Effects of High- Versus Low-heeled Shoes Study Title: The effect of walking in high- and low-heeled shoes on erector spinae activity and pelvis kinematics during gait Authors: Mika A, Olesky, Marchewka A, Clark BC Publication Information: Archives of Physical Medicine & Rehabilitation 2012; 91: 425-434. BACKGROUND INFORMATION “Is wearing high heels bad for my back?” This is a question many of us confront in our offices almost every day. When your patients ask this, what do you say? Many of us immediately dispense advice to avoid wearing such footwear for long periods of time, perhaps offering an eloquent explanation, including some sort of “compensation” (everyone’s favourite), muscle fatigue or ‘calf’ tightness, and even spinal alignment or pelvic tilting issues. Sound familiar? Is this correct? What does the research say? It may not be surprising, that footwear with increased heel height has been linked to low back pain (LBP), although cause and effect has not been firmly established.2 As it places the foot in a plantar-flexed position, it is obvious that wearing high-heeled footwear alters foot loading patterns – which could logically alter muscle activation, pelvic tilt, gait parameters, and so on. To date, the research on this topic is growing, but is highly variable and incomplete. High heels raise the centre of mass of the body, thus altering postural stability.2 This can result in compensatory alterations in lumbar muscle timing and activity,3 which may lead to discomfort and fatigue. Some, but not all, studies have shown an increase in lumbar lordosis when subjects wear high heels – this may represent a strategy to attenuate higher vertical loads.4 Biomechanical gait alterations, such as reduced efficiency, have also been observed in laboratory settings. The purpose of this study was to evaluate the changes in electromyographic (EMG) activity of the spinal erectors and pelvic kinematics during gait while wearing low- and high-heeled shoes. CONCLUSIONS AND PRACTICAL APPLICATIONS The most important finding from this study is that wearing a stiletto-type heel (10 cm) significantly increases lumbar spinae EMG during gait in both younger and middle-aged women. This effect of wearing high-heeled footwear may have clinical consequences, including increasing general or muscular fatigue, creating swelling or limited movement, raising the possibility of cumulative strain, promoting fibrosis in the paraspinal musculature, altering joint loading profiles . . . This list could go on and all these factors could be both consequences and causes of LBP. Another interesting observation was that sagittal pelvic range of motion seems to increase in younger women while wearing high heels, but such adaptations were not observed in the middle-aged women. This may indicate that over time, women adapt their mechanics to accommodate wearing footwear with higher heels. It could also reflect general age-related changes in body structure, soft tissue characteristics, joint mechanics, and so on. Further research is required to clarify this issue. This study could not answer all of our questions on the effects of wearing of high heels, but it does provide some useful information that we can incorporate into discussions with our patients. This is what evidence-informed practice is all about! To view this review in full, including study methods, strengths and weaknesses, pertinent results and additional references, please visit the Current Issue page at www.canadianchiropractor.ca. In addition to practising full time in Toronto, Dr. Shawn Thistle is founder and president of Research Review Service Inc., an online, subscriptionbased service designed to help busy practitioners integrate current, relevant scientific evidence into their practice (www.researchreviewservice.com). Shawn also recently launched The Epicurean Scholar, which offers continuing education seminars combined with gourmet food and wine events (www.Epicureanscholar.com). Dr. Thistle graduated from CMCC (where he lectures in the Orthopedics Department) and holds an Honours Degree in Kinesiology from McMaster University. He also holds a certificate in Contemporary Medical Acupuncture from McMaster University, and is a Certified Active Release Techniques (ART®) Provider and Functional Range Release®/Functional Anatomical Palpation® instructor and provider.