I am often asked about various techniques to help with low back pain. The questions usually are about physical therapy or a home exercise program, and back braces and equipment for independent exercise are common areas of interest. In general, being consistent with a comprehensive exercise program with stretching, strengthening and aerobic conditioning is the most important. How to do your exercises is highly variable, so find what works best for you.

Stretching exercises for the low back require no special equipment. A well-rounded program can be learned from a physical therapist, and it is also easy to find basic exercises on the internet.  The simplest is just bend over, keep the knee straight and touch your toes. This can also be done sitting on the ground and bending forward. This stretches the back and the hips. The counter stretch is doing pelvic tilt exercises. Balanced stretching makes sure opposing muscles do not become too tight. More advanced stretching can be done with formal activities like yoga. For those who like group activities, yoga as well as Tai Chi are excellent in working on gentle motion and stretching. Foam rollers are not recommended for the low back area.

What About Inversion Tables?

Another common question asked is whether an inversion table would be helpful. The answer is not straightforward. First, you must not have eye problems, uncontrolled blood pressure, or possible problems with brain swelling. If you have lower leg problems or foot or ankle issues, inversion tables would be difficult to use. The purpose of an inversion table is to use gravity and the weight of the body for traction to the low back region. Anchoring the ankles and being upside down can produce this effect.

The first attempt at this was the use of inversion boots; these were metal sleeves with hooks fastened to them and one would hang from a bar hoping that the bar or boots would not fail.  One person I knew was an ironworker who strapped on his boots and hung from the steel girders or beams in buildings he was constructing – not especially advised. This evolved to the inversion tables, a device that hooks in your ankles while standing on a platform of a table that can pivot the body position.  Most tables allow one to rotate to a variety of angles including all the way inverted. Complete inversion is not needed to be effective, but try to be at least 60 degrees angled.

If you are going to buy an inversion table, it is important to invest in a very sturdy one that can support your weight easily and has a large base that it is stable as you change positions. Whether this will help your back is unknown. The best way for it to help is to do the inversion and immediately lie down in bed afterwards so gravity and standing does not reverse the effect of the upside down position. This requires having the equipment bedside.

The last question I often receive with regards to low back pain is about wearing a back brace. In general they are not recommended. The appropriate time to wear these is only associated with stabilizing the back after surgery to allow good healing. Using a back brace to control pain and prevent movement is typically a poor strategy. Wearing a back brace does not control movement and pain well. The down side is it allows the muscles to become weak and tight since they are not working in their normal manner. Further, back braces do not help prevent back injuries when working. The better treatment for painful low backs is exercise and a healthy diet.