Physiotherapy in Southampton: Lower back pain and high heels
High heels are popular and some women can’t imagine going to a party or attend an important event wearing any other type of shoes. But by wearing high heels you weaken the body’s kinetic chain. Do not get me wrong. Walking is a fantastic way to prevent back pain, but choosing the right footwear is critical.
All the body parts are connected and the wrong shoes on your feet may cause issues and pain elsewhere. The thing is, problems may arise anywhere in the body. It is a domino effect that is at play here.
High heels and other factors aggravating pain
Around 72% of women wear high heels at some time. Wearing high heels may lead to back pain. In my clinic I always discuss with patients all the factors that may contribute to back pain or make it worse. Sometimes patients know straight away what causes the pain; they oftentimes mention work, especially its repetitive character, bed mattress, stress, tension, low mood, or injury. We usually do not think about footwear, but it is an equally important factor. On average we do 6000 steps a day. Multiply this by many years, and the importance of right footwear becomes obvious. There is almost always something in the patient history that can help explain the pain patient presents with. What is important is to remember that pain may be present even months or years after an injury. Tissues may heal up completely but there may be still some residual, lingering pain. Choosing the right footwear may help in recovery and is an act of care for your back.
It is not only therapy that one should be concentrating on while tackling and preventing back pain. You should also think about and eliminate various triggers that make your condition worse. The wrong footwear might be one of such triggers.
High Heels and pain
A pair of 4-inch heels can make any outfit and be an effective way to make you look taller. However, we need to remember that high heels can cause a lot of problems with your health. Wearing high heels frequently leads to certain muscles working too hard and others getting weak. This may cause an imbalance that will affect the way your joints work. We know this may cause pain. Inhibited muscles do not work properly. Your body needs to be balanced for the muscles to work in harmony. High heels may disrupt this balance, especially if you decide to wear them often. I think, there is nothing wrong to put them on now and again, but frequent use will not be good for your spine, knees, or hips. And, as you already know, everything in the body is connected so problems with your knees may lead to other problems.
Your spine acts as a great shock absorber. It is a bit like coil springs in the suspension of a car. It ensures that you are not having a bumpy ride while walking or running. Spinal curves must be maintained so that spinal joints and muscles can work efficiently. High heels cause the lumbar spine to flatten whereas the thoracic spine and your head move to the back so that you can keep your balance. That means your spine may lose its natural alignment and curves. The resulting excessive force may affect the structure and the function of intervertebral discs, spinal ligaments, and joints. This is why you may start feeling pain.
Heels and spinal conditions
And do not forget, wearing high heels over a long time ( we are talking years here) may heighten the risk of two spinal conditions – the slippage of one vertebra on another in the lumbar spine and stenosis. These conditions may affect the spinal cord and nerves leaving your spine. Narrowed spaces in the spine may squash nerves and you may have shooting pains, tingling, numbness, muscle weakness, spasms, and cramps. Pain radiating to the buttock, down the leg, and reaching foot is common.
How high heels affect your feet and calves
Heels will mimic the way a person walks on the ramp, and increase the pressure on the balls of your feet. It is that downward force that may cause some damage to the joints and tissues in the front of your feet. Your foot joints are not in a natural position. Due to elevated heels your calves will be working hard and that may result in cramps, muscle tightening, shortening, and blood circulatory issues. The soleus muscle in your calf is often called the second-biggest blood pump (after heart) in the body. It may stop working effectively and efficiently.
Heels and keeping an upright posture
Wearing high heels means your feet stay in a flexed position for prolonged periods. That is causing your body to lean forward and to compensate for that and keep your body straight some muscles will need to work harder. For example, knees extensors need to do extra work. Otherwise you would lose balance. Your lumbar spine and chest will move forward. To keep your body upright your back muscles will have to also work harder. There is always a trade-off in the form of stiffness, discomfort, aches, and pain.
Try to listen to what your body tells you. If you think high heels may be causing some of your problems, you need to do something about it. Try to switch to flat shoes for the time being and see if that makes any difference.
All is connected
And, as you know, everything in the body is connected, so problems with your knees may lead to other problems. It is a domino effect that is at play here. Heels may disrupt the natural balance and rhythm at which your joints should be working.
You may develop pain around your feet, calves, pelvis, low back pain, upper back, and even headaches
There will be also other factors that may add to the problem and make it worse such as lack of exercise, bodyweight (check your BMI), stress, lack of sleep, smoking etc…
Benefits of flat shoes
On the contrary, flat shoes help evenly distribute body weight throughout the foot. The small joints around the ball of your foot can work much better. Your posture will remain upright hence muscles along the kinetic chain can work effectively, doing exactly what are they are supposed to do: support your posture and work in tandem with the joints.
My recommendations to ease the pain
- Avoid wearing high heels for long periods.
- Apply gentle stretches before and after wearing them
- Wear 2-inch heels
- Buy shoes in the afternoon, when feet are at their largest
- Avoid pointed shoes
- Leather insoles are best
- Buy a wide variety of shoes and vary your footwear daily if you can
Patient with back pain
Therapy is one thing, but making changes in your lifestyle and habits may be even a more powerful weapon in tackling pain.
Recently, I saw a patient whose chief complaint was a low back pain due to excessive tension and stiffness. She was wearing high heels when I saw her. Even though her back pain was terrible, she did not think it might be actually her footwear that was causing it. She did not make a connection between high heels and back pain. She explained she wore high heels almost daily due to being short and wanting to add a few inches to her height. My advice to her was to stop wearing heels completely and allow the joints and muscles to come back to a natural state. After a few days, she called me. The pain was gone, and she felt much better. Sometimes the solution is very simple, and it takes a small adjustment to make a huge impact on the level of pain.
I am a Chartered Physiotherapist and Master Myofascial Therapist practicing in Southampton, Hampshire. I was working in the NHS between 2008 and 2021. My speciality lies in treating musculoskeletal conditions and providing community rehabilitation.