It’s not better, it’s just more

I almost didn’t get this post done because I was busy banging my head on the wall.


Well done, “Health” Magazine, well done. You’ve managed to fill a column with a mis-leading piece that (gasp!) could do a lot of people harm.

If you’re reading this, stand up and then lean way back like you’re trying to do a back-bend while still standing. Did you feel your  “abs and back muscles” work more? Sure. Standing like this uses them more than not. Is walking this way (in a standing back bend) better for your body?

Guess what: using your muscles “more” says nothing about improvements. It’s not better that you stood in a back bend just because the measured muscles increased in activity. IT’S NOT BETTER, IT’S JUST MORE.

Guess what again: the researchers of the article, Influence of walking speed on electromyographic activity of the rectus abdominis and erector spinae during high-heeled walking, understood this as well. That’s why they did the study, to see how heels change muscle recruitment patterns, potentially leading to excessive lordosis:

Here’s the first paragraph from the introduction:
Most young women wear high-heeled shoes daily. High-heeled shoes have a narrow toe box and rigid heel cap; this design often causes an anterior shift of the body weight and an excessive plantar curvature of the forefoot. Therefore, high-heeled shoes cause biomechanical damage to the locomotor system. This may result in deterioration in walking (i.e., reduction in the stride length and increased energy cost). Repetitive and prolonged use of high-heeled shoes may be directly associated with increased fatigue of the lower limb and trunk muscles, musculoskeletal discomfort caused by mechanical changes in body structures, and pain in the lower back and legs.

Walking in heels changes the way you walk, which yes, can mean greater muscle activity. Many times that increased muscle force is a part of the body trying to tense in order to protect the tissues just below from the loads your new position is creating. That your spinal extensors contract and “work” to reduce the heavy loads to the vertebral disks created by walking in heels is a short-term adaptation to a dangerous-to-your-discs activity. In the short term (over a few seconds or minute) it can be awesome, but muscles recruited in the same way over time adapt and change, losing mass and losing the ability to generate force when necessary (which shouldn’t be the entire time you’re walking but when you bend, lift or carry something, slide something across the floor, etc.)

Either this piece was written with the intention to deceptively misrepresent research investigating how high heels lead to damaged tissue and altered dynamics of human walking or it was written out of ignorance. I suspect the latter. This is probably another case of someone scanning a study headline and reading the results section,

RESULTS: For all heel heights, the EMG activity of the RA and ES muscles was significantly higher at the 6 km/h speed than at the 3 km/h speed (p < 0.05). Furthermore, EMG activity increased significantly with increasing shoe heel height, regardless of the walking speed (p < 0.05),

and then putting this information through the fitness filter (aka that any extra muscle work must be a good thing because doesn’t that mean we burn more calories and build more muscle mass and doesn’t that mean that we stay lighter and leaner?). In this case I can see how one would extrapolate that stilettos are a “fitness secret.” What we have here is either a case of bad journalism or poor ethics. In either case it is irresponsible.

The conclusion of the Korean* study reads: “…increased lumbar lordosis induced by wearing high-heeled shoes requires more muscular effort to control the changing functional demands in the trunk during walking. Hence, muscle fatigue and overload is unavoidable when wearing high-heeled shoes during daily routine activities, leading to musculoskeletal problems in the trunk such as repetitive strain and low back pain.” OOPS. You forgot to mention that in your article. And, P.S. your contributing ortho quote doesn’t undo what you’ve done here.

This. This is what we’re surrounded by. This is the filter through which scientific research is being channeled to you. Start paying attention.

*Dear Health magazine, why is “Korean” the notable attribute for this study? How about “according to a study published in the Journal of Back and Musculoskeletal Rehabilitation?” Or “according to research done by physical therapists?”

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20 thoughts on “It’s not better, it’s just more

  1. Thanks to you, Katy, I skipped right past that article without giving it any opportunity to infiltrate my brain! I discovered your work a couple of months ago and by following the stretching guidelines from “Every Woman’s Guide to Foot Pain Relief,” the horrendous pain from my recurrent plantar fasciitis has diminished significantly. I’ve thrown out shoes and moved into zero and negative heels. I am a complete convert!!

    Anyhow, back to Health magazine, that issue also gives conflicting advice regarding “healthy” eating (see pgs. 134 and 142 on whole-fat dairy). Between this contradiction and the heels article you discuss, this magazine completely discredits itself as an “authority” on health. Ironic, isn’t it?

  2. I almost didn’t finish reading this article because I was poking out my eyes with a pencil. Gah!!!!

  3. *snort* This made me laugh. I’ve always been skeptical about what magazines print. Sometimes I look at the covers at work and just think of how much crap they are full of. It tickles me to see a professional call it out. So thanks for this post 🙂 And thanks for clarifying the reality.

  4. Very sad that a magazine called “Health” would print this rubbish, especially now that evidence to the contrary is abundant. It’s reminding me of how Fox News claims to be reporting news. I wonder how many people can discern between this entertainment/PR and real/unbiased/well-researched health reporting. I tend to think “most” but I bet the figure is way lower, just in the same way that many people put their faith in Fox News. My main peeve is that the organizations involved (Health, Fox, etc) aren’t completely ignorant to the fact that they’re selling crap under the guise of good and useful, though many individual writers or presenters are probably two sandwiches short of a picnic.

  5. Ugh!
    Definitely entertainment not news! They had to have known what they were doing.

    Thanks for this Katy. Hopefully it will show up on search engines to rebut that article.

  6. Katy, I am a trainer myself. Wouldn’t saw him walking in Hills be good for ME? Not everybody. I have a big posterior tilt to my pelvis. I run around all day in either five finger toe shoes or air Nike Max. For me, with my slouching issue, couldn’t some heel walking be good for me? Someone told me a 1 inch heel would help correct my pelvic tilt… What do you think? So the earth shoe idea, heels lower, would not work for my pelvic tilt? I know you are proponent of those earth shoes. I really want to work on this. And correct this issue so I don’t look old before my time. What you think?

  7. Sorry, that last post made no sense. I use the dictation function of the iPhone. Just writing to see if I should wear small heels occasionally for my posterior pelvic tilt?

    1. Any amount of heel will keep a person in a post tilt. One can not keep a neutral pelvis with a positive heel. The angle of the pelvis changes and the body weight is forward rather than back in the heels. working on lengthening the muscles on the back of the leg will be beneficial in helping you with finding neutral pelvis. Katy has so much info in her blogs about neutral pelvis and how to stretch the hamstrings- great place to start. 🙂

  8. Katy,
    I had the same response when I saw this in Health Magazine. They sent a copy to my Pilates studio so I gave it a glance and was horrified to see this off the cuff mini article with the glossy picture of pretty stilettos and a catchy headline. Most subscribers will read the headline and the first sentence and run with it (probably in their high heels) without taking the remainder into account where they say that there are better ways to work your core. The take away is that even though Pilates and balance challenges are better wearing high heels is a smart alternative. The sentence “won’t make you susceptible to injury” isn’t really attached to what seems like advice to wear high heels and work your core. Outrageous! I can imagine the talk around the water cooler: “Health magazine says wearing heels strengthens your core and back, let’s go shopping for some Louboutins!” I feel sorry for these women who may eventually suffer from a multitude of problems from their feet to their shoulders and everything in between. Thank you for your smart, scientific blog. I love your work!

  9. Great article Katy. Sorry I missed you and your family when you were here. Hope to see you all the next time.

  10. Dear Katy,
    I think, with no supporting reasearch, that banging ones head repeatedly against a wall is detrimental to the allignment of ones neck, and back as well if the wall is some distance from your body. Better to bang ones fingers on the keyboard.

  11. Thank you Katy for showing us the untruths we are told in our modern society when it comes to movement. I have suffered pain due to positive heel wear and excessive exercise without alignment balancing activities. I appreciate your work. I wish people would leave their rants to other venues. Fox News?? Am I missing something or is this a personal rant?

  12. Because, Dear Katy, high heels – you are too sensible! This ‘health’ rag wanted to show some ‘sexy’ shoes and justify doing so. Here’s one from my library to add to your discussion!

    High heels ‘may improve sex life’ (I kid you not, their title not mine!)

    Wearing higher heels – although perhaps not stilettos – may improve your pelvic floor muscles and in doing so boost your sex life, a study suggests.
    An Italian urologist and self-professed lover of the sexy shoe set out to prove that high heels were not as bad for women’s health as some suggest.
    The shoe has been linked to a range of problems – from corns to schizophrenia.
    But in a letter to European Urology, Dr Maria Cerruto said her research showed it was time to stand up for the heel.
    She said her study of 66 women under 50 found that those who held their foot at a 15 degree angle to the ground – the equivalent of a two inch heel – had as good posture as those who wore flat shoes, and crucially showed less electrical activity in their pelvic muscles.
    This suggested the muscles were at an optimum position, which could well improve their strength and ability to contract.
    The pelvic floor muscles are an essential component of the female body. As well as assisting sexual performance and satisfaction, they provide vital support to the pelvic organs, which include the bladder, bowels and uterus.
    But they often weaken after pregnancy and childbirth, and as the woman gets older. There are exercises to strengthen them, but Dr Cerruto hopes her findings may eliminate the need for these.
    “Women often have difficulty in carrying out the right exercises for the pelvic zone and wearing heels could be the solution,” she said.
    “Like many women, I like high-heeled shoes,” she added. “It’s good to know they have potential health benefits.”

    I would love to cite the article – sadly I don’t have the info – but I wanted to share it with you!

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