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Ready to dance the night away without backache?

Do high heels cause back pain?

After the Christmas festivities, you may be thinking that we can all relax and put our feet up. But as we approach the New Year, there may be more parties to attend! If you’ve ever wondered why your feet feel sore and why you often have backache after a night out, it may not be your style of dancing that is the culprit.

So my awesome dancing isn’t to blame?

Often, the main cause tends to be our footwear. But before you throw out those 4-inch stilettos, did you know that flip-flops could also cause backache? As if we didn’t already have enough to worry about when choosing an outfit! So to begin, let’s look at the connection between our spines and our shoes.

Structural support

The spine is naturally designed to have a gentle s-curve from front to back. Supported by a huge network of muscles, tendons and ligaments, it is connected to the pelvis, which in turn balances on the tops of our thigh bones. These connect at the knee joint to the lower part of the leg (which includes the shin bones and ankle joint). Finally, we have the foot, where its 26 bones and 33 joints provide an amazing base of support, enabling us to propel ourselves in many directions at varying speeds!

The feet need to have a great degree of flexibility and control, allowing us to cope with uneven ground, and transferring forces up the legs so that we can move. When we wear shoes, we add extra factors in to the way that our feet interact with the ground. Depending on the type of footwear, this produces different effects on the way that we move. And anything that changes our body mechanics in a way that we are unused to has the potential to cause discomfort.

Take flip-flops for example; they are easy to slip on, but they have a tendency to fly off when we are walking about. As a result, we may end up gripping with our toes to keep them secure on our feet. Generally, this causes us to take shorter steps, which in turn affects the way that pressure is transferred from the foot up the leg. As we know, any changes in alignment here can have a knock-on effect on the spine.

High heels also affect your natural gait and stride length (hence the phrase “tottering on heels!”)

So why might high heels cause issues?

When you walk in high heels on the balls of your feet, your centre of gravity shifts forwards. In some cases this can cause the lower back to arch. To compensate for the change of balance, we often stick our chests out and force our shoulders back, exaggerating the curve of the lower back even more, and leaving us prone to neck and shoulder tension!

Over time, the increased compressive forces acting on the curvature of the lower back can lead to disc compression. Therefore for some people, the change in loading pattern could aggravate existing conditions. As the body tries to adjust itself, the changes in our lower back could cause problems elsewhere in the body, making issues such as knee or neck pain worse.

What else is affected?

However, on the other foot (!), some studies (1) found that when the heels were elevated, the pelvis tilted backwards, thereby flattening the lumbar spine when compared to a barefoot stance. Further studies (2) commented that the short term effects (flattening) may be different from the longer-term effects (where they suspected that over time, there could be an increase in lower back curvature).

More research is needed in this area, as there could be other factors that affected the results such as age, experience wearing heels and level of fitness. However it would appear that any change in the spinal curves can also affect muscle activity in that region (3).

Researchers found that muscular coordination changed when higher heels were worn (4) . The muscles that supported the spine had to work earlier (and harder) when 4-inch heels were worn. As the buttock muscles were activated later, they were not helping to support the body as effectively when in the high-heeled posture. This abnormal muscular activity could actually be the reason why our backs end up sore after a night in heels.

This is where assessment and treatment by a Chiropractor can be helpful. As well as looking at the alignment of your spine, they can also look at any areas where muscles may be affected. Treatment that takes into account the whole body will be the best approach to help minimise any discomfort during the party season.

What shoes should we choose?

Invariably, if you are not used to wearing them, high heels could put you at a higher risk of experiencing backache and back pain. But remember, so too can flip-flops!

  • Here are some helpful tips for anyone wearing high heels:
  • Try to choose round or square toed shoes instead of those with pointy toes. These can squeeze your toes and make it uncomfortable to walk (not to mention the risk of blisters!)
  • Give your feet (and back!) a break by wearing high heels only for a few hours at a time.
  • If you’ve worn high heels for most of the day, or for a couple of nights in a row, try and spend some time in low-heeled shoes to maintain a bit of balance between the two.
  • Compromise when considering style or comfort – smaller heels of about 2 inches can still be fashionable and may be more beneficial in the long-run than those 6 inch stilettos!
  • Likewise, thicker, sturdier heels tend to be more stable, spreading the weight and reducing the risk of ankle strains!
  • Use non-slip or gel insoles to help keep feet secure and comfortable.
  • Your feet expand during the day; if you are buying shoes, buy them later in the day to ensure they won’t end up pinching. Ensure that any shoes you buy fit well.
  • Lastly, remember to stretch your legs regularly to relieve tired, tight muscles.

So to enable you to see the New Year in with a bang instead of back pain, remember to book an appointment to see Philippa

1. Bendix T., Sorenson S.S., Klaussen K. Lumbar curve, trunk muscles, and the line of gravity with different heel heights. Spine. 1984;9(2):223–227. [PubMed] [Google Scholar]

2. Opila K.A., Wagner S.S., Schiowitz S., Chen J. Postural alignment in barefoot and high-heeled stance. Spine. 1988;13(5):542–547. [PubMed] [Google Scholar]

3. Different ways to balance the spine: subtle changes in sagittal spinal curves affect regional muscle activity. Claus AP1Hides JAMoseley GLHodges PW.

4. Mika A. The influence of high and low heeled shoes on EMG timing characteristics of the lumabr and hip extensor complex during trunk forward flexion and return task. Manual Therapy 2013.

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