High heels can cause neck, back and knee injuries. *MCT photo
High heels can cause neck, back and knee injuries. *MCT photo

Colin Ayliffe is a certified Personal Trainer and Holistic Lifestyle Coach with over 10 years experience in training clients. Colin is Head Trainer at Court House Squash and Wellness in Hamilton. He graduated from the University of Surrey with a Bachelor’s Degree in Sport Science and is also a CHEK Practitioner, Golf Biomechanic and accredited by the National Academy of Sports Medicine.


High heel shoes have always been a popular accessory to any woman’s wardrobe in Bermuda. They are commonly worn during the work day and typically increase in height for the evening. Most women can wear high heels for the whole day but many complain of pain in the feet, back, shoulders and neck once they take their shoes off. 

They feel good wearing them but end up feeling terrible afterwards. Can the pain experienced by women actually be associated with their choice in footwear?

The shock absorbing foot is the only contact point that the body has with the ground and represents its base of support. 

Any elevation of the heels can alter the angle of this base of support in proportion to the height of the heel. 

Research from Dr Elizabeth Arendt’s publication, Common Musculoskeletal Injuries in Women, states that for every inch the heel is lifted, the body throws itself forward by about 11 degrees. This means a two-inch heel causes the body to lean forward 22.5 degrees and a 4-inch heel makes the body fall forward by 45 degrees. No wonder women have difficulty walking in high heel shoes. 

What is more important is that the body compensates from the ankle up to the skull in order to keep the eyes level with the horizon. This is a primitive survival mechanism.

These compensations lead to many postural distortions and adaptations just so you can see where you’re going. You cannot be walking around all day looking at the ground. 

There are three common dysfunctions from wearing heels. First is hyperextension in the lower back causing an increased arch in the spine and a forward head carriage. This normally causes lower back pain and neck strain. Second, is hyperflexion in the knees with a flat back. This is when the knees are too bent and the lower back becomes very straight causing shoulder and upper back pain. 

Third, is when the knees are hyperextended so they are nearly locked out and the spinal curves are all exaggerated which produces hip and knee pain.

When joints have deviated from their neutral position the gravitational forces that are usually supported by the skeleton become supported by the muscles instead leading to tension headaches, low back pain, musculoskeletal complaints and degenerative joint diseases. Most of the pain will be experienced in the big toe, knee, hips or spine.

So what can women do about this? Does it mean you can never wear heels again? 

Sure, these shoes match your outfit nicely and give the legs a better shape but it is important to get a posture assessment with a skilled personal trainer or practitioner so you can work around this problem and limit further damage and potential injury.

Once a fitness professional has assessed your posture you’ll be able to get to work straight away on correcting any imbalances found. 

For example, hyperextended knees are caused by tight and overworked thigh and hip flexor muscles with weak and lengthened butt and hamstring muscles. Stretching out the tight muscles and strengthening the weaker ones will help balance out this overcompensation so when you do wear heels you’ll feel less pain and be more comfortable.

We all know fashion has its price but that should never come at the expense of your health. 

If you are interested in seeing how a personal trainer can help you then contact spell@courthouse.bm for further information. Court House Squash and Wellness have two female personal trainers, Jill Bennett and Ashleigh Holland, who can help you become pain-free.