The theory behind high heels causing back pain relies on the thought that wearing them causes strain in the thighs and hip flexors which forces an increased curve in the spine, and this increased curvature of the spine causes back pain. Having never worn high heels, I cannot say for whether or not this is true; but, from what I’ve read and experienced with my patients, I’m not so certain that this is correct. As a matter of fact, I’ve had several patients with back pain and pinched nerves tell me that specifically wearing high heels has helped relieve their pain significantly. So, when there is controversy and uncertainly, one must turn to the medical literature (and not just google) to try and find the truth.
In my review of the literature, I found several studies attempting to scientifically qualify whether high heels cause back pain and through which mechanism. The most impressive study I found was published in the Journal of Chiropractic Medicine in 2010, by Brent S. Russell, D.C.1. This article provides a thorough review and analysis of the medical literature available regarding this subject. He concludes that the literature does not support the theory that wearing high heels causes back pain or increases the curvature of the spine. Furthermore, he proposes that both back pain and the wearing of high heel shoes are common and this makes it very difficult to determine a definitive causal relationship.
While it is unclear whether high heel shoes may or may not cause back pain, it is common for high heels to exacerbate an already present spinal condition. Particularly in the patient who has arthritis or muscular strain, the increased stress and workload put on the spine after a long day of walking on high heel shoes will likely aggravate the pain. This pain in the back may also result from foot or leg fatigue that results from wearing these shoes and this can affect whole body mechanics. On the other hand, I’ve had more than a handful of patients with pinched nerves tell me that they feel much better while wearing high heels and I presume this is likely due to an indirect spinal decompression from the altered posture created by the shoes.
In conclusion, I’m not sure if I’ve cleared anything up here but it is safe to say that there is no clear evidence that wearing high heels causes back pain. That being said, I would recommend wearing shoes with good arch support and cushioning if you do have a pre-existing back condition as they may limit the increased stress on the spine.Michael J. Musacchio, Jr., M.D. is a Center for Spine Care minimally invasive neurosurgeon specializing in the spine.
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