Friday, February 13, 2015

High Heels Causing Back Pain

After watching the Grammy’s this week, I’ve decided that most women have an incredible superpower. It’s not flying, or mind reading (I wish!), or time travel, but it is truly amazing nonetheless. When I started watching the red carpet, I was distracted by all of the beautiful people, beautiful clothes, and beautiful shoes. Everyone looked so elegant that it took a second for my chiropractic brain to kick in and realize that all of the women seemed to be wearing THE HIGHEST HIGH HEELS ON PLANET EARTH! I’m not kidding. There must have been some sort of rule that said, “If they’re not 5”, you won’t be let in,” because everyone was at least a half of a foot taller that night. The craziest thing is that these women glided from interview to interview, and through all of their performances as if they were wearing slippers…or Nike’s. That’s when I decided that the ability to stand, walk, dance, and generally function in everyday life while wearing heels, is a superpower. Here’s the thing though. I’m pretty certain that this is one superpower we don’t want to have. I mean it’s impressive, but if heels are that uncomfortable and difficult to wear, what are they actually doing to our feet and our bodies as they cart us around the city of Boston? Let’s talk…

When we step into a pair of heels, it’s like we’ve decided that walking around on our tippy toes the entire day is a great idea. It’s also as if we’ve decided that our posture, biomechanics, and center of gravity aren’t challenged enough during the day, and could use a liiiiittle added stress. As soon as we hop into those bad boys, our weight shifts forward, we bend slightly at the hips, and our bodies have to fight that effect all day long. As your center of gravity travels forward, your calves, hamstrings, and low back work and struggle to keep you upright. Meanwhile, in order to keep us from becoming a human version of the Leaning Tower of Pisa, our upper back has to work in tandem with our lower body to pull us back upright. As we’ve talked about before, the longer you put your body and soft tissues through unnecessary and excessive amounts of stress, the more apt they are to adapt accordingly. The simple act of standing in heels causes these muscles to tighten, shorten, spasm, and become very uncomfortable. So, I guess we now know why wearing heels makes your legs look great! They’re working overtime! Factor in a five-day work week in your favorite pumps, and you’ve got some permanent tightness and decreased flexibility developing.

Another way your body reacts to a large lift under the heel is by tilting your pelvis forward. Imagine the effect to be similar to the way that the weight of a pregnant woman’s belly draws her midsection forward. Or even, picture the posture of someone with “swayback.” If you’re not familiar with the term, it’s usually used to describe someone with an accentuated arch to her low back, making her glute muscles very prominent. So, high heels tilt the pelvis forward, causing us to the bend at the hips. This also forces the natural curve of the low back to straighten out. In order to adapt and stand up straight, our bodies throw an arch into the low back to draw our upper body back over our hips, instead of allowing us to remain bent forward. A couple of issues may arise from this (besides the muscles tension mentioned above), to cause low back pain. First, anytime you increase the curve of the low back, the joints that make up the backside of your spinal column end up jamming. Jammed (facet) joints can cause a decrease in joint motion which may lead to decreased flexibility in the low back. It can also mean inflammation, irritation, and radiation of pain from the low back into the glutes or leg(s). Also, occasionally we see an injury called a Spondylolisthesis associated with an increased low back curve. This is the shifting of at least one lumbar vertebra forward, potentially creating some instability, spasm, and pain.

Lastly, and most obviously, is the foot pain. Ohhhh, the pain. Now most of us don’t go into a department store actually looking to buy uncomfortable shoes. Some heels have more cushion than others and some are simply made better. Regardless, it’s not always torture when we try them on and take a 30 second test drive around the shoe department before deciding to buy them. The problem really does come with extended wear. This is because the pressure we feel on our forefoot while wearing heels is dependent on the height of the heel. The higher the heel, the more pressure that is transferred down underneath the ball of your foot. You may not even notice the effects of this weight transfer for the first hour or two, but this is why is feels like someone has broken your feet and rearranged your bones at the end of the day. Perhaps that was a little dramatic, but the point is that it hurts! The balls of your feet simply aren’t made to withstand that kind of pressure for long periods of time. As a result, the joints in your feet start to jam, extra stress can mean arthritic changes, and bunions can begin forming. If we take it one step further and think about the soft tissues of the feet, we realize there’s more potential for injury. The strong but easily irritated arches of the feet do not reallllly appreciate a high heel. For people with normal arches, a heel ends up straining them. Those with dropped arches or “flat feet” experience an even more dramatic version of this strain. Even if you’ve got nice high arches, a heel provides very little support to your foot. It’s like a very unfortunate lose/lose/lose situation. And don’t forget last week's discussion. Messing with the soft tissues and arches of the foot can put you in a world of hurt in the form of Plantar Fasciitis. No fun. Nooo fun.

So what are we going to do about this? I thought about banning all high heels in the city of Boston, but I’m not sure I have the authority to do that. Let’s talk about some realistic suggestions instead:

·      LIMIT the amount of time you spend in heels: Please, pleassseee! I’m begging you. I know they look great. I get that they do amazing things for your legs. I even realize that sometimes the workplace dictates a certain dress code. But attempt to cut back on the amount of time you subject your feet to the effects of a heel. I got pretty lucky as a female. My dislike for high heels has been perfectly paired with the lucky fact that if I tried to wear them while adjusting a patient, I’d probably tip over. Because some of you may not be so fortunate, I simply recommend that you start to listen to your feet, legs, and low backs and give them a rest every now and then. They’ll thank you!
·      Switch up your footwear: Try different heel heights throughout the week, or travel to work in one pair of shoes and pack a second pair for the office.
·      Ice your feet: Utilize the trick for Plantar Fasciitis we talked about last week. Freeze a water bottle and roll in under each foot for 4-5min at the end of the day. The ice will act as a natural anti-inflammatory and decrease any swelling. The bottle itself will serve to work out some of the tightness in the soft tissues under the feet.
·      Stretch: Keeping the muscles of your lower body flexible and limber will help prevent them from really shortening or spasming in response to the high heels. Focus on the bottoms of the feet, calves, hamstrings, and low back, and give them a little TLC at the end of a long day.
·      Consult your chiropractor: Sometimes you’re going to have to wear those heels, your superpower may fail you, and you might end up in some discomfort. If you aren’t able to squash it on your own with the other tips, let your chiropractor know. She can evaluate your feet and ankles for joints that aren’t moving well and need to be adjusted, or for injured soft tissues that need some work with the Graston technique to break up adhesions or scar tissue. I will strongly suggest seeing your chiropractor for any high heel-induced low back pain. Each cause of low back pain that we discussed today is treated a little differently, so it’s important to figure out exactly what’s causing your pain in order to properly address it. An exam will reveal which structure(s) are causing your pain, and your chiropractor may use adjustments, soft tissue techniques, or stabilizing exercises to treat them.

Until next time, try to remember that just because we havvvve a superpower, doesn’t mean we need to usssse it constantly. Be kind to your feet and low back, and throw on a pair of good sneakers every now and then.

-Dr. Lauren Doscher