High heels – high risk for injury?

We all have that beautiful pair of had-to-buy-them, outfit-enhancing, agony inducing high heels. Confession: I am a shoeaholic and I have way too many shoes! The perfect pair of heels can undoubtedly set off any outfit, but are they doing more harm than good?  And what can be done to counter the effects of these torturous beauties?

Changes that occur whilst wearing high heels:

  • Pressure on the foot is shifted from the heel to the ball of your foot.  High heels or restrictive shoes can force the ball of the foot into a small amount of space.  This will cause an aching or burning pain, especially after a long night out, as there is increased pressure on the area. Foot pain This pressure through the toes can build up, causing metatarsalgia (toe pain), resulting from inflammation from the foot bones.  Continuing to wear restrictive footwear can cause bunions, Morton’s neuromas as well as increasing the risk of osteoarthritis in the feet.

  • Wearing high heels regularly can alter normal alignment, causing extra force to be transmitted through the knees.   Your quadriceps (thigh muscles) have to work harder than usual to maintain your knee position, resulting in strain.  When you wear flatter shoes, your heel is closer to the floor, meaning your quads don’t have to work as hard to stabilise your knee.  This reduces the risk of anterior knee and patellofemoral pain.  Quads strengthening exercises (in particular for the vastus medialis oblique/VMO muscle) will help provide stability for the knee.

  • Lumbar lordosisHigh heels get a bad rep for causing back pain.  Physiotherapists have historically warned against wearing heels, as they can cause an increase in lumbar lordosis, the natural curve at the base of your spine. Lumbar lordosis - postureWearing heels causes the hips to angle forwards, arching the back and increasing the angle of lordosis.  This makes the paraspinal muscles in the back work harder, causing them to fatigue more quickly.  Activating your core whilst walking and trying to maintain a neutral spine will help to support the low back muscles.  [Click here to read about how to prevent poor posture.]  Lordosis has been linked to low back pain, although the jury is still out on the extent of damage wearing heels can cause.
  • Wearing high heels can, over time, tighten the calf muscles and Achilles tendon, resulting in an inefficient walking pattern.  Over time, the calf muscles lose their elasticity, so they are unable to lengthen to reach the ground altogether. This explains why some women who constantly wear heels claim that they are more comfortable in heels than flats.  Chronic heel-wearing can cause heel pain and tendonitis, which can be very painful and tricky to manage.
    High, Heels


Clearly, our high heels can potentially wreak havoc for our joints, alignment and posture, and can cause a wealth of musculoskeletal injuries.  However, if you’re anything like me, knowing the risks isn’t realistically going to deter you from wearing those gorgeous heels.

How to prevent footwear-related injuries

Follow these few tips to counter the harmful effects of high heels and reduce your risk of injury.

  • Ideally, limit the amount you wear your heels and opt for comfy shoes wherever possible.  If this is a total no-no, minimise the amount of time you wear your heels for.

  • High heel painMassage your feet after wearing heels, paying particular attention to the balls of your feet and the big toe area (which takes a lot of pressure)

  • Chunky heels put less pressure through the metatarsals, ankles and knees and are much more stable than stilettos.  Aim for wider, well-fitting heels to reduce pressure through your lower limbs.

  • Stretch!  Regularly stretching the calf muscles, feet and Achilles to help counter the shortening of these muscles.Calf stretch
  • Exercise your feet and core.  Try doing Pilates and some foot stretches to keep to stabilise your feet and reduce the stress going through your ankles, knees and back.

    Ruby slippers

  • Dorothy tottered around Oz all day in her ruby slippers, but knew that there’s no place like home to rest your weary feet.  Try and spend some time in flat but supportive shoes (such as trainers).  This will allow your feet to breathe and recover from the restriction that heels tend to cause.

  • Completely flat shoes such as ballerina pumps can be even worse than heels as they offer no support at all for your feet.  Try and ensure any shoes have some cushioning and good arch support.

  • Foot with arch supportIf you are struggling with footwear, speak to a physio or Podiatrist.  Many people have reduced medial arches or ‘flat feet’, which causes an over-pronation at the ankle, which increases the risk of sprained ankles and knee pain.  Wearing shoes with inner-arch support can provide huge relief from the pain associated with flat feet and plantarfaciitis.  A health professional will be able to advise on whether your footwear has sufficient support.



High heelsIn conclusion, there are ways to enjoy your favourite footwear but be aware of the risks to your joints.  Consider taking the steps above to reduce the risk of pain and injury whilst enjoying your best shoes.

Happy high heel-wearing!!


Naomi Sofer, Specialist Physiotherapist

May 2017

Pain-free Pesach Preparation

Each year my mum jokes about the irony of being chained to the kitchen sink during Pesach, the so-called “Festival of Freedom”.  My friends always laugh when I tell them that as a physio, the run-up to Pesach is one of my busiest times of year.  For many of us, despite the best-made cleaning schedules and most organised of meal plans, nothing quite prepares you for the physical effort and pressure of cleaning, shlepping, shopping and endless cooking.  Throw the worry of getting it all done on time into the mix, and stress levels can become overwhelming, both mentally and physically.  Stress can lead to many trying to cut corners in terms of safety.  Sadly, this is what can lead to people coming to see me with shoulder, neck, back and knee injuries – the last thing anyone needs to be worrying about right now.

Look familiar? The stress of Pesach can be both physically and mentally draining.
Look familiar? The stress of Pesach can be both physically and mentally draining.

Here are some tips to reduce the risk of provoking ‘back-breaking labour’ or nasty injuries and enjoy a pain-free Passover:

Try to divide up heavy loads.

Lifting heavy thingIt might be tempting to save time by carrying lots of heavy shopping bags into the house or bringing boxes of pots and pans down from the loft in one go. This can put unnecessary strain through your neck, upper back and shoulders, leading to strains, trapped nerves and occasionally muscle tears.  Try splitting anything heavy into more manageable loads to reduce the risk of injury.  Two journeys may take longer but your back and joints will thank you.

Most supermarkets, kosher shops and butchers will deliver groceries straight to your door.  Consider whether it’s worth ordering a shopping delivery rather than shlepping it all yourself, especially if you don’t have helpers at home.

Don’t risk a fall by over-stretching

FallingCertain household activities have a higher injury-risk based on the position required to perform the task.  For instance, hoovering is very much a forward-flexed posture for your spine.  Try to keep your back relaxed and always keep your core muscles tight whilst doing housework.  Try to use a step-ladder or stool to clean high cupboards or get something down from a high shelf. Avoid standing on boxes or balancing on unsteady furniture to access hard to reach places, to reduce the risk of a twisting injury, awkward reaching or falling.

Watch your lifting technique

When picking up boxes, however heavy, avoid bending from your waist, which puts a lot of stress on your joints.  Always bend from your hips and knees and if need be, kneel down to reach into low cupboards. Try to keep any load you are carrying at waist-height and close to your body, which helps keep your centre of gravity low.  Be especially careful when carrying hot, heavy dishes for example big pots of soup or taking heavy dishes out of the oven.  The same rules apply – keep your core muscles tight, bend your knees and breathe whilst lifting.

Always lift with good posture - even if you're picking something up that's really light. Bend your knees so you are in a squatting position to prevent straining your back.
Always lift with good posture – even if you’re picking up something really light. Bend your knees so you are in a squatting position to prevent straining your back.

Protect yourself from old injuries and try to de-stress

Pulling furniture or lifting things up to clean underneath can strain muscles, joints and put pressure on the spine. A pre-existing injury will make you more susceptible to re-injury.

If you’re stressed out by the pressures of cooking, cleaning and organising your family and home in time for Pesach, your muscles are probably in a heightened state of tension, and a slight stress may cause a disproportionate pain reaction.  Try not to over-exert yourself and listen to your body – if your pain starts, it’s probably time to take a break.

Some jobs simply are a two-person activity.  If a task is too much for you to manage alone, wait until you can recruit some help.  It’s a good idea to inform your family the night before of the jobs you’ll need them for the following day, so there are no excuses!

Break tasks down and pace activities

Being in one position for too long can lead to muscular tension and joint pain. Try to have more than one task on-the-go and switch between them to avoid maintaining the same posture for too long, for example: try to avoid standing for hours prepping your vegetables.  Divide them up and try sitting down to peel and standing to chop.  As long as you’re not static in one position for too long, your muscles shouldn’t fatigue too quickly and therefore won’t be as prone to straining.

Surviving Seder without injuring yourself

Seder leaningBy the time you sit down to Seder, you might well feel more exhausted than liberated.  But don’t risk an injury at this stage.  Sitting for the duration of Seder can itself be a challenge, especially if you are already suffering from low back or knee pain.  Think about stretching before you sit down and getting up where possible to break up the sitting period.

The question of leaning should perhaps not be why, rather, how we should to lean to protect our backs. Everyone has a different custom when it comes to leaning.  Whatever your minhag, think about using a pillow to avoid twisting and sitting in an awkward or uncomfortable position, especially if you lean for a large part of the Seder.  Consider using a chair with arms or else rotate your chair 90 degrees so you can rest your arm on the backrest of the chair, to support your back while you lean.

Listen to your body and don’t ignore pain

If you are in pain, STOP! Going for a quick walk, some deep breathing or stretching can not only relieve the aches and niggles, but should also help reduce your stress levels and make your more productive when you resume.

Don’t just ignore the pain and crack on.  There’s an awful lot to do at this time of year but if you are struggling with pain you won’t be much use to anyone!  As always, please seek professional advice from a doctor or physiotherapist if your pain persists.

Most importantly, try and relax – all of your hard work will be rewarded when you (finally!) sit down with your family and enjoy the fruits of your labour.

Happy Pesach

Naomi Sofer, Specialist Physiotherapist

March 2017

The Power of Posture

When it comes to posture, it seems like your mum did know best – her shouts of “sit up straight!” and “stop slouching!” were great advice.
At the beginning of the year, lots of us look to refocus our health and set ourselves goals for the upcoming year.  But most people forget one of the most important areas to concentrate on; bad posture can counteract hours spent in the gym and derail your fitness goals.  Improving posture will help to activate more muscles and boost their efficiency, meaning that by sitting up straight you burn more calories.
Good posture can help your muscles work more efficiently and improve your overall health and fitness
Slouching or stooping causes muscles to fatigue and ligaments to strain in order to support your spine, which can lead to back pain, headaches, muscle tension and injuries.  Correcting your posture may feel awkward and unnatural to begin with, but if you work at it, your muscles and joints will strengthen.  Over time, maintaining good posture will feel much more comfortable.
Postural awareness is the one guaranteed method to improve it long-term.  Sadly, the nature of habit means that maintaining good posture requires a lasting commitment.  However, with a few tips and tricks, you can be sitting taller and walking straighter in no time.

Benefits of good posture:

slouched posture
If you spend a large part of your day hunched over your computer, iPad or phone (let’s be honest, who isn’t guilty?!) you may well have a sore or tight neck by the end of the day.  Sitting with better posture will improve muscle efficiency, therefore reducing strain and tension through neck and upper back muscles.   Even more crucially, sitting up straight will reduce pressure going through discs and joints in your neck, therefore reducing the wear and tear that occurs naturally over time.

Good alignment can not only improve your posture, but can make you look taller, slimmer and more confident. Look at a photo of yourself where you’re slouching and compare it to one where you’re posing – unless you’re a natural ballerina, your posture and overall appearance will be much better with a few tweaks.

Good posture will make you look taller, slimmer and more confident
Good posture will make you look taller, slimmer and more confident

So lose the rounded shoulders and Dowager’s hump for an instanta-improvement.  If you’ve put better posture on your 2017 resolution list, follow this advice for a healthier spine, better muscle flexibility and improved confidence this year.

Top tips for posture: Balloon posture

1) Exercise to improve sitting posture: Imagine you have a helium balloon attached to the crown of your head.  Allow your neck to lengthen, gently tuck your chin in and allow your shoulders to relax.  This will eliminate the tendency to round your shoulders and gives the impression of a more elongated neck.

2)  Whilst sitting, lift your sternum forwards and upward, lengthening your collarbones whilst keeping your shoulder blades relaxed down.  This automatically straightens the upper back, making you look taller and relieving any pressure that might be accumulating between your shoulder blades and trapezius muscles.

Side plank
Core strengthening exercises are a great way to support your spine

3) Improve your core strength.  It sounds simple, but your core is your ‘powerhouse’, stabilising your pelvis, hips and spine.  The stronger your deep core muscles are, the more effectively the rest of your muscles will work (which is why there’s such a strong focus on alignment in Pilates and yoga).

4) Posture Prompts

Set yourself a reminder as a prompt to sit up straight.
Set yourself a reminder as a prompt to sit up straight.
Despite the best intentions, most of us forget about posture about thirty seconds after correcting it, so it’s essential to be reminded regularly. Whether it’s while you’re waiting for the kettle to boil or setting a reminder on your phone, find something to cue you to stop slouching, roll your shoulders back and take some deep breaths.  Not only will you feel calmer, posture-prompts will support your neck and spine and temporarily relieve tense muscles.

Lumbar lordosis
Wearing high heels, extra belly weight and tight hamstrings can make the natural curve of your spine appear more pronounced.

5) Everyone has a natural curve in their low back, known as a lordosis, however in some people this can be more pronounced.  Lumbar lordosis can be exaggerated by excessive weight, pregnancy and wearing high heels.  Doing regular glute strengthening exercises such as squats, clamshells and bridges can help correct standing posture and improve the appearance of a bum that sticks out (or in my family, affectionately named the ‘Donald Duck’ posture).

6) Sit well.  If your bum is too near the edge of the chair, you may find yourself leaning forward or slouching.  Ensure that your bum is as far back in the chair as possible, you have some lumbar support and that your feet are balancing your body weight on the floor.

Try and sit with feet on the floor, bum back and your lumbar spine supported
Try and sit with feet on the floor, bum back and your lumbar spine supported

7) Make ergonomic changes.  Make sure you have a good work-station setup with your shoulders relaxed, back and feet supported and computer screen at eye-level to avoid slouching all day.  And most importantly, try and take regular breaks and keep active to prevent bad postural habits from building up.


Remember, awareness of good posture is the first step to breaking poor postural habits.  Bear these things in mind and make 2017 the year where you sit up and take control of your posture.

Naomi Sofer
January 2017