Musicians' Health Collective

Musicians' Health Collective: Supporting the health of musicians (and normal people)

Filtering by Tag: high heels

Your Spine and Hips are Suffering from Your High Heel Use

I'm getting ready for my healthy feet workshop next Saturday, and came upon yet ANOTHER idiotic article on how high heels are "healthy."  Here's one of my favorite quotes:

“You shouldn’t walk in heels higher than three inches,” she says. “Anything over the three-inch mark changes the biomechanics of how you walk—your strides are shortened, you can’t walk as fast, your body weight shifts to the ball of the foot, which throws off your center of gravity and stresses the knees and lower back.”

Um, hello?  All high heels do that.  Not just ones over three inches- all elevated heels affect your gait pattern and standing, so here's a video I made last year showing how standing is affected by heels.  Do you believe me yet?  Also, this crazy article in the NY times reminds us that there are people wedded to their heels in crazy ways!

Just as I did in the video, can you see how I can arch my upper back (AKA. thrust my ribs forward) more to stand up "straight"?  Or I can bend my knees and create hyperkyphosis in the spine in A, or B, hyperextend/straighten the knees and overarch the lumbar and thoracic curves.  In addition, you can hyperextend your knees and look more like letter B.  There are quite of few combinations of these postural tendency.  What do you think the effect of these shapes are on your body? Every time you wear any sort of heel, even a low heel, you are affecting the geometry of your joints, your natural gait pattern, your ankles, knees, hips, spine, and pelvic floor muscles! 

Just as I did in the video, can you see how I can arch my upper back (AKA. thrust my ribs forward) more to stand up "straight"?  Or I can bend my knees and create hyperkyphosis in the spine in A, or B, hyperextend/straighten the knees and overarch the lumbar and thoracic curves.  In addition, you can hyperextend your knees and look more like letter B.  There are quite of few combinations of these postural tendency.  What do you think the effect of these shapes are on your body? Every time you wear any sort of heel, even a low heel, you are affecting the geometry of your joints, your natural gait pattern, your ankles, knees, hips, spine, and pelvic floor muscles! 

Caring for Your Feet, One Shoe at a Time

Unless you’re a full out body nerd (like myself) or a podiatrist, you probably didn’t know that April is national foot health awareness month, and since April is winding down, it's time to talk about your feet again. You may be wondering, “why is this relevant ?” or, “Geez, guess it was a slow day in health news.”  Seriously though, do you have foot, ankle, knee, hip, back, or neck pain?  Chronic, diagnosed, or undiagnosed?  What about bunions, hammertoes, collapsed arches, plantar fascitis, bone spurs, or tendonitis? And did you know that you have 26 bones in each foot, adding up to 54 foot bones out of your total two hundred and six bones in your body?  Any issue in the foot effects the whole body- high heels throw the knees, pelvis, and spine out of alignment, gait anomalies affect joint wear and tear in the ankle and knee, and a foot injury will affect gait, compensation patterns, and joint wear and tear, not to mention athletic performance and activity.  Perhaps now you’re just a little bit more interested?

A recent study at the University of Maryland concluded that 75% of people in the United States have foot pain, which I think makes this discussion relevant to the wider world.  As a culture, we are sedentary (even if you’re an athlete!) because we are sitting for 10-16 hours a day, most often in chairs.  We then place our feet in ill fitting shoes with small toe boxes, elevated heels, and non-flexible soles, and many of us attempt vigorous exercise with these constraints.   Our sedentary lifestyles, poor shoes, and minimal walking habits coupled with intense bouts of exercise mean that the muscles of our feet have checked out.  By constantly wearing shoes that restrict natural movement and toe position, we are essentially setting ourselves up for long-term issues, either in the foot or in the whole body.

Are your toes drifting towards each other?  Or is there space between your toes?

Are your toes drifting towards each other?  Or is there space between your toes?

When’s the last time you thought about self-care for your feet?  When did you last try to stretch your toes out wide?  How often do you wear elevated heels, i.e. the heel is above the toe?  (PS.  Many running shoes, cowboy boots, and men’s dress shoes have elevated heels, so this issue affects everyone!)  One of the easiest ways to address whole body health is in your shoes, and your family’s shoes.  I’ve long had right sided knee issues from a bike accident many years ago, which were always compounded by wearing heels, even "practical ones."  When I stopped wearing elevated heel shoes on a regular basis, I had a huge improvement in my pain, and increase in endurance and mobility.  So what’s the issue with wearing high heels on a regular basis?   

The smaller the toe box, the more the big toe will be smooshed towards the other toes---ouch!!!

The smaller the toe box, the more the big toe will be smooshed towards the other toes---ouch!!!

#1: They limit your toe spread ability.  Your toes have natural toe spread, believe it or not, and shoes with a small toe box limit that range.


#2: They push your big toe towards the little toes.  Whether you have a bunion or know someone who does, bunions are no fun.  Bunions are a bony lump at the MTP (metatarsolphalangeal joint), also known as hallux valgus, which results from a combination of different movement, shoe choices, and genetic factors.


#3: They put pressure on the big toe, which can encourage the body to build additional bone at the site of a present or future bunion, through a process known as Wolff’s Law.


#4: Heels force your calf muscle to contract perpetually, which may be some of the aesthetic appeal.  In addition, the foot is trapped in plantarflexion, which can affect the plantar fascia, ankles, and musculature of the foot.  However, shortened and overworked calf muscles can affect gait, standing alignment, and sitting alignment.  In addition, elevated heels affect your ability to breathe fully because your diaphragm is affecting by your postural compensation. 

Elevated heels force your body to adjust in other ways, perhaps in the spine, hips, knees, and neck!

Elevated heels force your body to adjust in other ways, perhaps in the spine, hips, knees, and neck!


#5: Heels move the pelvis and spine out of neutral alignment, either into a posterior tuck of the pelvis or anterior shift, which then will affect the spine, head, neck, and shoulders.  If you watch someone in heels walk or stand, they will most likely be rounded in the upper body as a result.

Go grab a ruler and measure your day to day shoes.  Notice if your sneakers or running shoes have a heel in relation to the front of the foot.  Now take a look at your feet-where are your toes?  Are they drifting towards each other with the big toe moving towards the little toes?  Almost all of us wear shoes regularly with some sort of elevated heel, and varying your shoes and moving towards flatter shoes with a wider toe box can help.  If you’re used to wearing heels, you soft tissues and muscles may need a transition period, as well as corrective exercises to begin naturally lengthening in response to your shoe choices.  (http://www.katysays.com/sitting-in-heels-is-the-new-smoking/)  Other suggestions: try being barefoot at home (or in socks) more often, skip flip flops (which cause our toes to grip with each step), and look for ways to strengthen the feet through Restorative Exercise, bodywork, self-massage, and physical therapy.  Whether you’re going for a walk, attending a wedding (where women wear crazy impractical shoes) or just going out on the town, consider your feet, and notice the difference.  

Last year, I did a series of foot posts, which you should check out!  Shoes make a big difference in your whole body health, as noted in Katy Bowman's two books: Whole Body Barefoot and Every Woman's Guide to Foot Pain Relief.

 




Still in Pain? Ditch the Heels and the Purse

Every once in a while, a musician friend will come to me in a panic because they have sudden shoulder, arm, neck, or back pain that's never been a problem before.  I usually ask them two (maybe three) questions: what sort of shoes do you wear, how big is your purse/case, and how do you sleep? If you're a regular reader of the blog, or if you know me personally, you know I don't like wearing high heels (or standing or walking in them) for long periods of time.  I frankly feel gypped- our society has told us that women look sexy, tall, powerful, etc., in heels, despite the fact that the shoes are killing our feet, knees, hips, back, and neck.  Any mainstream magazine will have articles for "comfortable heels" or "treatment after heels," but it wasn't until this year that I learned that elevated heel shoes are seriously contributing to your pain.  However, the combination of a heavy purse and heels is the real kicker.  Last week, I mentioned how carrying your instrument case can be a source of pain and misalignment, especially if you have a repetitive pattern of carrying that is never changed.  But let's take a quick look at purses and how they're really causing some pain.

For most people, it's not the style of purse that's the problem, it's how much it weighs and how you carry it.

For most people, it's not the style of purse that's the problem, it's how much it weighs and how you carry it.

There are a few different types of purses out there:

1.  The Over the Shoulder Holder

2. The handbag, which you must carry in hand or over the elbow.

3. The Big @$$ Tote, or the BAT

4. The Cross Body Bag (or a messenger bag)

Now quick, if you have a scale, go weigh your full purse, man bag, messenger bag, etc.  I'll wait.  Every once in a while, I weigh my purse, especially if I'm at an airport and they have one of those luggage scales, and it's disturbing how much we carry.  I've had bags weigh 10-20 lbs, and in school, my backpacks and messenger bags weighed 20-30 lbs.  Yikes!  Couple that with high heels, and no wonder people have back pain!

How high heels force a compensation pattern in the body- letter C is the control, and A,B, and D, are a few of the different ways your tissues might adapt.

How high heels force a compensation pattern in the body- letter C is the control, and A,B, and D, are a few of the different ways your tissues might adapt.

*Just in case you're wondering about my beef with high heels, take a moment to read these.*

Heels force the foot, knee, pelvis, spine, and neck out of alignment, and causing them to tuck their pelvis and jut the chest forward or round the spine, pushing the head forward.  Think of that as your starting position, and then add an 8 lb weigh on one shoulder when your body is already vulnerable.  Ouch!  If the head is in a forward position from heels (see images A, B, and D), and a one shouldered purse is added (and a case), the risk for injury is much greater, especially if you've already had neck, shoulder, or nerve pain in your life.

With our four types of bags, each poses a risk.  The over the shoulder bag tends to favor one shoulder all of the time.  Few people switch sides, which can pose a long term risk to those tissues, who remain on tension and in contraction which widens the asymmetry between the sides.  The handbag can be a great option if you carry it in your hands and don't rest it on your elbow constantly.  When heavy handbags dangle off the elbow, we put extra risk on the radial side of the forearm, specifically the delicate tendons and nerves.  The BAT is especially suspect because most of us (myself included) will fill that bag to the brim with things that we may not actually need.  If you need to carry lots of stuff, consider a messenger bag, a backpack, or carrying your tote in your hand to reduce the stress on your shoulders.  Lastly, the crossbody bag is a great option if you switch the sides with some frequency and keep the weigh in check. 

In the last year or two, I've moved away from carrying everything in my life on my shoulder (and ditched most of my heels...still have my cowboy boots, which have a half inch-1 inch heel), and my pain has diminished exponentially.  If this is something you've never thought of, stop walking in heels (and I don't just mean stilettos- I mean everything.  Take a ruler to your closet, folks!) and switch out your bag for something lighter.  Even if you don't have a scale in your house, look to see what you're carrying, and whether you need it.  If I'm honest, I don't need half of the things I used to carry, and I'm not in pain for it.



A Double Whammy- the Heeled Flip Flop

Do you remember those crazy platform flip flops popular in the late 90's?  Well, they're back, and Buffy the Vampire Slayer is long gone.  Combining both heels, wedges, and flip flops, the foot-murderer-flip-flop is here, much to my chagrin.  What's wrong with them?  Elevated heels affect the spine, the flip flop style forces the toes to grip and the bottom of the foot to contract, and you start walking oddly to compensate.  As warmer weather begins to permeate the east coast, choose sandals that are friendlier to your feet, and don't cause pain.  And don't even think about walking or playing your instrument!!!

PS.  Read Katy Bowman's blog post from yesterday about how flip flops affect your feet!

On Shoes: Part 3

In part 1, and 2 I illuminated (with the help of smart biomechanists and podiatrists!) some of the issues behind high heels/shoes with small toeboxes in regards to bunions and spine.  Let's apply it to music performance and put it in context.

Scenario 1: You're a wind/brass player, and you often practice sitting.  For your quintet/solo performances, you wear heels.

Fun fact: The diaphragm is a muscle...that attaches to your lumbar vertebra.  Remember what's happening to your spine when you're wearing heels?  You're changing the shape of your spine, which affects your diaphragm. If your spinal curves are changing in response to your shoes, your diaphragm's capacity for full expansion is probably affected.  (You could also already have a hypertonic diaphragm, meaning super tight, which is also not good.)  Why would you want to intentionally shorten your capacity for a full and supported breath under pressure when you're musical instrument depends on it?  I don't know.  (Singers, I'm talking to YOU too!)  Not only that, but your body will go to the more shallow area of respiration, or that upper chest/hyperventilation breath, which is not good for anybody, regardless of instrument, under pressure.

Scenario 2: You're a string player, and you only wear heels for solo concerts.

First of all, glad you don't wear them all the time.  However, let's think about this practically.  If you practice barefooted/flat shoes on your repertoire, finding a place of neutral axial extension (good posture), neutral pelvic tilt, and good foot position (topic for another day), why are you going to throw that into limbo in a concert, when you're under pressure?  Or even worse, at an audition???  Perhaps you're not as into the whole "grounding" thing as I am, but your feet are your foundation when you're nervous, and your knees definitely shake more in heels.  (Or mine do.)  So why change another factor of anxiety and performance when you could have something absolutely consistent and secure to base your body on?  I don't know.

Scenario 3: You're a pianist, and you wear heels regularly.

I'm not a very good pianist, but I do know you need access to your pedals and your ankles/calves, in order to point and flex the feet.  (Plantar flexion and dorsiflexion).  We already know that heels limit your ankle flexibility and shorten your calves, so over time, that whole area with begin to shorten and lose range of motion.  Yikes!  That doesn't sound good.  There have been some studies on how habitual wear affects long term R.O.M., so beware!

  If you can't drive in the shoes you're wearing, you probably shouldn't walk, perform, or stand in them.

It doesn't mean that you can't wear fun shoes sometimes...it just means that you should wear them sparingly, and not in stressful performance situations.  Help your diaphragm, your feet, and your general stress level by saving the heels for a non-performance situation.

 

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