections with Dr. Andrew Sumich.
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
Sponsor: 00:00
This podcast is sponsored by our partner QxMD. QxMD builds mobile solutions that drive evidence-based medicine in clinical practice. Check out Read for easy access to research personalized for you and Calculate for over 500 easy-to-use decision support tools. Try them today at QxMD.com/apps. Again, that is QxMD.com/apps.
Intro: 00:30
Welcome. You're listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health, brought to you by Carolina Neurosurgery and Spine Associates, where providing personalized, highly-skilled and compassionate spine care has been our specialty for over 75 years. And now, it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.
Sanjiv Lakhia: 01:04
In the world of back pain and back care, there are many different things out there in the market that patients like to try, I'm sure you have tried, to try and help yourself if you hurt your back. Obviously, from a medical side, we've covered many different things that can be offered to help with back pain, such as injections, physical therapy, different types of surgery, certainly different types of medications, but there are a couple of things out there that are very popular and I want to touch on them today. They really fall under the category of gravity-assisted devices or gravity-assisted modalities to help with back pain.
Sanjiv Lakhia: 01:46
Probably the most popular question I get from an individual that may come to see me after straining their back pertains to the concept of inversion therapy or an inversion table. A question I'll often hear is, "Doc, I've got a inversion table. I picked it up from Costco or Sam's or my buddy has one. When I tilt on that thing, it helps. Is that safe? Is this something that's effective? Something that I should use?"
Sanjiv Lakhia: 02:15
So, Inversion is one of them, and let's dive into that. There's really not a lot of research on this topic. I've looked at it extensively. I have been able to pull an article from the journal entitled Disability and Rehabilitation. There's a 2012 article entitled Inversion Therapy in Patients with Pure Single-Level Lumbar Discogenic Disease: A Pilot Randomized Trial. Let's get into that.
Sanjiv Lakhia: 02:44
This is a small pilot study, and what that means is it's really a investigation just to try and get an initial impression about a research topic and decide is a worthwhile creating larger scale, more expensive studies. This one originated in the United Kingdom through the Department of Neurosurgery at James Cook University Hospital and Newcastle, along with the Department of Physiotherapy at Northumbria Newcastle upon Tyne, United Kingdom.
Sanjiv Lakhia: 03:18
What they aimed to do really was to look at a couple of different groups of people. This is a very small study that was done, where they basically recruited about 25 individuals into the study. They really wanted to find out is it even feasible to develop a larger randomized controlled trial, meaning they wanted to see if there's any positive benefit at all from inversion therapy that would make it worthwhile to investigate this on a deeper and more complex level. Actually, it was a 26 patients that were enrolled into this trial and 24 were randomized, that means they were basically randomly split into a couple of different groups. 13 were split into a group where they received physical therapy and inversion to treat their back pain, and then 11 were split into a group where they received physical therapy or physiotherapy alone.
Sanjiv Lakhia: 04:14
Let's get into this just a little bit here. Before I get into the nitty gritty of the research article, let's back up and just discuss what exactly is inversion of why you would even consider it. I would consider inversion ... And for those who aren't aware of it, an inversion table or a tilt table, you definitely can buy this over the counter. They're around two to 300 bucks, oftentimes you'll see them for sale at Costco or Sam's Club or Walmart. The device requires you to lay in it and get strapped in, and then it'll tilt you basically upside down or any varying degree of that, any angle that you decide. What we're utilizing there is a concept of gravity and body weight, and the combination of the two, theoretically, can basically stretch out your spine and decompress tight muscles, ligaments, nerves, and discs.
Sanjiv Lakhia: 05:08
Now, lumbar decompression, or lumbar traction, has been around for a long, long time. When you take a deep dive into the medical literature on it, it's really not that compelling. Meaning, I haven't been able to see a whole lot of evidence that lumbar decompression is very effective. Although to be fair, there's conflicting results and there are a lot of practitioners, physical therapists and chiropractors, who own lumbar decompression tables. Now, these are tables where you lie supine or flat, and you basically get strapped in and stretched out. Those are extremely expensive. Inversion tables are definitely more affordable and economical, but they work on a similar concept, that is, gravity-assisted decompression.
Sanjiv Lakhia: 05:52
So this study divided the individuals in a couple of different groups and the results are very interesting. Essentially, the group that went through physical therapy along with inversion seemed to have a much lower incidence of requiring surgery than the others. I'm going to share a few more details about the study with you. Again, they were split up into two different groups and they were put into these different pathways where they received physical therapy and inversion or physical therapy alone. Then they measured the outcome using a couple of different outcome measures, one of them looks at basically function, the other one looks at pain. The results for that were somewhat mixed, not quite as impressive as the idea that if you went through the inversion group you really seemed to avoid surgery quite a bit.
Sanjiv Lakhia: 06:46
One other thing they did though is they also looked at MRI studies, because of the thought process out there that lumbar decompression or traction can actually create a vacuum phenomenon and, in effect, maybe suck back in a herniated disc. I personally have never felt that this was possible or to be true, and I haven't seen any research that would speak otherwise. I like to tell patients that, you know, if the disc material comes out, it's kind of like toothpaste out of the tube, you really can't put it back in. This study kind of supports that. The MRIs pre- and post-treatment really didn't show any significant change. That was an interesting finding of the study.
Sanjiv Lakhia: 07:26
They used a couple of different, like I mentioned before, questionnaires. They use what's called a Roland Morris Disability Questionnaire and an SF-36. These look at things like your function and quality of life. The other one they use is very popular, it's called the Oswestry Disability Index. The results for all of these were somewhat mixed, but again, what's compelling is when they split the groups up, again, you had 26 eligible individuals, 24 enrolled, 13 were randomized to the inversion and physiotherapy group and 11 are randomized to the physiotherapy group only, what happened was in the inversion group, 10 avoided surgery and in the group that only received physiotherapy, two avoided surgery. That's compelling. Even if the functional measures, the pain measures, the MRI changes were equivocal or not really significant, it appears that those in the inversion therapy group received enough relief at least that they decided against surgery.
Sanjiv Lakhia: 08:30
Now, I don't have a whole lot of details about what exactly were the diagnoses, what type of disc herniations or any significant neurologic issues. There's not a whole lot of information beyond that they had low back pain and radiculopathy, or sciatica, but it does pique my interest a little bit more. I think if you're out there considering using an inversion table for your back pain, or even for your sciatic pain, it may not be an unreasonable thing to try.
Sanjiv Lakhia: 09:00
Now, a couple of considerations here, when you look at any treatment, you want to look at the dosage. When you're using traction, the general consideration is that traction less than 25% of your body is considered to be what's called low dose or sham traction, so you need a traction load of at least 60% of the body weight to cause some theoretical reduction in intradiscal pressure. This is more important if you're going to the chiropractor's office and they are trying to determine how much traction to apply, and they tend to know this information. The inversion table though can really easily achieve that. When you combine gravity with the body weight, you really achieve high levels of traction force.
Sanjiv Lakhia: 09:47
I think though that in this study, they did not mention any adverse effects in either group, but there are a couple things I've observed over my career that are of some concern. When I was practicing at Ohio, I did have a patient who was trying inversion. Now, she was in her 70s, and unfortunately, due to the inversion, suffered a retinal detachment. Why would that happen? Well, I mean, obviously you're in an inverted state, you're increasing the pressure, the blood pressure, particularly to the head and neck, and I think unfortunately for her that happened. If you have any history of head injuries, strokes, high blood pressure, visual disturbances, dizziness, vertigo, I would just stay away from it. It's not well documented, the side effects and problems, but it just makes sense to me that really choose caution in that scenario.
Sanjiv Lakhia: 10:42
There you go, that's inversion therapy in a nutshell. There's not a whole lot of research on it. If you're considering buying a unit, I think it's relatively affordable, but again, it's not going to be a cure all. It might give you some temporary relief. I'd put it in the same bucket as using a TENS unit or taking a pain medication. We're not talking about a fix. Really, you can't avoid doing the work, and that is living healthy, keeping your self in an ideal body weight, going through proven physical therapy approaches and then seeing a qualified spine physician if you're having issues.
Sanjiv Lakhia: 11:17
The second article falls into the same kind of category of treatments, and that's gravity-assisted interventions. This is very popular and I think has a lot more research behind it, and that's quite simply aquatic exercise. I want to review with you an article from the Journal of Exercise Rehabilitation, this is a 2019 article. We'll have links to these articles in the show notes. The title of the article is called The Effect of Aquatic Exercise Program on Low Back Pain Disability in Obese women. Once again, this was done outside the United States. This study was conducted in Malaysia. It's a very easy article to read and follow.
Sanjiv Lakhia: 12:05
Once again, they divided, well, they actually placed patients into a 12-week water therapy program. It was really a low requirement. It was a 60-minute, two-session-a-week program that they were asked to participate in. During this program, they went through a variety of exercises and the main exercise component lasted about 40 minutes. Examples of these exercises include water walking, this is where they're either walking or jogging forward or backwards in the pool. They also did forward lunges, side lunges. They did hip and knee bending. They also do some upper body exercises and mobilization with a kick board, along with arm pendulum exercises. Deep water cycling was offered as well. Then with an assisted device called a woggle, they did some pool planks and some wall pushups. This was preceded by a warmup period with some static stretches and then a cool-down period for 10 minutes where they did some stretching, some deep breathing exercises, relaxation, and some self-care.
Sanjiv Lakhia: 13:19
Let's get to the results. Again, there were 40 enrolled participants, 19 of the 20 that were actually in the aquatic exercise group, along with the rest that were in a control group. All completed another Oswestry questionnaire. Again, Oswestry is a questionnaire that's designed to look at functional improvement. What's very interesting is that there was a high rate of compliance. The average attendance of their aquatic exercise group was 92%, which is really amazing in a research study, and that after six sessions the participants were notably enthusiastic to continue with the exercise program, which is, frankly, quite unheard of. Trying to have an exercise program that people really want to stay in and enjoy is very difficult at times. In the control group, it mainly consisted of physiotherapy exercise instruction. This was done, it turns out to be, rather irregularly at home, two to three times per week. That tends to be the compliance that we often see.
Sanjiv Lakhia: 14:21
The results were really, really positive for the aquatic therapy group. The Disability Index scores improved quite significantly. They reported far less pain, improved ability to walk, sit, stand, improvements in sleep, social life, pain intensity, and personal care, so really across the board. There wasn't any real significant difference in the ability to lift, walk or social life between the two groups, they all improved across both areas, but when you look at the progressive intervention of the aquatic exercise program, it really seemed to improve pain intensity, personal care, again, the ability to sit, stand, and sleep, as well as employment and homemaking. This was quite remarkable and these findings are really aligned with other research articles that I've read about water-based exercise intervention programs. It seems to be a consistent theme in the medical literature that when you get in the pool, you generally feel better and it's really an all-around good exercise.
Sanjiv Lakhia: 15:26
Let's talk briefly about why that is. Well, there's some research that shows that when you're in the pool, and let's say you're in a pool up to about the shoulder level, you effectively reduce your body weight almost up to 90%, depending on where you look and what type of research you're investigating. Additionally, the viscosity of the water increases the resistance and this allows for strength exercise training with very little friction. Another benefit of pool therapy or aquatic therapy is that because the water density is about 800 times more dense than air, you combine the buoyancy and viscosity of the water, it can provide a really significant source of resistance to improve the muscle strength without bearing weight. That's the key. Many of you out there are struggling with pain in your back, hips and knees, and when we tell you you need to exercise to lose weight or build strength, it's a vicious cycle in that the more you try to exercise, the more you hurt and the less that you want to. Finding a low impact way to build strength is a challenge and this could be the solution for you.
Sanjiv Lakhia: 16:32
The other benefit really is that the hydrostatic pressure in the water, it's a perpendicular or it's a direct force on your joints. It can actually reduce the swelling in your joints and improve what's called your proprioceptive sense, which is very important for your balance. The last thing is people can be more motivated to work out in the water because you're not worrying about pain or discomfort.
Sanjiv Lakhia: 16:56
That's a pretty good summary of two very common potential interventions for your low back pain. I would categorize these as gravity-assisted. Think about it, again, traction, if you're using inversion, you're using gravity plus a distractive force to basically stretch out your spine and theoretically really pressure on your disc. Then certainly in the pool, you combine the effects of the compressive forces of water along with the ability to de-weight your body in the pool. Really, pool therapy is the closest thing you can find to exercising in outer space, where you do not have gravity. The only other tool I've seen is the gravity-assisted treadmill, which is out there on the market as well if you have a chance to look at that or research that in your community, but it's extremely expensive and very hard to access and find. On the contrary, most local YMCA programs have aquatic therapy classes for seniors, some of them are sponsored by the Osteoarthritis Foundation. I encourage you to check that out.
Sanjiv Lakhia: 18:03
I hope you found this episode to be useful as you continue to explore ways to improve your back pain and overall quality of life.
Outro: 18:13
Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and Spine Associates with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.
This podcast is sponsored by our partner QxMD. QxMD builds mobile solutions that drive evidence-based medicine in clinical practice. Check out Read for easy access to research personalized for you and Calculate for over 500 easy-to-use decision support tools. Try them today at QxMD.com/apps. Again, that is QxMD.com/apps.
Intro: 00:30
Welcome. You're listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health, brought to you by Carolina Neurosurgery and Spine Associates, where providing personalized, highly-skilled and compassionate spine care has been our specialty for over 75 years. And now, it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.
Sanjiv Lakhia: 01:04
In the world of back pain and back care, there are many different things out there in the market that patients like to try, I'm sure you have tried, to try and help yourself if you hurt your back. Obviously, from a medical side, we've covered many different things that can be offered to help with back pain, such as injections, physical therapy, different types of surgery, certainly different types of medications, but there are a couple of things out there that are very popular and I want to touch on them today. They really fall under the category of gravity-assisted devices or gravity-assisted modalities to help with back pain.
Sanjiv Lakhia: 01:46
Probably the most popular question I get from an individual that may come to see me after straining their back pertains to the concept of inversion therapy or an inversion table. A question I'll often hear is, "Doc, I've got a inversion table. I picked it up from Costco or Sam's or my buddy has one. When I tilt on that thing, it helps. Is that safe? Is this something that's effective? Something that I should use?"
Sanjiv Lakhia: 02:15
So, Inversion is one of them, and let's dive into that. There's really not a lot of research on this topic. I've looked at it extensively. I have been able to pull an article from the journal entitled Disability and Rehabilitation. There's a 2012 article entitled Inversion Therapy in Patients with Pure Single-Level Lumbar Discogenic Disease: A Pilot Randomized Trial. Let's get into that.
Sanjiv Lakhia: 02:44
This is a small pilot study, and what that means is it's really a investigation just to try and get an initial impression about a research topic and decide is a worthwhile creating larger scale, more expensive studies. This one originated in the United Kingdom through the Department of Neurosurgery at James Cook University Hospital and Newcastle, along with the Department of Physiotherapy at Northumbria Newcastle upon Tyne, United Kingdom.
Sanjiv Lakhia: 03:18
What they aimed to do really was to look at a couple of different groups of people. This is a very small study that was done, where they basically recruited about 25 individuals into the study. They really wanted to find out is it even feasible to develop a larger randomized controlled trial, meaning they wanted to see if there's any positive benefit at all from inversion therapy that would make it worthwhile to investigate this on a deeper and more complex level. Actually, it was a 26 patients that were enrolled into this trial and 24 were randomized, that means they were basically randomly split into a couple of different groups. 13 were split into a group where they received physical therapy and inversion to treat their back pain, and then 11 were split into a group where they received physical therapy or physiotherapy alone.
Sanjiv Lakhia: 04:14
Let's get into this just a little bit here. Before I get into the nitty gritty of the research article, let's back up and just discuss what exactly is inversion of why you would even consider it. I would consider inversion ... And for those who aren't aware of it, an inversion table or a tilt table, you definitely can buy this over the counter. They're around two to 300 bucks, oftentimes you'll see them for sale at Costco or Sam's Club or Walmart. The device requires you to lay in it and get strapped in, and then it'll tilt you basically upside down or any varying degree of that, any angle that you decide. What we're utilizing there is a concept of gravity and body weight, and the combination of the two, theoretically, can basically stretch out your spine and decompress tight muscles, ligaments, nerves, and discs.
Sanjiv Lakhia: 05:08
Now, lumbar decompression, or lumbar traction, has been around for a long, long time. When you take a deep dive into the medical literature on it, it's really not that compelling. Meaning, I haven't been able to see a whole lot of evidence that lumbar decompression is very effective. Although to be fair, there's conflicting results and there are a lot of practitioners, physical therapists and chiropractors, who own lumbar decompression tables. Now, these are tables where you lie supine or flat, and you basically get strapped in and stretched out. Those are extremely expensive. Inversion tables are definitely more affordable and economical, but they work on a similar concept, that is, gravity-assisted decompression.
Sanjiv Lakhia: 05:52
So this study divided the individuals in a couple of different groups and the results are very interesting. Essentially, the group that went through physical therapy along with inversion seemed to have a much lower incidence of requiring surgery than the others. I'm going to share a few more details about the study with you. Again, they were split up into two different groups and they were put into these different pathways where they received physical therapy and inversion or physical therapy alone. Then they measured the outcome using a couple of different outcome measures, one of them looks at basically function, the other one looks at pain. The results for that were somewhat mixed, not quite as impressive as the idea that if you went through the inversion group you really seemed to avoid surgery quite a bit.
Sanjiv Lakhia: 06:46
One other thing they did though is they also looked at MRI studies, because of the thought process out there that lumbar decompression or traction can actually create a vacuum phenomenon and, in effect, maybe suck back in a herniated disc. I personally have never felt that this was possible or to be true, and I haven't seen any research that would speak otherwise. I like to tell patients that, you know, if the disc material comes out, it's kind of like toothpaste out of the tube, you really can't put it back in. This study kind of supports that. The MRIs pre- and post-treatment really didn't show any significant change. That was an interesting finding of the study.
Sanjiv Lakhia: 07:26
They used a couple of different, like I mentioned before, questionnaires. They use what's called a Roland Morris Disability Questionnaire and an SF-36. These look at things like your function and quality of life. The other one they use is very popular, it's called the Oswestry Disability Index. The results for all of these were somewhat mixed, but again, what's compelling is when they split the groups up, again, you had 26 eligible individuals, 24 enrolled, 13 were randomized to the inversion and physiotherapy group and 11 are randomized to the physiotherapy group only, what happened was in the inversion group, 10 avoided surgery and in the group that only received physiotherapy, two avoided surgery. That's compelling. Even if the functional measures, the pain measures, the MRI changes were equivocal or not really significant, it appears that those in the inversion therapy group received enough relief at least that they decided against surgery.
Sanjiv Lakhia: 08:30
Now, I don't have a whole lot of details about what exactly were the diagnoses, what type of disc herniations or any significant neurologic issues. There's not a whole lot of information beyond that they had low back pain and radiculopathy, or sciatica, but it does pique my interest a little bit more. I think if you're out there considering using an inversion table for your back pain, or even for your sciatic pain, it may not be an unreasonable thing to try.
Sanjiv Lakhia: 09:00
Now, a couple of considerations here, when you look at any treatment, you want to look at the dosage. When you're using traction, the general consideration is that traction less than 25% of your body is considered to be what's called low dose or sham traction, so you need a traction load of at least 60% of the body weight to cause some theoretical reduction in intradiscal pressure. This is more important if you're going to the chiropractor's office and they are trying to determine how much traction to apply, and they tend to know this information. The inversion table though can really easily achieve that. When you combine gravity with the body weight, you really achieve high levels of traction force.
Sanjiv Lakhia: 09:47
I think though that in this study, they did not mention any adverse effects in either group, but there are a couple things I've observed over my career that are of some concern. When I was practicing at Ohio, I did have a patient who was trying inversion. Now, she was in her 70s, and unfortunately, due to the inversion, suffered a retinal detachment. Why would that happen? Well, I mean, obviously you're in an inverted state, you're increasing the pressure, the blood pressure, particularly to the head and neck, and I think unfortunately for her that happened. If you have any history of head injuries, strokes, high blood pressure, visual disturbances, dizziness, vertigo, I would just stay away from it. It's not well documented, the side effects and problems, but it just makes sense to me that really choose caution in that scenario.
Sanjiv Lakhia: 10:42
There you go, that's inversion therapy in a nutshell. There's not a whole lot of research on it. If you're considering buying a unit, I think it's relatively affordable, but again, it's not going to be a cure all. It might give you some temporary relief. I'd put it in the same bucket as using a TENS unit or taking a pain medication. We're not talking about a fix. Really, you can't avoid doing the work, and that is living healthy, keeping your self in an ideal body weight, going through proven physical therapy approaches and then seeing a qualified spine physician if you're having issues.
Sanjiv Lakhia: 11:17
The second article falls into the same kind of category of treatments, and that's gravity-assisted interventions. This is very popular and I think has a lot more research behind it, and that's quite simply aquatic exercise. I want to review with you an article from the Journal of Exercise Rehabilitation, this is a 2019 article. We'll have links to these articles in the show notes. The title of the article is called The Effect of Aquatic Exercise Program on Low Back Pain Disability in Obese women. Once again, this was done outside the United States. This study was conducted in Malaysia. It's a very easy article to read and follow.
Sanjiv Lakhia: 12:05
Once again, they divided, well, they actually placed patients into a 12-week water therapy program. It was really a low requirement. It was a 60-minute, two-session-a-week program that they were asked to participate in. During this program, they went through a variety of exercises and the main exercise component lasted about 40 minutes. Examples of these exercises include water walking, this is where they're either walking or jogging forward or backwards in the pool. They also did forward lunges, side lunges. They did hip and knee bending. They also do some upper body exercises and mobilization with a kick board, along with arm pendulum exercises. Deep water cycling was offered as well. Then with an assisted device called a woggle, they did some pool planks and some wall pushups. This was preceded by a warmup period with some static stretches and then a cool-down period for 10 minutes where they did some stretching, some deep breathing exercises, relaxation, and some self-care.
Sanjiv Lakhia: 13:19
Let's get to the results. Again, there were 40 enrolled participants, 19 of the 20 that were actually in the aquatic exercise group, along with the rest that were in a control group. All completed another Oswestry questionnaire. Again, Oswestry is a questionnaire that's designed to look at functional improvement. What's very interesting is that there was a high rate of compliance. The average attendance of their aquatic exercise group was 92%, which is really amazing in a research study, and that after six sessions the participants were notably enthusiastic to continue with the exercise program, which is, frankly, quite unheard of. Trying to have an exercise program that people really want to stay in and enjoy is very difficult at times. In the control group, it mainly consisted of physiotherapy exercise instruction. This was done, it turns out to be, rather irregularly at home, two to three times per week. That tends to be the compliance that we often see.
Sanjiv Lakhia: 14:21
The results were really, really positive for the aquatic therapy group. The Disability Index scores improved quite significantly. They reported far less pain, improved ability to walk, sit, stand, improvements in sleep, social life, pain intensity, and personal care, so really across the board. There wasn't any real significant difference in the ability to lift, walk or social life between the two groups, they all improved across both areas, but when you look at the progressive intervention of the aquatic exercise program, it really seemed to improve pain intensity, personal care, again, the ability to sit, stand, and sleep, as well as employment and homemaking. This was quite remarkable and these findings are really aligned with other research articles that I've read about water-based exercise intervention programs. It seems to be a consistent theme in the medical literature that when you get in the pool, you generally feel better and it's really an all-around good exercise.
Sanjiv Lakhia: 15:26
Let's talk briefly about why that is. Well, there's some research that shows that when you're in the pool, and let's say you're in a pool up to about the shoulder level, you effectively reduce your body weight almost up to 90%, depending on where you look and what type of research you're investigating. Additionally, the viscosity of the water increases the resistance and this allows for strength exercise training with very little friction. Another benefit of pool therapy or aquatic therapy is that because the water density is about 800 times more dense than air, you combine the buoyancy and viscosity of the water, it can provide a really significant source of resistance to improve the muscle strength without bearing weight. That's the key. Many of you out there are struggling with pain in your back, hips and knees, and when we tell you you need to exercise to lose weight or build strength, it's a vicious cycle in that the more you try to exercise, the more you hurt and the less that you want to. Finding a low impact way to build strength is a challenge and this could be the solution for you.
Sanjiv Lakhia: 16:32
The other benefit really is that the hydrostatic pressure in the water, it's a perpendicular or it's a direct force on your joints. It can actually reduce the swelling in your joints and improve what's called your proprioceptive sense, which is very important for your balance. The last thing is people can be more motivated to work out in the water because you're not worrying about pain or discomfort.
Sanjiv Lakhia: 16:56
That's a pretty good summary of two very common potential interventions for your low back pain. I would categorize these as gravity-assisted. Think about it, again, traction, if you're using inversion, you're using gravity plus a distractive force to basically stretch out your spine and theoretically really pressure on your disc. Then certainly in the pool, you combine the effects of the compressive forces of water along with the ability to de-weight your body in the pool. Really, pool therapy is the closest thing you can find to exercising in outer space, where you do not have gravity. The only other tool I've seen is the gravity-assisted treadmill, which is out there on the market as well if you have a chance to look at that or research that in your community, but it's extremely expensive and very hard to access and find. On the contrary, most local YMCA programs have aquatic therapy classes for seniors, some of them are sponsored by the Osteoarthritis Foundation. I encourage you to check that out.
Sanjiv Lakhia: 18:03
I hope you found this episode to be useful as you continue to explore ways to improve your back pain and overall quality of life.
Outro: 18:13
Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and Spine Associates with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.