What's That in Your Shoe? Is it Helping Your Back?
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| Illustration: Anne Asher 2007 Licensed to About.com |
Seeing the array of shoe inserts at my local drugstore leads me to believe that not everyone who buys these things can really be sure of what they are getting. First, if you don't read the package carefully, you might not even get a product that is offering the pain relief you seek. Some of these inserts are designed for arch support, some for cushioning shock at the heel, and some for the relief of back pain.
But beyond the package, what do we really know about the effect of insoles on back pain? The Cochrane Collaboration* recently published a review of medical literature that tested for the effect of insoles (over the counter and custom fitted) on the relief of back pain. Here is a summary of what they found:
Insoles really didn't help reduce or prevent back pain, even when study participants were on their feet a good part of their workday. One problem with the review was that the only studies available for Cochrane to look at focused on young active males. This limits the applicability of the findings to that population. Also, long term treatment or prevention measures with insoles were not included in any of the studies. The reviewers call for more clinical trials on this topic, but until then, they say that the evidence has mounted against the use of insoles or shoe inserts for the prevention or treatment of back pain.
Please note: the Cochrane reviewers looked only at cases of back pain not due to a leg length discrepancy. In my experience, leg length discrepancy adds a whole different dimension to the question of shoe inserts for back pain - it should, and is, being considered separately. In their background summary, the Cochrane reviewers acknowledge that the use of inserts, including custom orthotics, for back pain associated with leg length differences doesn't look very promising either. This is because the parties involved cannot agree on an exact measurement that would provide the definition of a leg length discrepancy.
| Leg Length Difference | Kinetic Chain | Tilted Pelvis | Alignment | Plumb Line |
* I am a consumer reviewer for the Cochrane Back Group, which means I look at their work and provide comment as to how it might answer the questions of non-medical people with back pain.
Comments
I got my first pair of custom made orthotics in 1981 & I knew within 15 minutes that was what I needed. My leg length was I think 1/8″ difference & I had scoliosis among other things. Over the years I have developed a number of other conditions with my muscle/skeletal system (some maybe not previusly diagnosed & some congenital) & I definitely can tell the difference on the rare occasions I have not had them in my shoes.
I also have them changed every several years which I understand is important due to body changes.
Thanks for sharing your experience, Diann. As the blog post mentions, there are few studies out there on the topic of insoles for back pain, which limits the Cochrane Collaboration’s ability to release a definitive statement about how well they work.
Also, as I mentioned, orthotics for leg length discrepancy is a different ball of wax, and so again I thank you for sharing your experience here. There is still much that can be learned about this topic.
Anne
Leg length discrepancy, I agree, is actually related to pelvic tilt. However this problem is most often the result, not the cause. Too much of forward rotation of the hip bone will push down the hip joint to a lower level. This produces a functional leg length discrepancy as well as a tilted pelvis. This rotation will also cause low back and hip pain.
One can use a heel lift to compensate for the leg length discrepancy or one can have a knowledgable practitioner fix it with gentle non-painful corrections. This is the work of Richard DonTIgny Physical therapist, who can be found on the web.
I have found this tremendously useful for the patients i see.
Thank you for the mention. I now have a website with a tremendous amount of information on pelvic dynamics. This is an integrated interdisciplinary analysis of the movement, structure, function, biomechanics, and kinesiology of the sacroiliac joint.
I invite you to visit my site at http://www.thelowback.com. Please share it with your colleages.