• Anna Mika, Lukasz Oleksy, Piotr Mika, Anna Marchewka, and Brian C Clark.
• Department of Clinical Rehabilitation, University School of Physical Education, Krakow, Poland.
• Am J Phys Med Rehabil. 2012 May 1;91(5):425-34.

ObjectiveWearing high-heeled shoes may produce deleterious effects on the musculoskeletal system. The purpose of this study was to evaluate the changes in electromyographic (EMG) activity of the erector spinae muscles and pelvis kinematics during gait while wearing low- and high-heeled shoes in both young and middle-aged adult women.DesignIn 31 young women (20-25 yrs) and 15 middle-aged women (45-55 yrs) without back pain, the EMG activity of the erector spinae muscle and pelvis kinematics in the sagittal, frontal, and transverse planes were assessed during gait on flat surface at natural speeds in three conditions: without shoes and in low- (4 cm) and high- (10 cm) heeled shoes.ResultsIn younger women, significant differences in lumbar erector spinae EMG activity were observed during gait at initial ground contact as well as in toe off between the three conditions, with an increasing amount of EMG activity being observed in association with increased heel height. In middle-aged women, significantly higher lumbar erector spinae EMG activity was noted during gait with high-heeled shoes compared with gait without shoes. Interestingly, younger women exhibited an increase in pelvic range of motion in the sagittal plane during high-heeled gait compared with low-heeled gait and walking without shows; however, this compensatory response was not observed in middle-aged women.ConclusionsFrom a clinical perspective, increased lumbar erector spinae muscle activity associated with wearing high-heeled shoes could exacerbate muscle overuse and lead to low back problems. The lower pelvic range of motion associated with wearing high heels in middle-aged women may indicate that tissues in the lumbopelvic region become more rigid with age and that the harmful effect of high-heeled shoes on posture and spinal tissues may be more pronounced with advancing age.

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