Up to two-thirds of women wear high heels on a daily basis. In fact, it’s been estimated that over half of American and European women wear high-heeled shoes between one and eight hours per day. High heels are commonly associated with a more upright, feminine posture. But there has been some controversy as to whether high heels contribute to back pain.
Step Into the Research
A group of scientists from Poland recently published a study of body posture for women wearing shoes without a heel, with 1.5-inch heels and with 4-inch heels. In an article that appeared in Spine in 2013, they reported findings that women wearing taller heels tended to push their thoracic spine forward, which could result in more difficulty in maintaining a symmetrical posture, something more notable in women wearing 4 inches. In other words, taller heels make you stick out your chest.
The spine carefully balances its curves between lumbar lordosis (backward curvature), and thoracic kyphosis (forward curvature) (see image).
There does exist some controversy in this area, but a number of other studies have noted that there’s a flattening of lumbar lordosis associated with increasing heel height. Traditionally, high heels were thought to actually increase lumbar lordosis. If lumbar lordosis is reduced, then the low back is at risk of being overloaded as more load is carried by the lumbar discs. Additionally, when your trunk and chest are inclined forward, which can occur in high heels, then you must exert more muscle tension using the lumbar extensor muscles to maintain a balanced spine.
Taller heels do appear to change spinal alignment, and there is a likely compensation in pelvic alignment. There is contraction of the gluteal musculature (buttocks) and the quadriceps (thighs) to maintain posture. This results in a more prominent and firmer bum on appearance.
So while we can establish that wearing 4-inch heels can change spinal and pelvic alignment and adjust body posture, we also know that many women love the look of taller heels. What can you do to prevent back pain and maintain your spine health?
If You Love Wearing Heels…
My first recommendation is to change up your shoe routine. Mix up your stilettos and taller heels with flats, wider heels and boots to prevent overuse in one foot position or one posture.
Second, it is important to focus on a strong abdominal core foundation to take some of the load off the lumbar discs and facet joints. I also encourage exercises to improve hip flexor and hamstring muscle flexibility, which enable the pelvis and hips to balance spinal posture. Pilates and yoga are both excellent supervised activities to improve these areas.
The exercises I recommend for patients with low back pain can be performed at home for 10-15 minutes daily include wall squats, lunges, pelvic tilts and bridges.
Third, engage in some lower impact aerobic activity if you have any back issues. I recommend the elliptical trainer, stationary bike and swimming.
If you are having any significant back pain, I recommend taking some time away from the heels, using ibuprofen or any other non-steroidal anti-inflammatory drug, together with hot and cold packs. Some of my patients do benefit from massage, acupuncture and chiropractic treatment as well. You may benefit from supervised physical therapy if you’re having difficulty pursuing the exercises outlined in this article.
If you experience ongoing leg pain together with back pain that doesn’t resolve within 4-6 weeks, or any numbness or weakness or bowel or bladder difficulty, I recommend you contact your physician for an evaluation.