swayback - woman with high heels

Swayback, high heels, what’s the deal?

In Health and Nutrition, Women's Health by Dr Matt RadfordLeave a Comment

Wearing shoes, and high-heels in particular, can lead to a whole range of health issues. Here’s what you can do about it.

Many years ago, as a young physio, I was asked to visit a woman in a nursing home who had suddenly lost the ability to walk. She was in her mid 90s, but had previously been quite active. Neither the nursing staff nor her doctor could ascertain what had happened to create this sudden change.

Impeccably dressed, with full make-up, pearls and bright red lipstick, she explained to me that after a few steps she felt she was falling backwards and couldn’t get her balance. After a quick assessment, I had an idea. I asked, “Have you changed your footwear recently?”

“Oh, yes dear. My daughter came in last week and took all my beautiful shoes. She said they were too unsafe for me.”

“Were they all high heels by any chance?”

“Of course dear. I’ve never worn anything but high heels. I was a dancer in the war, don’t you know.”health

“You wouldn’t happen to have a pair left would you?”

“Well, I did hide my favourites.” Following her directions, I found a beautiful pair of red three-inch heels in her wardrobe. She popped them on and walked perfectly again!

“There you go,” I said, “You just need to go and do some more shoe shopping.”

Although that is a cure that will probably appeal to many of my patients, it is NOT what I would ideally recommend! After a lifetime of wearing high heels, this lovely woman’s calf muscles had contracted to the point where she could barely drop her heels to the floor. Her entire body was out of alignment and her balance perception had completely adjusted to walking on tip toes.

Not designed for shoes or asphalt

We are designed anatomically to walk barefoot on uneven, yielding ground. This gives our foot muscles plenty of exercise in adapting. And it forces us to use our leg, and even our core muscles, to cushion the impact. But most people reading this will be wearing shoes – maybe even high heels – most of the time. So what effect is this having on your body?

The few patients I see who rarely wore shoes growing up have incredibly well-developed intrinsic foot muscles. Conversely, most people nowadays have very weak foot musculature. This can develop problems such as bunions, hammertoes, plantar fasciitis and heel spurs.

In extreme cases when shoes are too tight, it can even cause irritation of the tiny nerves in the feet resulting in numbness and tingling. Squeezing into overly tight shoes, even just for a wedding or a day at the races, can result in months of suffering. Morton’s Neuroma is a painful foot condition where long term compression, often from wearing overly tight shoes, results in thickening of tissue around the nerves. This can be painful in the ball of the foot or between the toes. It can even feel as if you are standing on a pebble. It is treatable with acupuncture and physiotherapy, but wider shoes and properly fitted supports are a must.

High heels

Some lucky people are not affected badly by wearing high heels, but many find that once into their 30s the problems start. Foot, knee and hip pain and an achy, tired, sore lower back are common issues we see in clinic.

Why is that? Being up on the ball of your foot in high heels gives your calf muscles a more defined shape, but eventually they become tight and contracted, causing further problems for your back and legs. When you are up on your toes, it can also lead to a swayback posture.

‘Swayback’ is a loose term used to describe poor standing posture, where the pelvis is shifted forward or backwards relative to the upper back. There are two main types we see in clinic. The ‘flat back’ type is more commonly seen in men. Here the pelvis is pushed forwards, the lower back is flattened and the chest is leaning back. Women more often have an exaggerated curve in the lower back. The technical name for this is increased lumbar lordosis. The pelvis is tilted forwards – the front of the hips tilt down and the sitting bones rise, and weight shifts forward onto the balls of the feet. This makes the lower belly protrude more and the upper body compensates by leaning backwards and rounding the shoulders forwards.

If you have this type of swayback, the accentuated curve in your lower back adds to the compression in your lower spine. Over time the facet joints in your spine become inflamed and eventually start to wear. At first it is just an ache that goes away when you bend forwards. However, it can become much worse if uncorrected. It can also lead to degeneration and arthritis in the hip joints because of misalignment and uneven wear.

Factors contributing to swayback posture:

  1. Standing with your weight shifted forwards over the balls of your feet, such as when wearing high heels, can contribute to sway back posture. One of my yoga teachers encourages “standing over your bones”. That is, shifting your weight back towards your heels when standing. In  tai chi postures, the knees are slightly bent, which allows the lower back to soften.
  2. Tight hip flexor muscles. Many of us spend so much time sitting that it causes the muscles at the front of the hip to contract. We rarely do any activities that open up and stretch these areas on a daily basis. So we all need to do frequent hip flexor and quads stretching. This is even more important if you are doing lots of squats and lunges, or cycling exercises.
  3. Weak abdominal girdle. This is especially exacerbated post pregnancy and childbirth. Many women are diagnosed with pelvic instability pain during pregnancy, partly caused by the forward tilt of the pelvis.
  4. Over-stretched hamstrings and weak gluteal muscles.

The great news is that all these factors can be fixed with specific exercises. It is sometimes tricky to know if you are doing the right ones for your condition, so it often pays to seek help from a qualified professional.

The solution – healing from the heels

Here are a few tips that can help:

  1. Alternate wearing heels with flatter shoes. It’s great from a physio point of view that runners are more acceptable in the workplace now. Take advantage of this!
  2. Try bare feet where possible. If you have a chance during the day to take off your heels, do so. Give your feet and calves a chance to stretch out.
  3. Daily stretches are a must! My top two are: hip flexor and calf stretches. The hip flexor stretch ican be a tricky one to master. The standing version of this is more effective. Just be careful that you are only feeling a stretch in the front of your hip, with no pain or pressure in your lower back. Calf stretches are more straight-forward. Just no bouncing! And note that the research suggests at least five minutes a day is needed to make any impact.
  4. A great exercise to strengthen foot muscles is to spend a few minutes scrunching up a towel on the floor with your bare feet.
  5. When you are walking, think about keeping your knees and feet soft. This helps the leg muscles absorb the impact rather than the joints. Have a play around and experiment with it. Earlier this year, while hiking in Himalayas, it was a joy to watch Bhutanese people seemingly effortlessly gliding up the mountains, their knees slightly bent and upper bodies completely relaxed.

May we all be healthy and happy and walking well into our nineties. Let’s keep stretching and put some spring into this spring!

About the author
Dr Matt Radford

Dr Matt Radford

Dr Matt Radford is a physiotherapist, Traditional Chinese Medicine physician, and the director of Centre of Health – Physiotherapy & Chinese Medicine in Melbourne. Matt also lectures in anatomy, acupuncture and orthopaedics. A keen surfer and meditator, he tries hard to live up to his own advice.

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