LADY GAGA DOES IT!
YOUR FRIENDS ARE DOING IT!
THE BEST DESIGNERS FROM MANOLO BLAHNIK, CHRISTIAN LOUBOUTIN, AND JIMMY CHOO MAKE ALL WOMEN DO IT
What am I talking about? I am talking about women everywhere since the beginning of fashion will suffer through PAIN and DISCOMFORT to look sexy and glamorous!
Rap artists like FABOLOUS coined the term “SHOE-ICIDE”
The specific pain and discomfort I want to focus on in this article is BACK PAIN associated with using HIGH HEELS
HOW DO HIGH HEELS CAUSE BACK PAIN?
1) High heels make women walk off balance. This causes certain muscles to contract or spasm in the hip, thighs, and low back (Lee, 2001). Over time, these muscles may be overused-or, strained and eventually become tight and weak. Here at Performance Spine & Sports Medicine, we can see how far off balance women can get while on heels using sophisticated but portable gait analysis tool using a treadmill and optojump gait analysis technology
2) High heels cause women to change their normal posture. The spine in the lower back becomes more curved (or in medical terms, more lordotic). Ironically, this is an effect that some women want to have because a more curved back makes the buttocks more prominent, hips seem more curvy, thighs and knees are flexed and driven forward, and legs seem longer. The more curved spine also helps drive the shoulder blades backward and the chest naturally become more prominent. The reason for all this seems to be related to how heels casue the body’s center of gravity to pulled more in front of the body and a tad higher on the body (Lee, 2001). To compensate for this, the body’s posture changes to counterbalance this so that you don’t fall flat on your face!
The heels tend to tip you forward because it pushes the center of gravity more forward relative to the body. To compensate for this, the body adjusts the posture
3) Over time with more consistent use of high heels ,the change in posture and loss of balance causes very prominent tightness in some muscle groups and weakens other groups of muscles. For example, back pain can be associated with weakness in the glutes (buttock muscles) and tightness of the hip flexors (these are the muscles involved in bringing your knees to your chest. Imagine standing with both feet on the ground. If I then told you to bring your knee up toward the ceiling in front of you, the hip flexors are the main muscles involved for lifting the knee up).
Hip flexion
4) The combination of all of these factors listed causes stress to the low back and hips which explains why many women experience back pain from wearing high heels (Lee, 2001)
PAY ATTENTION TO BACK PAIN
So, this brings us to the types of back pain to look for so that you know how best to treat yourself before seeing a doctor.
MUSCLE SPASMS
Many patients with back pain simply have muscle spasms in the back initially. A simple trick is to try a massage. If you get instant relief, then chances are it is a simple muscle spasm and may get better on its own. Treat yourself to a spa visit or a massage 2 – 4 times a month to help relax those back muscles. If pain worsens or does not get better with massage AND the pain lasts longer than a couple of weeks, then this may be a sign of a serious condition!
SACROILIAC PAIN
This type of back pain is the most common type seen in my practice and is often associated with high heels. Sacroiliac Pain is pain in the Sacroiliac Joint. One trick you can do see if you have Sacroiliac (or SI pain) is to find your tailbone. Have your loved one or family member two finger breadths north of the tailbone and then two fingerbreadths either to the right or left of that point.
The other way to find the SI is to see if you have dimples in the lower back and just above the buttock. If you identify the dimples and the tailbone, and
The SI joint is between the dimple and the tailbone
there is pain when you press in this area, then chances are you have SI pain. Other clues include: Worse Pain WHEN GETTING up from a chair or stepping outside a car; there may be pain in the buttocks or hips on the same side. Leaning forward may HELP the pain but leaning back (that is, back extension) may make it worse.
If you might have SI pain, the best thing is to be evaluated by a qualified professional like myself and my partners since there are many conservative treatments fort this condition (Zelle, 2005). For a review our previous blog on Sacroiliac Pain, click here
SCIATICA
The worse scenario is Sciatica which is caused by a pinched or irritated nerve and can be caused by a herniated disc in the spine.
First, a person can have a herniated disc in the spine because of bad posture or misalignment in the spine as well as weakened muscles that fail to support the spine.
Second, the herniated disc can get worse over time and start to press on or irritate nerves that come out of the spine. These are nerves that control the muscles in your arms and legs. An example of this is the sciatic nerve. The sciatic nerve is the longest nerve in the body, coming from the lower spine and going down into the leg and branching into the foot. If the herniated disc is in the low back and irritates the nerve, the result can be something called sciatica, pronounced SIA’DIKA. Not all leg pain is sciatica, but almost all sciatica involves leg pain. The pain is described as a “toothache” like pain, sometimes sharp, with stabbing or “electric shocks” going down the leg or foot. Sometimes the leg can have cramps or weird sensations of something crawling with “pins and needles” up and down the leg.
When this happens, definitely talk to your doctor about treatment options that DO NOT INVOLVE SURGERY (Weinstein 2006), including CHIROPRACTIC THERAPIES, PHYSICAL THERAPIES, ACUPUNCTURE, OR INJECTIONS.
TIPS TO KEEP THE PAIN AWAY!!
NOTE: BEFORE UNDERTAKING ANY EXERCISE PROGRAM, PLEASE CONSULT YOUR DOCTOR BEFORE STARTING
Now ladies, I know many doctors tell you to simply stay off the heels but let’s be honest…YOU ARE NOT GOING TO STOP WEARING HEELS IF YOU CAN HELP IT
Because of this, here are some tips and solutions for you to try
1) APPLY tiny heel wedges to widen the base of the heel. You can have the wedges tailored to your liking but the point is to give you more stability while you walk. A shoemaker can customize the wedges to increase the area of the heel or transform the shoe to a platform shoe.
2) LEARN to Brace your abdominal muscles. To find out how to effectively do this, read our article on abdominal bracing . At the very least, tighten your stomach muscles while walking on heels as this will help support your spine and buffer the stress to the spine while walking.
3) According to Dr Emily Splichal, Podiatrist and Creator of Catwalk Confidence: THE Workout “one of the best way of protecting the lower back when in high heels is through a tight core and strong glutes”. Dr Splichal explains that the abdominals and glutes help keep the low back straight and prevent excess lumbar curvature when in heels
4) Do hip flexor stretches and calf stretches once or twice a week for a few minutes after a 5 minute warmup on an exercise bike or treadmill. This will help prevent tightness in these muscle groups that may contribute to hip and low back stress
Soleus Stretch
Starting Position: 1) Begin standing with leg to be stretched extended behind body. Leg should be straight with heel on ground. 2) Bend front knee slightly slowly setting hips back allowing rear leg to bend while maintaining heel-floor contact. A gentle stretch should be felt in lower calf muscle. Hold for 20-30 seconds. Repeat for 2 sets sets for each leg
Gastroc Stretch
Starting Position 1) Begin standing with leg to be stretched extended behind body. Leg should be straight with heel on ground. 2) Slowly lean forward, putting weight onto front leg while maintaining straight leg and heel-floor contact. A gentle stretch should be felt in upper calf muscle. Hold for 30 seconds and repeat on opposite side. Repeat for 2 sets for each leg.
Side Lying Quadricep Stretch
Starting Position 1) Begin lying on side. Grasp ankle, or foot, and flex leg at knee. Keep knees side by side not allowing bent knee to move forward of opposite side. 2) Gently pull foot toward buttock, while extending leg back until gentle stretch is felt in front of leg. Hold for 20-30 seconds. Perform on opposite side. Repeat for 2 sets for each leg.
Kneeling Hip Flexor Stretch
Starting Position 1) Begin on floor, kneeling on one leg. A towel may be placed under knee for comfort. 2) Slowly allow hips to glide forward slightly until gentle stretch is felt in front of kneeling leg. Hold for 20-30 seconds. Repeat for 2 sets each side
References
Lee, C-M et al. “Biomechanical Effects of Wearing High Heel Shoes”. Int’l J of Industrial Ergonomics 28: 321 – 326, 2001.
Weinstein, J et al. “Surgery Vs Non-Operative Treatment for Lumbar Disk Herniation: The Spine Patient Outcomes Research Trial: A Randomized Trial” JAMA 296(20):2441-2450, 2006.
Zelle, B et al. “Sacroiliac Joint Dysfunction Evaluation and Management”. Clinical J Pain 21(5): 446 – 453, 2005.
