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High-heeled shoes have long been associated with femininity, elegance, and sophistication. But despite their popularity, many women are unaware of the potential long-term health consequences of wearing high heels for a prolonged period. While the visual appeal of high heels remains a major attraction, their impact on posture, balance, and musculoskeletal health is frequently overlooked. High heels alter the body's natural alignment by shifting weight forward, leading to increased strain on various muscle groups. Over time, this unnatural posture can cause discomfort, fatigue, and significant biomechanical changes that may contribute to chronic pain conditions, including low back pain (LBP).

Link between high heels and low back pain

LBP is one of the most common musculoskeletal conditions affecting individuals worldwide. It is a leading cause of clinical consultations and workplace disability, particularly in professions that require prolonged standing or walking. Research has established a strong correlation between wearing high heels and the increased risk of LBP due to postural alterations and musculoskeletal strain.

Women who regularly wear high heels experience higher levels of pain and functional limitations compared to those who wear flat shoes. This is primarily because high heels force the lower back into an exaggerated curve (lumbar lordosis), increasing pressure on the lumbar spine. The unnatural redistribution of body weight causes excessive muscle activation, particularly in the lower back, leading to fatigue, discomfort, and, in severe cases, chronic pain.

Additionally, factors such as poor posture, malnutrition, vitamin D deficiency, lack of physical activity, and incorrect lifting techniques can further contribute to the development or worsening of LBP. Unfortunately, many individuals remain unaware of these risk factors and continue wearing high heels without recognizing the long-term consequences.

Biomechanical effects of high heels

High heels significantly alter body mechanics and walking patterns. The primary biomechanical effects include:

• Excessive foot pronation: High heels cause excessive inward rolling of the foot (pronation), which disrupts natural gait patterns and places strain on the knees, hips, and lower back.
• Increased lumbar lordosis: The forward tilt caused by high heels exaggerates the curvature of the lower spine, increasing pressure on the vertebral discs and surrounding muscles.
• Compensatory muscle activation: To maintain balance, the muscles in the lower back, legs, and core must work harder, leading to increased fatigue, spasms, and discomfort.
• Thoracolumbar fascia strain: The connection between the lower limbs and the back is mediated by the thoracolumbar fascia, a network of connective tissue that transmits forces between the upper and lower body. Uneven pressure from high heels disrupts this transmission, leading to muscle imbalances and pain.
• Joint strain and degeneration: Prolonged use of high heels can lead to wear and tear on the knee and hip joints, increasing the risk of degenerative osteoarthritis.

Although high heels may give the illusion of improved posture and confidence, they ultimately contribute to biomechanical dysfunction and chronic pain.

Contradictory findings on high heels and posture

While most studies emphasize the negative impact of high heels on posture and spinal health, some research suggests that habitual wearers do not always exhibit significant postural changes. However, these individuals may still experience discomfort and pain, particularly when transitioning to lower-heeled shoes. This suggests that prolonged high-heel use leads to adaptive changes in the musculoskeletal system, making it difficult for individuals to switch to more ergonomic footwear without experiencing pain or discomfort.

Preventing low back pain

As physiotherapists, there are several proactive steps that can be taken to help individuals prevent LBP associated with high heels:

• Public awareness campaigns: Publish educational brochures, articles, and online content to inform women about the risks associated with high-heel use. Organize lectures and workshops to highlight the long-term consequences of wearing high heels.
• Posture and movement education: Conduct awareness programs led by qualified physiotherapists to teach correct posture during walking, standing, lifting, and carrying objects. Demonstrate proper gait techniques and recommend alternative footwear that supports natural foot alignment.
• Guidance on footwear selection: Encourage individuals to choose ergonomically designed shoes that provide adequate arch support and shock absorption. Suggest alternatives such as low-heeled shoes or orthopedic insoles to reduce strain on the lower back.
• Exercise and strength training: Recommend exercises to strengthen core muscles, which play a vital role in stabilizing the spine and maintaining proper posture. Emphasize flexibility training to reduce muscle tightness and prevent compensatory movements that lead to LBP.
• Encouraging lifestyle modifications: Promote regular physical activity to improve overall musculoskeletal health. Educate individuals on the importance of proper nutrition, including vitamin D and calcium intake, to support bone health.

Conclusion

The relationship between high heels and LBP remains a significant concern in the medical community. Numerous studies have demonstrated that prolonged high-heel use contributes to postural imbalances, muscle strain, and joint stress, leading to increased pain and disability. Physiotherapists play a crucial role in spreading awareness, educating individuals about ergonomic practices, and recommending evidence-based interventions to prevent and manage LBP.

By prioritizing preventive measures, such as proper footwear choices, posture correction, and targeted exercise programs, individuals can make informed decisions about their footwear and reduce the risk of LBP associated with high heels. Addressing this issue through education and lifestyle modifications will not only enhance musculoskeletal health but also improve overall well-being and quality of life.

Hiking has emerged as one of the most popular activities in Kathmandu, especially after the Covid-19 pandemic brought life to a standstill. During the lockdown, many residents of the Kathmandu Valley found themselves confined to their homes, with little to do except watch TV or scroll through their phones. This period saw a dramatic rise in anxiety, depression, and other mental health issues. As a result, people eagerly awaited the day when the lockdown would be lifted, allowing them to venture outdoors and seek solace in the serene green hills. This longing for nature gave rise to a thriving hiking culture in Kathmandu. Here are five must-visit hiking destinations around the Kathmandu Valley:

Shivapuri

Standing at an elevation of 2,732 meters, Shivapuri Peak is one of the most popular hiking destinations near Kathmandu. The hike begins at Budhanilkantha and takes approximately five to six hours to reach the summit. The trail winds through the dense, biodiverse forests of Shivapuri National Park, leading to Nagi Gumba, a tranquil Buddhist monastery perched atop the hill. Along the way, hikers can enjoy stunning views of the Kathmandu Valley and visit Bagdwar, believed to be the source of the Bagmati River. A large fair is held here every Nepali New Year. From Bagdwar, it takes about an hour to reach Shivapuri Peak, where a large open ground and a statue of Shivapuri Baba await. The peak offers breathtaking panoramic views of the Ganesh, Langtang, and Jugal Himalayan ranges. Shivapuri is the second-highest hill in the Kathmandu Valley and can also be accessed via Tarebhir.

Jamacho

For those seeking a shorter hike near Kathmandu, Jamacho is an ideal choice. Located at an altitude of 2,128 meters, the hike begins at the Phulbari gate. As you enter the forest, the serene environment quickly helps you forget the chaos of city life. The hike takes about three to four hours to complete and leads to a sacred Buddhist site with a monastery at the hilltop. From here, you can enjoy clear views of the Manaslu, Ganesh, and Langtang Himalayan ranges, as well as the Kathmandu Valley.

Bhasmasur

Bhasmasur, the third-highest hill in Kathmandu at 2,500 meters, is a fantastic hiking destination in the southern part of the valley. The hike starts from Hattiban and takes around six hours to reach the top. The trail passes through Hattiban Resort and Champadevi, where you can visit the Champadevi Temple and the Padmasambhava Cave. The path winds through dense forests of pine and rhododendron, offering a peaceful escape into nature.

From the summit, hikers are rewarded with panoramic views of the Langtang, Jugal, and Gaurishankar Himalayan ranges. For those looking to extend their adventure, the hike can continue to Chandragiri.

Kakani-Suryachaur

The Kakani-Suryachaur hike is a short and easy trail located to the north of Kathmandu. Situated at an altitude of 2,000 meters, the hike begins in Kakani, a popular picnic spot known for its strawberries and trout fish. The trail takes you through dense forests of pine and rhododendron within Shivapuri National Park. After about three hours, you’ll reach Suryachaur, an open ground offering spectacular sunset views. Local eateries along the way provide opportunities to enjoy a hearty meal amidst nature.

Nagarkot-Sankhu

Nagarkot, a well-known tourist destination, is famous for its sunrise and sunset views. The Nagarkot-Sankhu hike is a perfect getaway from the hustle and bustle of city life. Starting from Nagarkot Bazaar, the trail passes through an eco-trail, Kattike Bhangyang, a Tamang village, and Jaharsinghpauwa before reaching Sankhu, a charming Newari village. The hike takes about five hours and is relatively easy, offering majestic views of the Jugal and Gaurishankar Himalayan ranges. Along the way, hikers can explore traditional Tamang villages and immerse themselves in local culture.

Photos: Achitra Thieng

Happiness isn’t defined by a single day or event but by a cumulation of moments. Whether it’s spending time with family, helping others, or connecting deeply with friends, happiness takes many forms. In a world increasingly consumed by technology, it’s essential to remember the value of real-world connections and meaningful experiences that truly bring us joy. As we celebrate World Happiness Day on March 20, ApEx talked to three people about what makes them happy.

Aayush Basnet, 22

For me, the happiest days are those when I get to celebrate occasions with my family. There’s nothing that brings me more joy than that, and I define happiness by these moments. True happiness comes when you’re surrounded by people who appreciate you for who you are and for what you do. Many people I know say they find joy in spending time with their partner, playing games, or enjoying different activities. I remember the last time I truly felt happy. It was two years ago, when I spent a night with my friends and family before leaving the country. I don’t think I’ve ever felt as content as I did at that moment.

Binda Thatal, 30

I think every day can be seen as a day of happiness. As a child, I remember the joy I felt when my father bought me a hairband. I was so excited that I couldn’t sleep the whole night. I found happiness in even the smallest things, like when my parents would bring home sweets or take us to the mela, holding our hands. Now, as an employee at the National Campaign for Women, I feel immense happiness in my work, especially in supporting women and addressing topics that matter to them. Through the years, I’ve also come to understand that being a supportive friend or partner brings its own kind of happiness. There’s a sense of relief, safety, and a comforting feeling of having backup support. It’s this connection that makes us feel cherished and valued.

Bijay Ram Ghimire, 48

When we were younger, we would spend entire days outside, but nowadays, people seem addicted to their phones, rarely stepping out. I remember how happy I felt when I went outside to play football, volleyball, kabaddi, and dandi biyo. We spent most of our time playing, socializing, and exploring, while today, many people are absorbed by their mobile devices. One of the happiest feelings back then was when we could help someone in need. It was a simple joy, but it brought a sense of fulfillment. Perhaps the definition of happiness has changed over time. Today, many people find happiness through their phones and social media, tying their well-being to digital validation. But it’s important to look beyond screens—to stay active, engage with the world around us, and disconnect from materialistic pursuits. By managing our time wisely, we can rediscover happiness in the real world too.

The ongoing debate surrounding Nepal’s Civil Service Bill raises concerns about the effectiveness of bureaucratic reforms and their potential to improve public service delivery. While the bill is a step toward modernizing the Civil Service Act, many argue that it fails to address the core issues plaguing the bureaucracy, including inefficiency, lack of motivation, and poor service delivery at the local level. The real question is whether the bill will bring about meaningful change or simply become another bureaucratic hurdle.

A decade has passed since the promulgation of the Constitution, yet the Federal Civil Service Act, has not been passed. The lack of this foundational law has contributed significantly to the problems at the local level. For example, while municipalities are designed to be self-governing entities, they face severe staffing shortages and inefficient resource management. The education branches of municipalities, such as those with 15 schools, are staffed with just four positions, including a deputy secretary, while rural municipalities with over 80 schools face similar issues. These staffing arrangements are meant to be a solution but have instead become a significant source of dysfunction.

Moreover, senior employees are often posted under junior subordinates, violating principles of natural justice and further exacerbating internal tensions. The mechanical process of adjusting staff has created more problems than it has solved, and currently, over 300 municipalities are struggling with administrative failures, which have become a chronic issue in the federal system.

The root causes of bureaucratic inefficiency are complex and multifaceted. Are employees demotivated because they lack a working environment conducive to productivity? Is it because they don’t have clear career development paths or feel marginalized in decision-making processes? These questions must be addressed before any meaningful reform can take place.Without a proper working mechanism and clear standards for promotion, transfer, and career development, employees often lack the motivation to perform at their best. Additionally, the public service system in Nepal remains highly politicized, with leaders often selecting personnel based on political loyalty rather than merit or competence. This system leads to inefficiencies, as unqualified individuals are placed in key positions, affecting the overall functioning of government bodies.

The current Civil Service Bill fails to tackle these deep-rooted issues. While it introduces provisions regarding the appointment of administrative heads in municipalities, the role of the provincial secretary, open competition quotas, and retirement age, these measures do little to address the fundamental problems within the bureaucracy. By focusing on these surface-level changes, the bill misses the opportunity to bring about real structural reform.

Currently, many employees in Nepal’s civil service are trapped in a system that does not reward merit or effort. Career progression is often determined by political considerations rather than performance, leading to widespread dissatisfaction. Moreover, the lack of effective leadership and clear communication further contributes to poor morale within the bureaucracy.

A cultural shift is needed within the civil service, one that prioritizes professionalism, accountability, and public service over political loyalty. This can only be achieved through comprehensive reform that goes beyond changes in the law and addresses the underlying values and systems that govern bureaucratic behavior.

The Civil Service Bill, as it stands, fails to address the core issues within Nepal’s bureaucracy. To improve public service delivery, governance, and development, a more comprehensive and thoughtful approach to reform is needed. The bill must go beyond surface-level changes and focus on creating a civil service that is motivated, accountable, and capable of meeting the needs of the people.

Ultimately, the key to improving bureaucratic performance lies in addressing the root causes of inefficiency, such as political interference, lack of motivation, and ineffective career development systems. If these issues are not tackled head-on, any new law or bill will simply perpetuate the existing problems rather than solve them.