Or…at least the heels…In my one-on-one physical therapy work with patients, I am often helping them to incorporate changes into the ways in which they already move in the world, before I add heaps of exercises. Let’s face it: we all lead full lives. We have newborns, jobs, recreation, community events, school, soccer practice, and a host of other activities in our days and weeks.
I want my patients to improve, and often it’s the little tweaks to their typical movement regimen done consistently over time that make a big difference. One of the most common recommendations I make to women who see me for issues related to leaking (known in the medical world as ‘urinary incontinence’), hip pain, or pelvic organ prolapse (such as cystocele or rectocele), is to experiment with their footwear...
I’m not super into telling people exactly what to do, as much as engaging their curiosity in their own bodies and noticing how their symptoms change.
In this case, I offer patients the opportunity to try using different footwear that they already own and changing the amounts of time that they spend in their various types of footwear, especially as it related to the height of the heel in their footwear.
For example, I may suggest to a working mom who wears heels to work every day to try flats for a day or even a week and see if she notices anything different in her body. I may suggest to a female athlete to try her strength and conditioning routine in an athletic shoe that has minimal to no heel rise and see how it affects her squatting position, and also her symptoms.
Why do I suggest dropping the shoe heel? Because it changes the standing alignment of the body, which includes the alignment of the pelvis, among other things. A couple different studies (HERE and HERE) have shown consistently that a heel in a “positive” position, meaning, that the heel is situated higher than the forefoot (the base of the toes where they all meet together), show decreased pelvic floor muscle contraction ability (a different and more appropriate term in the physical therapy world for ‘Kegel’) than when the heel shows no height difference with the forefoot or a “negative” heel, where the heel sits lower than the forefoot.
This information may be important for conditions such as stress urinary incontinence or pelvic organ prolapse, where we want to facilitate as strong of a pelvic floor muscle contraction as possible (*Note: I am not saying doing hundreds of contractions per day here – it’s a little more complicated than that) to help strengthen the part of the pelvic floor muscles that provide the actual support to these organs.
In addition, there may be correlations between positive heel positions assumed for long periods of time in the day, over years at a time and pain along the spine – headaches, neck, or low back pain in particular (HERE and HERE). The spine has to accommodate for the raised heel and shortened calf position that the high heel causes a woman to assume. Usually it does this by increasing the curve in the low back, mid back, and backside of the neck.
So, while this topic deserves an entire blog site of its own, my simple intention is to peak your curiosity with your own body to try the above experiment yourself. What changes to you notice in your body with different footwear and heel heights, or better yet, barefoot compared to the others. Check in with your head, neck, back, pelvis and legs to see what changes for you.
I would love to hear how it goes for you! Email me to share your findings at email@example.com. And, if you like what you’re feeling, it’s important to not simply get rid of all your shoes…occasional heels for a wedding are nice (followed by a foot massage), and transitioning into decreased-heeled footwear is a process, not to be done overnight.
Oh, and I don’t recommend jumping into flip-flops as a solution…that’s a whole other blog post!