TENS machines, inversion tables and traction: do they work?

Walk through any pharmacy or search online for back pain relief, and you’ll encounter TENS machines, inversion tables and traction devices, often marketed with confident claims about resolving back pain. These are three genuinely different technologies working through different mechanisms, and separating the honest evidence for each from the marketing claims helps you decide whether any of them are actually worth trying for your specific situation.

TENS: using electricity to interfere with pain signals

Many people are understandably surprised the first time they try TENS at how noticeable the relief can feel, precisely because the mechanism is genuinely unfamiliar compared with more commonly understood treatments like medication or physical manipulation.

This model, while genuinely useful for understanding why TENS can provide real relief, is a simplified explanation of a more complex underlying neurophysiology, and ongoing research continues to refine understanding of exactly how and for whom this kind of electrical stimulation works best.

TENS, short for transcutaneous electrical nerve stimulation, works by delivering mild electrical pulses through electrodes placed on the skin near the painful area. The proposed mechanisms include interfering with how pain signals travel to the brain, described by a long-standing scientific model called gate control theory, and potentially stimulating the body’s own natural pain-modulating chemicals, though the precise mechanism remains an area of ongoing research.

Many people using TENS report genuine, real-time reduction in pain intensity while the device is active, and this is a plausible, recognised effect rather than simply a placebo response, though placebo and expectation effects likely also contribute to some degree, as they do with many pain treatments. Evidence for lasting benefit once the device is switched off, or for TENS resolving an underlying cause of back pain, is considerably more limited, which is why TENS is best understood as a tool for managing pain in the moment — genuinely useful for that purpose for many people — rather than a standalone treatment for the underlying problem.

TENS is generally very low-risk, with the main precautions being avoiding electrode placement over broken skin, the front of the neck, directly over the heart, or in people with certain implanted electronic devices like pacemakers, who should check with their doctor before use.

Inversion tables: using gravity for spinal decompression

It’s a genuinely appealing idea — using nothing more than gravity and your own body weight to create relief — and this simplicity is part of what makes inversion tables an attractive product to market, even though the significant physiological effects of inversion deserve just as much attention as the potential spinal benefit.

Inversion tables work by securing the ankles and allowing the body to be tilted or fully inverted, using gravity to create a gentle traction force along the spine as the weight of the upper body pulls the vertebrae slightly apart. The theory behind this approach is that this temporary decompression can relieve pressure on compressed discs and nerve roots, and some people do report genuine short-term relief, particularly for symptoms consistent with disc-related nerve compression.

The significant caveat with inversion tables is that being inverted, even partially, produces substantial physiological changes beyond the spine itself — blood pressure redistributes significantly, and pressure within the eyes increases. These effects mean inversion tables carry genuine contraindications and aren’t a universally safe, gentle option the way they’re sometimes marketed.

Traction: a more controlled approach to spinal decompression

This more controlled delivery is a genuine practical advantage over inversion tables for many patients, since the force can be precisely adjusted to a comfortable, appropriate level and directed more specifically toward the affected spinal segment, rather than relying on body weight and full or partial inversion to generate a less targeted, less adjustable decompressive force across the entire spine at once.

Traction aims to achieve a similar decompressive effect to inversion tables but through a more controlled method, applying an adjustable pulling force to a specific part of the spine while the body remains in a neutral, typically lying-down position, avoiding the significant blood pressure and eye pressure changes associated with full inversion. Traction can be delivered manually by a trained therapist, using their own hands to apply a gentle, sustained pull, or through a mechanical device that applies a more precisely controlled and adjustable force.

Evidence for traction is genuinely mixed across the research literature. Some studies show modest short-term benefit, particularly for disc-related leg pain, while others show little difference compared with other conservative treatments or no significant additional benefit when added to a standard treatment programme. This mixed picture is part of why current clinical guidelines generally don’t recommend traction as a primary, standalone treatment, though it continues to be used as one component within broader conservative treatment plans in some practices, based on individual patient response.

What none of these three devices actually does

This is a distinction worth keeping in mind whenever a product’s marketing implies it can resolve a back condition entirely on its own, since genuine, lasting resolution of most back problems requires addressing the underlying contributing factors directly.

This is worth understanding through a simple analogy: these devices can turn down the volume on pain signals or temporarily create more space around a compressed structure, but none of them retrains the muscles, corrects the movement patterns, or resolves the structural changes that are commonly the actual, ongoing source of the problem. A house alarm can be silenced without putting out the fire that triggered it, and a similar principle applies here — genuine symptom relief is valuable, but it isn’t the same as resolving the underlying issue.

It’s worth being direct about a shared limitation across all three approaches: none of them addresses the underlying strength, movement pattern or structural factors that are frequently driving chronic or recurrent back pain. TENS interferes with pain signal transmission without changing the underlying tissue. Inversion and traction both provide temporary spinal decompression that, by their nature as passive mechanical effects, ends once the device is removed, without producing the more durable adaptations that come from active strengthening and movement retraining through targeted physiotherapy.

This doesn’t mean these devices are without value — genuine, real symptomatic relief has real worth, particularly if it helps you participate more comfortably in active rehabilitation or simply improves your day-to-day comfort while an underlying issue is being addressed through other means. It does mean expecting any of these three devices, used alone, to resolve a genuine underlying spine problem is likely to lead to disappointment.

How to use a TENS machine effectively

Getting genuine benefit from a TENS machine often depends on correct electrode placement and settings, which vary depending on the location and nature of your pain. Most devices come with guidance on placement, generally recommending electrodes on either side of the most painful area, and offer adjustable intensity and pulse settings that allow some experimentation to find what provides the most relief for you personally. It’s common for the ideal settings to take a bit of trial and adjustment to identify, and what works well for one person’s back pain may feel quite different or less effective for another’s, reflecting genuine individual variation in response to this kind of stimulation.

Many physiotherapists can provide guidance on optimal electrode placement and settings for your specific condition if you’re not getting the results you’d expect from a home device, and this guidance can meaningfully improve how effective the device feels compared with generic instructions alone.

What a session of professional traction typically looks like

When traction is delivered in a clinical setting, it’s typically performed by a physiotherapist or other trained practitioner, often using a specialised table or harness system that allows a controlled, adjustable pulling force to be applied to the affected part of the spine, most commonly the neck or lower back. Sessions typically last a defined period, often somewhere between ten and twenty minutes, and the force applied is generally adjusted based on your comfort and response during treatment rather than a fixed setting applied universally to every patient.

Some practitioners combine traction with other treatments within the same session, such as heat application beforehand to help relax the muscles, or specific exercises immediately afterward while the temporary decompression effect is most pronounced, aiming to maximise whatever benefit the traction provides by pairing it thoughtfully with complementary treatment rather than using it in isolation.

Home devices versus clinical equipment

A practical distinction worth understanding is the difference between professional-grade equipment used in a clinical setting under supervision and consumer devices marketed for home use, which applies to both traction devices and inversion tables. Clinical equipment typically allows more precise control over the force and duration of treatment, and is used under the supervision of a trained practitioner who can adjust the approach based on your response and monitor for any adverse reaction during treatment. Home devices offer convenience and lower ongoing cost but place more responsibility on you to use them correctly and to recognise if something doesn’t feel right, which is part of why consulting a professional before purchasing and using either type of home device is a sensible precaution, particularly given the specific contraindications discussed for inversion tables.

Realistic expectations and combining approaches

Given the mixed and generally modest evidence for these devices used in isolation, a sensible approach is combining whichever of these tools provides you genuine relief with the more evidence-supported active approaches discussed elsewhere on this site, particularly targeted exercise and movement-based rehabilitation. Using TENS during a particularly painful flare to make daily activities more manageable while continuing an exercise programme, for example, uses the device for exactly what it does well — short-term symptom management — without relying on it to do more than that.

It’s also worth periodically reassessing whether a device you’ve been using for some time is still providing genuine value, rather than continuing out of habit alone. Symptoms and needs change over the course of managing a chronic back condition, and a tool that was helpful during one phase of your treatment may become less relevant, or occasionally more relevant again, as your underlying condition and treatment plan evolve over time. Revisiting this periodically with whoever is guiding your overall treatment keeps your use of these tools genuinely purposeful rather than simply routine.

Making a sensible decision about trying one of these

If you’re considering any of these three options, it’s worth approaching the decision with a few honest questions: what specifically am I hoping this will achieve, is there a reason based on my specific health conditions to avoid it, and how will I fairly judge whether it’s actually helping after a reasonable trial period. For TENS specifically, given its low risk profile, a trial is reasonable for most people. For inversion tables, checking the contraindications and consulting a doctor first is genuinely important given the significant physiological effects involved. For traction, discussing with a physiotherapist whether it makes sense as part of your specific treatment plan, rather than purchasing a home device independently, is generally the more sensible approach.

A proper consultation can help clarify whether any of these approaches make sense for your specific condition, and can help make sure whichever tools you use are genuinely complementing an appropriate broader treatment plan rather than being relied upon as a standalone solution to a problem that needs more active, targeted treatment.