Human Movement Science 30 (2011) 596–605

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Human Movement Science

journal homepage: www.elsevier.com/locate/humov

EMG and kinematics analysis of the trunk and lower

extremity during the sit-to-stand task while wearing
shoes with different heel heights in healthy young women
Min H. Kim a, Chung H. Yi b,⇑, Won G. Yoo c, Bo R. Choi a
a
Department of Rehabilitation Therapy, The Graduate School, Yonsei University, 234 Maji-ri, Hungup-myon, Wonju,
Kangwon-do, Republic of Korea
b
Department of Physical Therapy, College of Health Science, Yonsei University, 234 Maji-ri, Hungup-myon, Wonju,
Kangwon-do, Republic of Korea
c
Department of Physical Therapy, College of Biomedical Sciences and Engineering, Inje University, 607 Obang-dong, Gimhae,
Gyeongsangnam-do, Republic of Korea

a r t i c l e i n f o a b s t r a c t

Article history: This study investigated the EMG characteristics and the kinematics
Available online 12 January 2011 of the trunk and lower extremity during the sit-to-stand (STS) task
while wearing 1-, 4-, and 8-cm high-heeled shoes. We examined
PsycINFO classification: differences in the EMG data of the internal oblique, erector spinae,
2330
medial hamstring, and rectus femoris muscles during the STS task.
3370
The motion of the hip joint during an STS task was measured with a
Keywords: NorAngle Electrogoniometer System. Twelve young healthy
Sit-to-stand women were recruited to this study. EMG characteristics and the
High-heeled shoes hip joint angle were recorded during the performance of an STS
Kinematics task by subjects wearing high-heeled shoes of three different heel
Electromyography heights. The muscle onset time and EMG activity during this task
were analyzed. In 8-cm high-heeled shoes, the onset time for the
erector spinae muscle was significantly delayed, and the onset
latency for the medial hamstring and the rectus femoris was signif-
icantly decreased. There was increased activity in the erector
spinae and rectus femoris muscle during this task when wearing
8-cm high-heeled shoes. The initial hip flexion angle at the start
point of the STS task did not differ among the 1-, 4-, and 8-cm
heel-height conditions, but the trunk flexion angle, corresponding
to the displacement between the peak hip flexion and initial hip
flexion, was significantly larger in the 8-cm heel-height condition
than in the 1- and 4-cm heel-height conditions. The findings sug-

⇑ Corresponding author. Tel.: +82 33 760 2551; fax: +82 33 760 2496.
E-mail address: pteagle@yonsei.ac.kr (C.H. Yi).

0167-9457/$ - see front matter Ó 2010 Elsevier B.V. All rights reserved.
doi:10.1016/j.humov.2010.09.003
 M.H. Kim et al. / Human Movement Science 30 (2011) 596–605 597

gest that excessive heel height has the potential to induce muscle
imbalance during the STS task.
Ó 2010 Elsevier B.V. All rights reserved.

1. Introduction

In recent times, young women have preferred to wear high-heeled rather than low-heeled shoes to
make them look longer or slimmer and more fashionable. The American Podiatric Medical Association
(American Podiatric Medical Association, 2003) reported that 62% of women wear heels over 5 cm in
height, and Kim (2001) reported that about 40% of South Korean young women prefer to wear high heels
rather than low heels. However, many females who are accustomed to wearing high heels suffer from
mild to severe pain. Indeed it has been shown that habitual wearing of high-heeled shoes can cause knee
pain (Edwards, Dixon, Kent, Hodgson, & Whittaker, 2008), foot pain (Gefen, Megido-Ravid, Itzchak, &
Arcan, 2002), deformity, and alteration of normal gait patterns (Esenyel, Walsh, Walden, & Gitter,
2003; Yung-Hui & Wei-Hsien, 2005). Lee, Jeong, and Frievalds (2001) reported that 58% of 200 females
who periodically wore high-heeled shoes suffered from low back pain when wearing high-heeled shoes.
The sit-to-stand (STS) task is an important one and is the most frequently performed basic task of
daily living (Dehail et al., 2007). Vander Linden, Brunt, and McCulloch (1994) defined this task as a
transitional motion to the upright posture requiring movement of the center of mass (COM) from a
stable position to an unstable position. STS motion requires optimal neuromuscular coordination
and postural adjustments to control the moment changes and to prevent excessive energy generation
or loss of balance (Lee, Michaels, & Pai, 1990; Papa & Cappozzo, 2000). Postural adjustments necessary
for task modification or under altered environmental conditions must be controlled appropriately to
maintain postural balance (Dehail et al., 2007). One modification associated with the STS task is the
wearing of high-heeled shoes. Wearing high-heeled shoes during STS tasks performed repeatedly dur-
ing a normal day may contribute to changes in neuromuscular coordination and posture, and may in-
duce low back pain (Barton, Coyle, & Tinley, 2009).
Goulart and Valls-Sole (1999) reported the differential action of related muscles during the STS task
and determined that the pattern of muscle activity remained constant when the initial seated posture
changed. They demonstrated that postural adjustments and balance systems in the human body were
well controlled when the initial seated posture changed. If postural adjustments are impossible and
neuromuscular patterns are impaired, neuromuscular disorders (Ebenbichler, Oddsson, Kollmitzer,
& Erim, 2001) and abnormal postural adjustments (Hodges, 2001) may result. For example, the
paraspinal and abdominal muscles are critical for controlling posture (Oh, Cynn, Won, Kwon, & Yi,
2007). Excessive activity of the paraspinalis and weakness of the abdominal muscles can lead to ante-
rior pelvic tilt and lumbar lordosis, which may cause lower-back pain (Shum, Crosbie, & Lee, 2007).
Recent studies have focused on the effects of high heels on kinetic and kinematic changes during
gait or stair ascent (Barton et al., 2009; Hsue & Su, 2009). However, there have been few reports
regarding the effects of wearing such shoes on postural-related muscle actions and postural changes
during the STS task. It is important to understand the effects of wearing high-heeled shoes during an
STS task on muscle activations and postural changes, and this has yet to be established. Therefore, the
purpose of this study was to determine the EMG characteristics and the kinematics of the trunk and
lower extremity during the STS task in healthy women wearing high heels. Our hypotheses were that
wearing high-heeled shoes would affect the size or timing characteristics of the EMG activities of the
trunk and lower extremity muscles, and would increase hip joint angles during the STS task.

2. Methods

2.1. Participants

Twelve young healthy females, aged 22–33 years (25.33 ± 3.58; mean ± SD), participated in this
study. All were devoid of any history of low back pain or muscular dysfunction. The height and weight
598 M.H. Kim et al. / Human Movement Science 30 (2011) 596–605

of the participants was 161.75 ± 4.58 cm and 51.08 ± 6.67 kg, respectively. The study was a single
blind design wherein the participants were not informed regarding the purpose of the study. Ethical
approval was obtained from the Yonsei University Faculty of Health Sciences Human Ethics
Committee, and the participants provided written informed consent prior to their participation.

2.2. Instrumentations

The EMG characteristics were recorded with a Noraxon TeleMyo 2400T instrument (Noraxon,
Scottsdale, AZ, USA) and the data were analyzed using MyoResearch Master Edition 1.06 XP software.
Surface electrode pairs were placed 2 cm apart over the following representative muscles on the right
side: internal oblique (IO), erector spinae (ES), medial hamstring (MH), and rectus femoris (RF). The
locations of active electrodes were as follows (Cram, Kasman, & Holtz, 1998): IO, at 2 cm medial to
the right anterior superior iliac spine, in the horizontal plane; ES, at approximately 2 cm from the
L4 vertebra over the muscle mass; MH, at 3 cm from the lateral border of the thigh and half the dis-
tance from the gluteal fold to the back of the knee; RF, at the center of the anterior surface of the thigh,
half the distance between the knee and the iliac spine.
The motion of the hip joint during an STS task was measured with a NorAngle Electrogoniometer
System (Noraxon, Scottsdale, AZ, USA), and the obtained data were analyzed using MyoResearch
Master Edition 1.06 XP software. This system provides biaxial angle signals that can be interfaced
to a surface EMG instrument and provide up to two axis angles per joint.

2.3. Data collections

The EMG signals were bandpass filtered between 20 Hz and 500 Hz and then digitized at a sam-
pling rate of 1000 Hz (Edwards et al., 2008). The digital signals were then full-wave rectified and fil-
tered using Lancosh FIR digital filters.
The activity onset time of each muscle was defined as the point at which the signal amplitude ex-
ceeded the mean amplitude plus 3 standard deviations (SD) during the 200 ms before the start of the
STS task (Dehail et al., 2007). The degree of muscle activity was assessed for each muscle by calculat-
ing the root mean square (RMS) moving window of 300 ms duration of EMG data. The EMG activity
was normalized against the mean RMS of a reference voluntary contraction (RVC) for each muscle
(Kim, Yi, Kwon, Cho, & Yoo, 2008) and was calculated for the period during the entire STS task.
A synchronized two-arm electrogoniometer was used to measure the hip motion and to allow
detection of the start and end points of the STS task. The stationary arm of the electrogoniometer
was placed along the line of the superior iliac crest and the midaxillary line, and the moving arm
was placed on the line between the greater trochanter and the lateral epicondyle of the femur. The
onset of the STS task was determined as the point at which the hip joint angle increased continuously
for 100 ms, and the cessation of STS motion was the point at which the hip joint angle was constant or
unchanged for 100 ms after standing (Edwards et al., 2008). The duration of STS motion and the hip
joint angle during STS motion were analyzed using MyoResearch Master Edition 1.06 XP software.
The following kinematics variables were measured: the initial hip flexion angle at the start point of
the STS task, the maximal hip flexion angle as the angle of displacement between the peak hip flexion
and the initial hip flexion, and the terminal hip extension angle at the end point of the STS task (Fig. 1).

2.4. Procedures

Participants were asked to perform three repetitions of an STS task under three heel-height condi-
tions: 1 (or flat shoe, control condition), 4, and 8 cm. We prepared high-heel shoes of various shoe
sizes from 230 to 250 mm, all of which had the same design to avoid design-related effects. The order
of the heel-height test conditions was randomized. Participants were seated on an adjustable armless
and backless chair with their feet separated by a comfortable distance. The seat height was adjusted so
that the hip and knee joint formed nearly a right angle when the participant was sitting prior to per-
forming an STS task under three heel-height conditions. At this time the hip joint angle was measured
using a synchronized electrogoniometer and measured continuously; however, the knee joint angle
 M.H. Kim et al. / Human Movement Science 30 (2011) 596–605 599

Fig. 1. Kinematics of hip joint and STS task duration. (a) Initial hip flexion angle; (b) maximal hip flexion angle; (c) terminal hip
extension angle; (d) start point of STS task; (e) end point of STS task.

was adjusted only once using a universal goniometer to avoid altering the initial seated position. The
ankle angle changed with the heel height.
Participants sat in a relaxed and comfortable position with back straight and their arms crossed and
folded on their breast, and they were instructed to not perform intentional muscle contractions and to
maintain a relaxed and comfortable seating position. Participants were asked to rise from the chair
when instructed verbally by the word ‘‘go’’. The STS task was performed at a self-selected velocity. Par-
ticipants were asked to maintain the standing posture for more than 5 s after completing the STS task.

2.5. Statistical analysis

The STS task duration and hip joint angle during the task were measured under three heel-height
conditions. Also, muscle activities and muscle onset times were measured under three heel-height
conditions. One-way repeated-measures ANOVA was used to determine the main effects of wearing
high heels on these parameters during the task. The comparative analysis of the three heel-height con-
ditions was performed post hoc with Bonferroni’s correction. The level of statistical significance was
set at p < .05.

3. Results

3.1. Sit-to-stand duration

The mean value of the motion did not differ significantly among the three heel-height conditions
(Table 1), but the standard deviation was larger in the 8-cm heel-height condition than in the 1- and
4-cm heel-height conditions.

3.2. Kinematics of the hip joint during the sit-to-stand task

The mean values of the kinematics of hip joint describing the sagittal-view angle and the statistical
analyses are presented in Table 2. The initial hip flexion angle at the start point of the STS task did not
differ among the 1-, 4-, and 8-cm heel-height conditions, and was nearly 90°. Post hoc analyses re-
vealed that the maximal hip flexion angle, corresponding to the displacement between the peak hip
flexion and initial hip flexion, was significantly larger in the 8-cm heel-height condition than in the
1- and 4-cm heel-height conditions. The terminal hip extension angle at the end point of the STS task
did not differ among the three heel-height conditions.
600 M.H. Kim et al. / Human Movement Science 30 (2011) 596–605

Table 1
Results of one-way repeated-measures ANOVA of the STS task duration (s) among the 1-, 4-, and 8-cm heel-height conditions.

Conditions (cm) Mean (SD) 95% confidence interval F-Value p-Value

1 2.453 (0.336) 2.240–2.666 0.392 .686
4 2.498 (0.280) 2.320–2.676
8 2.716 (0.815) 2.198–3.234

Table 2
Analyses of hip joint kinematics (degree) during 1-, 4-, and 8-cm high-heeled STS tasks.

Kinematic variables Conditions (cm) Mean (SD) 95% confidence interval F-Value p-Value
Initial hip flexion angle 1 90.833 (3.511) 88.602–93.064 2.202 .161
4 88.708 (2.926) 86.849–90.567
8 88.708 (3.729) 86.339–91.078
Trunk flexion angle 1 22.200 (8.718) 16.661–27.739 6.456 .016
4 24.108 (5.433) 20.656–27.560
8 28.942 (7.699)a,b 24.050–33.834
Terminal hip extension angle 1 0.142 (5.085) 3.089 to 3.373 3.886 .056
4 1.700 (4.636) 4.646 to 1.246
8 3.267 (2.693) 4.978 to 1.556
a
Significantly different from 1-cm high-heeled STS task.
b
Significantly different from 4-cm high-heeled STS task.

3.3. Muscle onset time

Rectified EMG traces for a representative participant are shown in Fig. 2. The overall firing sequence
for the 1-, 4-, and 8-cm high-heeled STS conditions was IO–ES–RF–MH, ES–IO–RF–MH, and RF–MH–
IO–ES, respectively (Fig. 3). The muscle onset times during the STS task in women wearing high-heel
shoes are presented in Fig. 3. Heel height had no effect on the onset time of the IO. For the ES, however,
the onset time in the 8-cm heel-height condition was significantly delayed compared with that of the
1- and 4-cm conditions. In addition, the mean onset times in the 8 cm condition for the MH and RF
muscles were significantly earlier than for the 1- and 4-cm conditions.

Fig. 2. Rectified EMG traces including the thresholds used to determine the onset times of a representative subject during an
STS task. (A) 1-cm heel-height condition; (B) 4-cm heel-height condition; (C) 8-cm heel-height condition; ð&Þ, onset of muscle
activity.
 M.H. Kim et al. / Human Movement Science 30 (2011) 596–605 601

*
*
1300
1200 1cm
1100 *
* 4cm
1000 *
* 8cm
milliseconds (ms)

900
800
700
600
500
400
300
200
100
0
IO ES MH RF

Fig. 3. The mean and SD of muscle onset times during the STS maneuver while wearing 1-, 4-, and 8-cm high heels. ⁄Statistically
significantly different from the 8-cm condition at .05 level following Bonferroni adjustment. IO, internal oblique; ES, erector
spinae; MH, medial hamstring; RF, rectus femoris.

3.4. Muscle activity

The normalized EMG data collected during the STS task in women wearing high-heel shoes are pre-
sented in Fig. 4. Heel height significantly affected the EMG activity of the ES and RF muscles. Pairwise
comparisons with the Bonferroni correction revealed that for both the ES and RF there were significant
differences in EMG activities between the 1- and 8-cm high-heel conditions. The ES and RF EMG activ-
ities were significantly higher for the 8-cm high-heel condition than for the 1-cm high-heel condition
(padj < .05/3). Heel height had no effect on either IO or MH muscle activity during the STS task.

4. Discussion

Postural adjustments are activations of postural muscles that are specific to the condition of the
movement that is being executed. These adjustments maintain appropriate coordination between
the body and the environment so as to allow the completion of a task (Goulart & Valls-Sole, 1999).

450
1cm
400
* 4cm
350
Amplitude (%RVC)

8cm
300 *
250
200
150
100
50
0
IO ES MH RF

Fig. 4. The mean and SD of muscle activities during STS maneuver while wearing 1-, 4-, and 8-cm high heels. ⁄Statistically
significantly different from the 8-cm condition at .05 level following Bonferroni adjustment. IO, internal oblique; ES, erector
spinae; MH, medial hamstring; RF, rectus femoris.
602 M.H. Kim et al. / Human Movement Science 30 (2011) 596–605

In the present study, differential changes in postural adjustments occurred when the participants per-
formed the STS task while wearing high-heeled shoes of different heights.

4.1. Muscle onset strategy of postural adjustment for high-heeled STS

STS performed while wearing 8-cm high-heeled shoes resulted in changes in the muscle onset la-
tency of the ES, MH, and RF muscles such that in the ES it was significantly delayed and in the MH and
RF it was earlier than those observed in the 1- and 4-cm-heel condition. Goulart and Valls-Sole (1999)
reported that the abdominal muscles are utilized during postural activity, that the lumbar paraspinal,
hamstring, and quadriceps muscles are engaged in the actual execution of the STS movement, and that
the muscle activation order is abdominal–lumbar paraspinal–quadriceps–hamstring. In the study pre-
sented here, the activation order was IO–ES–RF–MH during the 1 cm high-heeled STS, a finding that is
consistent with those of Goulart and Valls-Sole (1999) and ES–IO–RF–MH during the 4-cm high-
heeled STS.
Investigations of lumbar stabilization have focused on the key point of motor control of the trunk
musculature, and this is increased by coordinated contraction of the IO and ES muscles. Investigations
of motor control of the trunk musculature have focused on the key point of lumbar stabilization (Hagins,
Pietrek, Sheikhzadeh, & Nordin, 2006; Moseley, Hodges, & Gandevia, 2003). An earlier activation of
trunk muscles reinforces lumbar stability during certain motions. In this study, the onset of muscle
activity in 1- and 4-cm high-heeled STS tasks occurred earlier in the IO and ES muscles than in the RF
and MH muscles. These results indicate that earlier activation of trunk muscles provides lumbar stabil-
ity for postural adjustment in 1- and 4-cm high-heeled STS tasks. Bird, Bendrups, and Payne (2003)
investigated the effects of foot wedging on lumbar ES muscle activation in healthy participants during
walking. They reported a significantly earlier onset of lumbar ES with 2 cm heel lifts, and indicated that
this alteration in ES activation reinforces lumbar stability prior to the pacing movement. Ebbeling,
Hamill, and Crussemeyer (1994) suggested that the risk of injury during walking can be reduced by
keeping heel height below about 5 cm. According to these reports, therefore, the 1- and 4-cm
high-heeled STS task would be considered as being within the normal postural adjustment range.
Remarkably, however, there was a change in muscle onset sequence during 8-cm high-heeled STS
to RF–MH–IO–ES, the onset of RF and MH being significantly earlier and that of the ES delayed com-
pared with the 1- and 4-cm conditions. The trunk muscles (i.e., IO and ES) are likely the most repre-
sentative muscles for lumbar stabilization, and the hamstring and quadriceps muscles the task
execution muscles for the STS task (Goulart & Valls-Sole, 1999). Induced early activation of the RF
and MH muscles prior to activation of the IO and ES muscles during STS suggests that in 8-cm
high-heel condition the execution muscles are providing mobility before the postural muscles are able
to provide stability. Postural adjustments are specific for each movement and can be altered according
to the internal and environmental factors (Massion, 1992). Wearing high-heeled shoes may induce
lengthening of the tibiofemoral lever arm due to extension of the lower leg due to the excessive height
of the heel (Esenyel et al., 2003), and the altered ankle posture compared to the flat or low-heeled con-
dition may have induced the different sequence of muscle activation.

4.2. Effects of ES muscle onset delay on actual execution of the STS

The changed kinematics in the high-heel condition compared to the flat or low-heeled condition
induce the different sequence of muscle activation (Esenyel et al., 2003). The function of the ES in
the STS task is to contract early and to provide trunk extension, counteracting excessive trunk flexion
(Bird et al., 2003; Dehail et al., 2007; Fotoohabadi, Tully, & Galea, 2010). Therefore, the delay in the
onset of the ES may represent a lag in the onset of the stabilizing postural events that should be acted
when particular movements are performed (Barton et al., 2009). In this study, the onset of the ES mus-
cle was significantly delayed in the 8-cm heel-height condition relative to the 1- and 4-cm heel-height
conditions, which would result in this muscle contributing insignificantly to the STS task, hence induc-
ing excessive trunk flexion. The kinematics data obtained in this study showed that the maximal hip
flexion angle was significantly larger in the 8-cm heel-height condition than in the 1- and 4-cm heel-
height conditions. These results support the above-mentioned hypothesis that the delayed ES muscle
 M.H. Kim et al. / Human Movement Science 30 (2011) 596–605 603

onset would induce excessive trunk flexion. Delayed onset of ES muscle and earlier onset of MH and RF
muscles can lead to break the lumbar stability (Oh et al., 2007), which may cause low back pain (Shum
et al., 2007).

4.3. Possible mechanisms between ES and RF muscle activity in 8 cm high-heeled STS task

The activities of the ES and RF during 8-cm high-heeled STS were simultaneously increased com-
pared to those during the 1-cm condition. Excessive contraction of the ES may increase the movement
of the trunk or lumbar spine, causing extension (Lee et al., 1990). Snow and Williams (1994) reported
that wearing excessively high heels induces a shift in the body’s center of mass (COM) anteriorly and
superiorly. In addition, the ankle is shifted superiorly and anteriorly, and the base of support (BOS) of
the foot is also moved anteriorly. To initiate an STS task, the trunk flexes forward, and the body’s COM
moves anteriorly (Mourey, Grishin, d’Athis, Pozzo, & Stapley, 2000). Theoretically, the trunk flexion
movements caused by the horizontal momentum of the COM during the initial phase of the STS task
generate the trunk flexion moments that are responsible for lifting the body from the seat (Janssen,
Bussmann, & Stam, 2002; Schenkman, Berger, Riley, Mann, & Hodge, 1990). To perform stable seat-
off, the body should keep the COM over the BOS. As already mentioned, the BOS of the foot is narrowed
and moved anteriorly when wearing high heels, and so the COM must move farther anteriorly to re-
main over the BOS (Lee et al., 2001). The anterior shift in the body’s COM can generate greater forward
flexion of the body (Schenkman et al., 1990). Under an 8-cm heel condition, the activity of the ES was
increased compared with the 1-cm condition. This occurred because the ES used more power to coun-
terbalance the exaggerated trunk flexion movement. Greater contraction of the ES counteracted trunk
flexion, bringing the trunk into extension to maintain balance on the BOS.
The activity of the RF during the STS while wearing 8-cm-high heels was increased significantly
compared to that in the 1-cm condition. The RF is one of the quadriceps femoris muscles and is
responsible for hip flexion and knee extension. During knee flexion to extension, the load on the quad-
riceps femoris increases if the flexion moment increases. During the transition from trunk forward
flexion to seat-off, the body COM falls within the area of the participant’s BOS (Magnan, McFadyen,
& St-Vincent, 1996). When lifting the body from the seat, excessive trunk flexion may induce knee
flexion movement. To prevent knee collapse, the quadriceps muscles are activated more (Esenyel
et al., 2003). Therefore, the increased RF muscle activity seen in this study may have served to com-
pensate for the tendency to flex at the knee when performing the STS task.
Also active anterior pelvic tilting is caused by the hip flexor and back extensor muscles and increas-
ing the control of these muscles induces a more lordotic posture of the lumbar spine (Neumann, 2002).
That is, ES and RF muscles are acting by ‘couple force’ to exaggerate lumbar lordosis and anterior pel-
vic tilting. Sustained and repeatedly increased activation of the ES and RF in women wearing high-
heeled shoes may thus induce lumbar lordosis (Barton et al., 2009), muscle fatigue (Bendix, Sorensen,
& Klausen, 1984; Lund, Donga, Widmer, & Stohler, 1991), and low back pain (Lee et al., 2001).
This suggests that although changes in muscle activation may be the natural outcome of the chan-
ged kinematics in the high-heel condition, the sustained and repeated wearing of heels with excessive
heights can induce inappropriate neuromuscular behaviors due to muscle imbalance. The limitation of
our study is that the participants represented a population of young women, and so our findings may
not be generalized to older populations. It is clear that further study is needed to analyze the effects of
wearing high-heeled shoes on the kinematics and kinetics of the lumbar and lower extremities in a
larger sample size.

5. Conclusions

This study showed that the muscle onset time and EMG activity differed significantly among the 1-,
4-, and 8-cm high-heeled STS conditions. The ES muscle exhibited delayed onset burst and increased
activity, and the RF exhibited an earlier burst and increased activity during STS wearing 8-cm
high-heeled shoes. STS from a chair while wearing high-heeled shoes demands significant ES and
RF muscle contractions. The sustained and repeated wearing of heels with excessive heights can
604 M.H. Kim et al. / Human Movement Science 30 (2011) 596–605

induce inappropriate neuromuscular behaviors due to muscle imbalance. This study has produced
clinically useful data on the effects of heel height on muscle activations and postural changes; this
study has confirmed that it is imprudent for women to repeatedly wear high-heeled shoes, and the
obtained data can provide information to assist the clinician in identifying and analyzing the STS mo-
tion, and in determining appropriate interventions.

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