By Steve Zachensky, MTI Contributor
Low back pain is the single most common chronic spinal disorder among Soldiers, and a viable remedy is as elusive as it is needed. Soldiers, specifically infantry and SOF troops, train and fight under uniquely burdensome loads. Activities such as running, strength training and even parachute operations can add stress to the body that the spine and lower extremities are forced to absorb. This kind of constant kinesthetic wear wreaks havoc on the spinal column and lower extremities. As a young Ranger Officer in my mid-twenties, I constantly fought lower back tightness and found myself doing stretches and foam rolling in the field, in the TOC and at home to no avail.
Today, along with mobility training, I utilize a technique called inversion therapy in my daily fitness regimen. After a morning workout and stretch, I hang upside down from my pull up bar for 3-5 minutes to decompress my spine and realign my posture for the day. While not for everyone, this technique (along with regular mobility work) has been shown to improve spinal compression, flexibility and muscle tightness. I argue that this technique has specific applicability to Soldiers, should be incorporated at the individual level, and further researched at the command level.
Physiological Impacts of load carriage training and combat operations
Whether in a training cycle or in combat, there is a pervasive mantra in the military about load carrying: “there’s always a little more room in a rucksack”. Countless operations have shown us that it is better to have and not need, and the ability to move heavy loads across land is an inescapable part of the job. That said, more focus should be given to balancing those loads with targeted recovery so troops can maintain their bodies with the sophistication of professional athletes.
An Army Public Health Center (1) study found that optimal loads (20%-30% combat, 45% non-combat) are very often exceeded in training, and Soldiers in combat operations during the GWOT were found to be carrying loads nearing 100lbs. For many Soldiers, that 100lb load might also be sandwiched in between a 5-mile run on pavement and 4 hours in a parachute harness before landing on hard clay. One day of this would make anyone’s back hurt. Researchers conducting a study on the spine system changes in Soldiers after load carriage training (2) found that “the spinal system encountered increased muscle volume, muscle congestion, tissue edema, IVD compression, decreased effective intervertebral foramen area, and increased lumbar curvature” and that a clinically significant correlation exists between load weight and the likelihood of paraspinal injury. While still acknowledging the need to train under heavy weights over terrain, units should also identify effective kinesthetic maintenance and rehab techniques like inversion therapy.
Inversion Therapy – Hanging upside down for maintenance and rehab
Inversion therapy (inversion traction therapy) comes in many different forms; you’ve probably seen inversion table commercials on TV, or seen one sitting in a someone’s home. I use gravity boots, similar to ski boots, but with hooks that allow the user to hang inverted from a pull-up bar. The proposed benefits relevant to Soldeirs include:
- Improved flexibility
- Improved posture
- Reduced back pain and discomfort
- Improved spinal health and decompression
- Healthier lymphatic system
The scientific findings on the benefits of inversion therapy are not concrete, as not enough large randomized studies have been completed, but there are smaller studies that suggest benefits associated with inversion therapy.
- A 1978 study by L J Nosse (3) looked at 20 men, splitting them 10-10 into experimental and control groups. Nosse took a baseline spinal length measurement and EMG reading (associated with low back pain activity), then had the control group hang upside down for 1-minute. The experimental group hung for an additional 245 seconds. His findings showed with statistical significance that inverted positioning for short periods increased spinal length and reduced EMG activity.
- A 2013 study by Yong-Seok Jee (4) randomly split 47 women with chronic low back pain into three groups: supine group, -30 degree inversion group, and -60 degree inversion group. Each group completed inversion therapy at their respective inversion for 3 minutes x 3 sets for 4-days/week over 8 weeks. His findings showed that inversion at -60 degrees reduced back pain and improved lumbar flexibility and trunk strength in patients, and he recommended this protocol for those with chronic low back pain.
- G Gianakopolous et al, in a 1985 study (5) of twenty people with low back pain, instructed participants in the use of three devices; two for inversion therapy and one for upright traction therapy. Researchers randomized the order in which the devices were used and found that inversion therapy resulted in spinal distraction (length between vertebrae) increases from 0.3mm-4.0mm in all cases. Of the 16 patients with chronic back pain, 13 reported a decrease in pain after all three devices were used.
There are some risks associated with hanging upside down for certain people:
- Those concerned with higher blood pressure while inverted
- Glaucoma patients (increased blood flow to the head)
- Pregnant women
- People with heart disease (head below heart for short periods)
Anyone should consult a physician before diving in. That said, the literature that exists (albeit not vast) does show meaningful benefits. The spinal decompression, reduction in low back pain and increased trunk flexibility are specifically relevant for troops often under heavy load.
Best Practices
There are generally two ways to practice inversion therapy in your home; an inversion table or gravity boots. An inversion table includes ankle braces and inverts at about the waist back. The user buckles their ankles in and lays backward allowing the table to invert and hang them upside down, with their back still touching the table (the table inverts ~-90 degrees, but the user is slightly less inverted).
Gravity boots are basically just the ankle braces from the table with two hooks to hang from a pull up bar.
I’ve used both and prefer gravity boots as they allow the user to hang freely and totally relax their muscles as there is no weight being put on the back like there can be with a table, and you can invert a full -90 degrees or more. Gravity boots are also much more cost effective and won’t take up space in your home like a table will. Teeter is a company that makes good quality boots and tables, and I’ve had my boots for almost 5 years with no signs of structural weakness yet.
It’s takes some practice getting in and out of a hanging position, but should be doable for most fit athletes. With gravity boots, I do a half pull up then bring my ankles to the bar to hook in. To get down after an inversion set, I swing upwards (leading with my arms) and grab the bar (similar to the sit ups Rocky did in the Russian barn).
Some research had patients hang for multiple times a day, but a 3-5 minute hang once a day (preferably after a workout/training, not before) have worked best for me. The muscle relaxation, posture alignment, and increased blood flow to the brain helps to jumpstart my mornings after a workout.
Two different studies (4,6) had patients use 3-min and 10-min sets with results. My personal experience is that less than 3 minutes doesn’t get the full effect, and longer than 5 minutes can start to stress the knees and create an uncomfortable amount of blood flow to the head, depending on the user. That said, starting with 1 or 2 minutes and working up to 3-5 minutes is a prudent way to begin. I’ve never experienced dizziness practicing with gravity boots, and it is not rampant with this technique, but should be monitored the first few times you try it.
Since incorporating inversion therapy into my own fitness and mobility routines, I’ve noticed my lower back pain and tightness drastically improve. My posture is more upright, I feel more agile, and on the other side of my SOF time, some people even ask if I’ve gotten taller.
Being past the 30-year mark, when I should ache and groan when getting out of bed to sit at a desk, I feel better than I did at 26 with kit on. Diligence has been key, practicing this technique almost daily after either a strength focused or endurance workout. While not undeniable, the literature that does exist points to meaningful benefits in spinal and muscular health. For troops under load, these benefits are uniquely relevant for improving and maintaining athletic ability and longevity, specifically in an occupation where you just need to carry it all with you.
Stephen Zachensky is a former Ranger Officer and accomplished endurance athlete
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Works Cited:
- Hauschild, Veronique. (2016). FOOT MARCHING, LOAD CARRIAGE, AND INJURY RISK.
- Qu, Hao et al. “Spine system changes in soldiers after load carriage training in a plateau environment: a prediction model research.” Military Medical Research vol. 7,1 63. 21 Dec. 2020
- Nosse L.: Inverted Spinal Traction. Arch Phys Med Rehabil 59: 367-370, Aug 78.
- Jee, Yong-Seok. (2013). The effect of inversion traction on pain sensation, lumbar flexibility and trunk muscles strength in patients with chronic low back pain. Isokinetics and exercise science. 21. 237-246.
- Gianakopoulos, G, et al: Inversion Devices: Their Role in Producing Lumbar Distraction. Arch Phys Med Rehabil 66: 100- 102, Feb 85
- Dimberg ,Olafsson A, Stefansson etc. :Sickness absenteeism in an engineering Industry – An analysis with special reference to absence for neck and upper extremity symptoms .1989