Is back pain from wearing high heels an urban legend or a real occurrence? Do high heels actually contribute to back pain and if so, how can the suffering be avoided? These are very valid questions that should be carefully considered by people who want to be fashionable, but do not want to endure torture in the feet, legs and back as a result of their efforts.
Women are particularly affected by high heel-related back pain, but men are not spared. Some men choose to wear heeled shoes or boots of various styles and might also suffer dramatic symptoms as a direct result of their choice in footwear. Remember that back pain is not a gender-discriminating health issue.
This discussion provides answers to many questions about the relationship between wearing high heels and the occurrence of back pain. We will look at various factual scenarios that suggest a possible link between back pain and heeled shoes, as well as argue the counterpoint point of view that supports the idea of shoes being coincidental to back pain that may occur.
There are several theories of why back pain might result from wearing high heeled shoes. Most center on the idea that high heels disrupt normal posture and change the natural alignment of various structures in the anatomy. Let’s look at some of the evidence of possible pathological consequences of high heels on the body:
High heels tilt the body from its normal positioning, aligning many of the bodily joints at odd and sometimes extreme angles. This can be seen from the ankle up, including the hip, sacroiliac, pelvis, the entire back and the neck. All the muscular attachments to these many structures will suffer some degree of strain from trying to normalize movement and posture at such an unnatural angle.
High heels tension the hamstrings, which can play direct pressure on the lumbar paraspinal muscles and the deep muscles of the buttocks. This can lead to muscular strain or exhaustion. Likewise, the piriformis muscle might become so tense as to spasm and create the symptom set known as piriformis syndrome, also known as pseudo-sciatica.
High heels change the spinal curvatures, influencing the lumbar lordosis, and then having a cascade effect up the back including the thoracic kyphosis and the cervical lordosis as reactionary consequences. Changes in spinal curvature might create pain through various mechanisms which are detailed in the section covering lordosis and kyphosis.
Finally, since the angles of the spine change, it is very possible that spinal pathologies might also suffer exacerbation of symptomology, including nerve compression or spinal cord compression which is due to spondylolisthesis, herniated discs or general central or foraminal spinal stenosis.
The arguments above are very compelling and certainly provide insight as to why some people suffer pain in the back when wearing high heels. However, many people practically live in high heels and wear them daily without any health consequences at all. How is this possible? Let’s look further to understand why many people are spared any pain when wearing even the highest heeled shoes:
It is well known that the human body is excellent in its compensatory capabilities. Basically, this means that the body can adapt, especially if challenged repeatedly over time. This is one of the primary reasons why so many structural abnormalities of the spine and musculature might create visual presentation, but are not painful to the people who experience them.
Some people are simply more fit and flexible than others. Conditioned and relaxed back muscles will naturally adapt to changes such as those instigated by wearing high heels with less stress and strain.
Some people are of a softer personality type that is less prone to internalizing tension and suffering effects of mindbody origin. High heeled back pain can definitely qualify as a mindbody pain syndrome in many patients, while others will avoid such suffering.
Let’s take a middle ground stance on the possibility that high heeled back pain may occur in some people, some of the time. This is a safe position, since evidence supporting both sides of the argument exists throughout medical and complementary medical health journals, as well as in the clinical experience of millions of care providers. So what can be done to prevent back pain when wearing high heels?
Compromising on platform shoes will help considerably. After all, it is not necessarily the height of the shoe that is detrimental, but the angle of the foot that imbalances the remainder of the anatomy. If the front of the shoe is a similar height, then the bodily angle will revert to a more nature stance and the compensatory adjustments should be minimal in the anatomy.
Limiting the amount of time spent wearing high heels while standing really helps most people to decrease symptoms. When feasible, wear comfortable shoes when high heels are not absolutely needed and save focal time periods of wearing high heels for times when you can sit, stand on a softer floor or otherwise not strain your body.
Finally, if none of these practical solutions works for you, at least consider buying shoes with a wider and stronger heel. This will help minimize the amount of work the body will have to do to maintain balance when standing and walking, as well as increase the surface area of the shoe and therefore minimize focal pressure on the foot that will transfer up the leg and possibly affect the posture, sciatic nerve and overall spine.