The purpose of this case study is to demonstrate improved techniques of inversion therapy using pelvic-trunk inverted positions to treat low back syndrome.

Basic inversion therapy involves hanging from the feet.  This procedure proved to distract the ankle, knee, and hip joints more than the lumbar spine and is limited in treatment versatility.

 (5) Pelvic-trunk inversion therapy provides greater distraction of  the lumbar spine/vertebrae than the straight table inversion technique of hanging from the foot/ankle. (4) (1) Also, during pelvic-trunk inversion with the patient hanging straight down there is a symptom improvement with disc herniation, and increased disc space distraction with disc degeneration. (2) This modality may be the most effective method at this time for the relief of low back pain. (3)

The fifty year-old university professor’s history of 7 lumbar endoscopic surgeries did not include any fusion of the spine, so intersegmental motion was not inhibited and inversion traction could have a positive therapeutic effect. The patient is a health care professional and was compliant with three years of physical therapy prior to using pelvic-trunk inversion therapy. The patient had exhausted his use of modalities and exercise, and did not continue any modalities after starting pelvic-trunk inversion therapy.

Imaging studies indicated decreased disc height L2-S1, levoscoliosis, disc bulges at L2-S1 with IVF encroachment, and L2 on L3 retrolisthesis. SEMG indicated (R) quadriceps paralysis and bilateral anterior tibialis paresis. The SEMG does not stand alone as an evaluative modality and we integrated the SEMG with the clinical findings of manual muscle testing (MMT).

Clinical findings included limited (L) lateral flexion ROM due to pain, facet sclerotome pain referred to bilateral hips, dermatome pain radiating down (R) lateral thigh to the dorsum of the foot, myotome weakness of (R) quadriceps and bilateral drop foot. The myotomes affected in this case study relate to the L2-L5 nerve roots with manual muscle test (MMT) findings of (R) hip flexors 2/5, and knee extensors 3+/5, bilateral dorsal flexors 3/5.

The pelvic-trunk inversion technique enlarges the wedge-shaped disc to a rectangle shape by taking up the bulging of the annulus ligament via a vacuum  effect.  This reduces the disc pressure on the annulus ligament thereby releasing the nerve root entrapment reducing the dermatome pain and myotome weakness. (fig. G) Chronic radicular pain was resolved and sporadic pain due to activities in daily living also respond to a few inversion sessions lasting two minutes.

Trunk inversion from the pelvis hanging position reduced the retrolisthesis by aligning the vertebrae thus reducing the central canal stenosis.  To address the weakness found in the (R) quadriceps and bilateral anterior tibialis the patient assumes the anterior flexor surface inverted position supported under the calves.

This exercise technique supports the patient treatment program by three different methods. First, an isometric contraction of the anterior tibialis to promote dorsal flexion, endurance and strength, to improve the neuromuscular symptoms of drop foot. Second, an eccentric contraction of the rectus femoris to improve the neuromuscular symptoms of quadriceps weakness.

Third, an eccentric contraction of the abdominal muscles which incur a co-contraction from the multifidus stabilizing muscles of the spine, for improved low back support following therapy. The inverted flexor surface eccentric exercises improved muscular strength.

As described under  clinical findings the myotome weakness improved to the following MMT levels: hip flexors 5/5, knee extensors 5/5, dorsal flexors 5/5 or normal strength.  For this patient with (R) quadratus lumborum pain limiting (L) lateral trunk flexion the patient was inverted in the pelvic trunk position hanging freely allowing him to laterally flex in the inverse gravity position.

Upon reversing the effect of gravity (L) lateral flexion now is provided by the (L) quadratus lumborum and there is no pain generated. Movement of (L) lateral flexion changes the proprioception/pain sensations and breaks the pain cycle.  Post-inversion therapy lateral flexion could be completed with no pain and to a greater degree.

To address the facet syndrome, the inverted position was bending forward over the vertical thigh pad with the patient’s feet on the platform and the patient’s arms reaching towards the lower handgrips.

 This position gaps the facet joints (similar  to a manipulation) and releases the entrapment to ease the referred hip pain.