The Monday Shakeout: How Shoes Impact Our Spines
By Matthew Klein
Happy Labor Day to those who celebrate! Today Matt takes a look at some research on how running shoes impact our spines. We hope to explore some more research looking at running and injuries moving forward. Stay tuned!
A frequent group of questions we have recently received has been about how footwear may impact the spine. While we endless discuss the impact shoes can have on the joints and tissues of the lower extremity, the spine is not mentioned as much due to the greater distance away from where the footwear is located. That said, the whole body is connect and certainly interacts. The challenge is that there is limited evidence on how our spines react to footwear conditions, but we can still make some educated guesses based on what is out there.
How Cushioning Plays a Role
The amount of cushioning can impact the spine. Soft and unstable cushioning has been found to increase the trunk extensor muscle activity and increase the general extension (lordosis) of the spine (Lison et al., 2016). This makes sense given that unstable surfaces have been known to increase trunk muscle activity (the entire core) due central balance correction strategies. Lower cushioned/minimalist shoes have been found to do the opposite, decreasing lumbar extensor activity (Lee et al., 2018). This may be due to the improved proprioception and shock absorption required at the lower extremity. What is interesting about the minimalist study is that although lumbar extensor muscle activity decreased, the lumbar extension position increased in the spine. What this occurs I do not know but both seem to do the same thing while having opposite impacts on spinal muscle activity.
How Heel-to-Toe Drop Makes a Difference
Heel drop, or the difference between the height of the heel and the forefoot, has been one that we have talked about. A higher heel drop may shift the center of mass forward, which the lumbar spine would have to extend to the center of mass backward. Additionally, a higher heel drop may allow greater relative motion that would normally be limited by the calves, allowing a person to achieve greater hip extension toward the end of gait and potentially compensatory lumbar extension. On the contrary, a low or zero drop shoe may shift the center of mass posterior, which the lumbar spine would theoretically have to go into more lumbar flexion to keep the center of mass forward. However, the limited evidence done in women experienced with high heel footwear suggests that their lumbar position did not change with or without high-heeled footwear (Schroeder & Hollander, 2018). This research was done in non-runners and those with experience with this footwear type, suggesting that people may adapt over time. Therefore, caution must be taken with an assumptions until further research is done.
Conclusions?
What little research is out there suggests that softer/unstable footwear tends to increase lumbar muscle activity while minimalist/firmer shoes may decrease lumbar muscle activity. Both conditions increase lumbar extension, while the true impact of heel drop on the spine is unknown. The research on rockered shoes on the spine is limited, with most suggesting there is little to no impact. Therefore, we must be cautious with the assumption that footwear makes major positional impacts on the spine. What the limited evidence does suggest is that those with a muscle strain of the lumbar spine may do better with a firmer/minimal shoe, while those with a ligament sprain or instability may do better with a softer shoe to increase lumbar muscle activation. Outside of those ideas, further evidence is needed before we can draw any more conclusions.
References
Lee, S. P., Bailey, J. P., Smith, J. A., Barton, S., Brown, D., & Joyce, T. (2018). Adaptations of lumbar biomechanics after four weeks of running training with minimalist footwear and technique guidance: Implications for running-related lower back pain. Physical Therapy in Sport, 29, 101-107.
Lisón, J. F., Pérez-Soriano, P., Llana-Belloch, S., Sanchez-Zuriaga, D., & Salvador-Coloma, P. (2016). Effects of unstable shoes on trunk muscle activity and lumbar spine kinematics. Eur J Phys Rehabil Med, 52(4), 440-6.
Schroeder, J., & Hollander, K. (2018). Effects of high-heeled footwear on static and dynamic pelvis position and lumbar lordosis in experienced younger and middle-aged women. Gait & Posture, 59, 53-57.
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NEXT: Do I Need Insoles?
