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Just say no to heels

High heeled shoes are very popular among women. Many of my clients who wear high-heels experience low back, due to altered postural characteristics of the spinal-pelvic region from wearing the footwear. For people who wear these shoes it is important to understand how altered pelvic positioning can lead to back pain, how high heels alter lumbo-pelvic alignment, and how to relieve low back pain associated with this posture.

The pelvis’s positioning is a very important factor in lower back pain. Pelvic tilt, as defined by Levine and Whittle (1996), is the angle between the horizontal plane and a line passing through the midpoint of posterior superior iliac spines and the midpoint of the anterior superior iliac spines. The pelvic tilt angle among people without low back pain is , on average, 3.5° (Lim, Roh, & Lee, 2013). When the pelvis is tilted through poor posture, it increases the depth of the normal lordotic curve of the lumbar spine, which in turn increases pressure on the intervertebral discs between L4-L5 and L5-S1 (Levine & Whittle, 1996). This can lead to degeneration of the discs and lower back pain. Sufferers of lower back pain typically have a pelvic tilt angle of 6° (Lim et al., 2013).

Wearing high heel shoes can affect a person’s pelvic tilt and increase lumbar lordosis. The shoes force a person to move their center of gravity forward, resulting in postural deviations such as hip hyperextension, posterior displacement of the trunk and horizontal movement of the pelvis (Dai et al., 2015). Although the change in pelvic tilt is relatively small (.7°) when a person wears high highs compared to being barefoot, the change in angle of lumbar lordosis is more significant (10.9°) ((Dai et al., 2015). Small alterations in pelvic positioning leads to greater compression of the interverbal discs in the lower back.

To avoid altered pelvic posture causing low back pain, a person should avoid wearing high heels. Yet if the client persists, Yoo (2013) recommends exercising the muscles that control anterior pelvic tilt. For example, to strengthen the erector spinae use trunk flexion and trunk extension, to strengthen the iliopsoas use hip flexion, and to strengthen the rectus femoris use knee extension. These exercises should help correct pelvic tilt angle.


Dai, M., Li, X., Zhou, X., Hu, Y., Luo, Q., & Zhou, S. (2015). High-heeled-related alterations in the static sagittal profile of the spino-pelvic structure in young women. European Spine Journal, 24(6), 1274-1281.

Levine, D., & Whittle, M. W. (1996). The effects of pelvic movement on lumbar lordosis in the standing position. Journal of Orthopaedic & Sports Physical Therapy, 24(3), 130-135.

Lim, H. S., Roh, S. Y., & Lee, S. M. (2013). The relationship between pelvic tilt angle and disability associated with low back pain. Journal of Physical Therapy Science,25(1), 65-68.

Yoo, W. (2013). Effect of individual strengthening exercises for anterior pelvic tilt muscles on back pain, pelvic angle, and lumbar ROMs of a LBP patient with flat back. Journal of Physical Therapy Science, 25(10), 1357-1358.

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