All too often idolised in TV shows like Sex and The City and Desperate Housewives, high heels seem to be as popular as ever. I often sneak a peak in the corner of the room at what the female patients have on their feet. Some have even gone to the lengths of hiding their heels under their jackets or as I discovered in one case changing them in the car park before coming in for their appointment, for fear of having them spotted by me.

So why are high heels considered bad news for your back? Well it really comes down to biomechanics. In simple terms your feet are your foundations. They contain the primary shock absorber for the entire body, most commonly known as the arch of the foot. The heel and forefoot are also designed to sit at the same level – makes sense if you want to have a stable base. So what happens when you slip on those Blahniks, Choos or even harmless enough looking Russell and Bromleys.

 Chiropractors are trained to appreciate and understand the premise that structure and function are closely inter related. High heel shoes not only change the position of the foot but naturally impact on the way in which the foot goes on to function which can over a longer time come back to affect the structure.

“No Carrie, perhaps we no likey”

 The high heel position places an increased amount of strain on the forefoot which can result in hammer toes and possibly bunions, not very sexy! But even more importantly it takes out the slack from the arch which in the normal foot would dissipate the force of each step from travelling up the leg to impact on the ankle, knee, hip and back joints.

The changed foot position causes the muscles of the calf to shorten, and makes the muscles around the knee and hip work much harder. Now although this may sound like a good way to have a work out, it is never that simple. The effects of the changed foot position are amplified the higher up we go.

 Your back is designed to be a particular shape, the curve/hollow at the base of the back along with the curve/rounded midback are designed to cancel each other out thus acting as a shock absorber – all very clever. Unfortunately the high heels cause the wearer to change the position in which their back is held. Heels result in a flattening of the curve at the base of the spine and in order to compensate the upper back has to relocate itself backwards to ensure you are still upright. This new position causes a narrowing of the area in the lower back where the nerves leave the spine and this can lead to back pain and varying types of leg pain including sciatica.

 As we all know, not everyone that wears high heels ends up getting back pain, but in conjunction with other aspects of your lifestyle they can predispose you to getting pain in a number of joints in the lower body if the overall scenario is not favourable.

As I finish writing this blog entry, I have just found a curious article. It’s a quote from a researcher in Italy (where else!). She says that wearing a pair of “moderately high heeled shoes” had beneficial effects for a woman’s sex life by working the pelvic muscles and reducing the need to exercise them. I somehow don’t think i’ll be passing this information on to my offending patients.

From an increased risk of tendonitis in the foot and heel, the risk of early wear and tear of the knee, hip and even spine, it might be worth thinking about some ways to limit the use of your favourite fashion statements to those times when you really want to wear them. Here are some tips to help you keep your joints comfortable whilst still enjoying your favourite shoes.

 1)      Choose your heels wisely: in simple terms the smaller the heel the less impact it is likely to have on your body. Once you are over 1.5 to 2 inches the verdict seems to be that you are likely to experience an even greater set of problems.

2)      Favour flat shoes for day to day wear and only wear your prize heels on special occasions or when you are not on your feet very often.

3)      Wear trainers or supportive shoes when travelling to and from work, you’ll be much comfier.

4)      Make sure you have the right size shoe to fit your foot. Even narrow toe boxes can result in a pinching of the nerves around your toes which can give severe pain.

5)      Always choose leather shoes over synthetic alternatives as they tend to adapt to your foot and be more comfortable.

6)      Strengthen your spine even if you are not currently suffering. Core muscle training such as Pilates or the rehabilitation exercises taught by your local BCA Chiropractor can help achieve this.

7)      Stretch your calf, hip and back muscles to keep yourself supple and minimise the chances of getting pain. It is best to seek a professional opinion on how to do this safely for your individual body. Your nearest BCA Chiropractor can advise on this and can be found through the British Chiropractic Associations website


I drove to Cardiff last week for our annual conference. I started looking at the posture of drivers in the cars along side me on the motorway. The slumpers far outnumbered the upright drivers. One gentleman was so bad he even had his chin over the steering wheel – yikes!

For the last few years I have been advising patients a very neat little trick to keep reminded of maintaining a good position in the car. Here’s how it works.

Before getting into your car. Stop and look at the position you are about to get into. Once in, perform all your usual adjustments like adjusting the seat to ensure you can reach the pedals, gear stick and steering comfortably without over reaching or even being too close. Set your head rest so that the little bump on the back of your head is approximately lined with the middle of the head rest. Many car seats these days are a bucket style seat and are difficult to get in and out of, in addition to placing your body in an unnatural position. If this is the case you can get hold of a seat wedge which reduces the bucket effect and minimises the pressure on your spine during the long distance drives.

Now here comes the tip. Lift your chest up so you are comfortably touching the back of the seat with your shoulder blade, usually a slight lift of the chest is sufficient, around 5 degrees. If you are feeling uncomfortable then you may have gone too far (like in the middle of the 3 postures in my first post picture). Now re-adjust your rear view mirror so you can see clearly out of the back window using your eyes mainly and only a small movement of your neck.

From here on in, when you are driving and unable to see out of the back window using the rear view mirror and mainly your eyes – you know you have slumped again from your upright position. It’s kind of a biofeedback technique as a reminder that you have changed position.

I would always recommend you get a trained professional to help you find the ideal position the first time, so you can be sure of getting it right in the future.

Current British Chiropractic Association (BCA) consumer research shows

“Over half (56%) of the UK population currently believe they have a bad posture, compared to 38% in 2007, a dramatic increase of 16%”.

“Around 60% of 16 to 18 year olds have an undesirable posture”

What does that say for the future incidence of back pain in the UK?

Good posture is so very important! I tell all my patients this. Over the last few days whilst hearing myself say this over and over again I realised that perhaps I need to point out WHY good posture is so very important? Helping them realise that it’s not just for reducing their sore back or other spine related problems but actually extends far beyond this. Then the thought occurred, why not share it with everyone on this blog.

So here are a few great reasons to maintain a good upright and natural posture.

1)      It makes you look much better! Whether you are of school age, at work or in retirement, avoiding that slouching posture that you see around you every day will help you make a better impression. Go on, take a look. Look for someone that is slouching and then look for someone that is sitting upright. Which looks better?

Having good posture can often make you look

–          Slimmer: Your tummy sticks out less.

–          Younger: Stooping forwards with narrower, rounded shoulders gives the appearance that you are older than you are.

–          Confident: it’s a no brainer, everyone else sees you walking tall and proud.

2)      You may live longer! Posture can affect the way the organs inside your body work.

Here’s some examples:

–          Breathe easy: If you slump or slouch your rib cage and the lungs underneath are in a compressed or squashed position. Less air can get in to them and you reduce the amount of oxygen that you can send round the rest of the body. If your cells don’t get enough oxygen then they aren’t working at full potential and that can affect all the functions in the body. Also shallow breathing means you have to breathe more often so you are working harder than you need to. Hardly sensible!

–          Give your engine some room: The heart can also work less efficiently if the rib cage is compressed. This could lead to problems later in life which could affect your blood flow.

–          Better digestion: Your stomach and digestive system can also become compressed and absorbing the nutrients could take longer or be less efficient.

–          There’s a lot more going on in there: don’t forget your Liver, Kidneys and a bunch of other organs are working away in the chest and abdomen and could become affected.

3)      Keep your body balanced! Much like balancing the wheels and tyres on a car, it keeps the wear and tear away for longer.

Poor posture can put unnecessary pressure on the body. Here are some examples:

–          If your head is abnormally forward it can put a strain on the joints within the neck, shoulders and the muscles which are holding it there.

–          Slouching can causing pulling of the muscles that surround the rib cage, this in turn can cause the muscles to spasm and stop ribs from moving freely. An often painful situation which can make breathing in difficult. In other cases the vertebrae of the mid back can become worn out due to the extra weight they have to carry and this can cause stiffness.

–          Arching back with your low back and carrying your body weight further back than normal can cause premature wear and tear in the joints of the low back. This can lead to a wear and tear type of arthritis that often affects the elderly.

–          Your spine has a washer in between each of the individual segmented bones or vertebrae. These washers are called discs and act like suspension or a shock absorber. If the weight is not balanced optimally over the discs and weight bearing joints then this can cause a shearing force on the disc which can result in damage to the disc over a period of time.

–          Muscles that are helping support a poor posture are more likely to become injured as they have to work harder to keep things in their place or perform the activity they are meant to.

Whilst this is a good bit of motivation for maintaining a balanced posture.  It’s not just about straightening yourself up. All too often with the slightest mention of the word posture I see patients perform the following ritual. First they pull back their shoulders as they thrust their head back rather uncomfortably. Then they try holding their breath so as to keep their stomach flat. This is the point I usually ask them to imagine holding that position for the whole day……………..

The ritual described above is certainly not considered ideal posture. See the picture on the previous post and the way in which the line should pass certain landmarks on the body. This is the position that is considered most likely to help minimise the pressure on your joints and muscles.

Achieving good posture requires some attention to your body and the way it has developed over time. There may be specific muscles that have shortened/tightened and others that have become lazy or weak. This is why putting yourself in a neutral or good posture position can sometimes feel uncomfortable. There are specific exercises that can be done which can help you stretch/lengthen the short and tight muscles and then others which can help you strengthen the weak ones. They can be provided by your chiropractor or other health professional that manages these types of problems.

For a more general home based approach the BCA has devised an excellent 3 minute exercise routine which can be incorporated into our daily lives to help strengthen the spine and improve posture. The exercise routine is available to download at no charge from

Once you have the balance right between the previously weak and tight muscles you can start to maintain good balanced posture. If you feel you have difficulty maintaining a healthy posture then you should consider getting some advice or an assessment from a trained professional. To find a local BCA registered chiropractor go to the website and use the “find a chiropractor” facility.

Note: Ears, shoulders and hips are aligned whilst keeping feet at a comfortable hip width apart. You should feel relaxed and not experience discomfort, if you do stop.

good posture

There’s far more to chiropractic care than posture, but just making sure that you follow a few very simple rules you can ensure that your back is being held in its most natural position, and therefore will be more likely to remain comfortable and relaxed. I’ll be discussing perfect posture to begin with, so stay tuned.