First, let me admit I like a lady in high heels. So it pains me to right this...
Case Report:
A 30yo female patient arrives with back pain. Among applicable data (for sake of brevity on this post) you find that she has a no obvious directional preference and a dysfunctional, but non-painful multisegmental flexion (MSF), with the breakout demonstrating a motor control deficit. You provide her with an excellent combination of exer and manual that enhances her muscle recruitment by improving glut and post chain activation and thereby restoring a more “uniform movement pattern” and achieving a functional MSF.
Maybe something like this exercise will improve their motor control:
Assume this position with knees and hips at 90/90 and firmly press the heels down isometrically to engage gluts and perform a small bridge. Slowly and with breath control extend leg straight. 5-10 on each side for a short hold. Retest MSF.
We can give this exercise to do at home to reinforce but what else can we add, OR RATHER DELETE, to improve her outcomes and motor control carryover. Well, according to the Journal of Manual Therapy, we can tell her to kick off those high heels. However now we can see that EMG activity shows that high heels aren't just bad for you for a plethora of orthopedic conditions but high heels also will alter your motor control: Women who wear high heels will have a delayed onset of the glut max as well as early inhibition of the gluts during MSF. Repetitive compensations, disuse, and posture are likely culprits to delayed glut firing, but so can something as simple as wearing high heels. Think about this way; do you feel a difference when you're in a deep squat with your heels are up compared to your heels being down. Of course, because when you're only on your toes you can rely more on the anterior chain. So someone in heels will also likely rely on the anterior chain and then subsequently leads the lumbar erectors to over facilitate as a ‘lower crossed’ brace. The research confirms this as the erectors are significantly earlier onset.
Further, delayed onset and a shorter duration of facilitation of the glut max can also lead to Achilles tendinopathy in runners, according to Smith et al in a 2013 study. More evidence is adding up that motor control deficits (per SFMA) are in fact altered neuromuscular strategies seen by EMG and a part of the patient’s pathology and disorder.
Thus, reinforcement (education and HEP) can be a great opportunity to not just improve their outcomes but actually get to the cause of their motor control disorder. At the very least, don't wear the heels to work every day!
