No you do not have to totally hang upside down to gain the benefits. Most inversion tables come with a strap underneath that you can adjust to your desired incline that way you can just hang without worry of position. When starting out I recommend a person use the strap and always have someone with you the first few times. Even after 15 years of hanging I use the strap and on occasion will go the full locked 90 degrees. Just for the yahoo of it!! JM