New research published in forthcoming issue of the journal Spine shows that 'rocker sole' shoes, widely used worldwide to help treat people with lower back pain are no more effective than traditional training shoes (trainers) and that trainers appear to be more beneficial for those with back pain aggravated by standing or walking. This research provides the first robust evidence showing that, contrary to claims made by manufacturers, rocker sole shoes do not help reduce lower back pain. The study was led by Dr Sian MacRae, Kings College London, UK, and colleagues within the UK's National Health Service (NHS) and the University of Hertfordshire.
In this randomised clinical trial, 115 people with chronic lower back pain (LBP) were assigned to wear rocker sole shoes or trainers for a minimum of two hours each day while standing and walking. The primary outcome of the study was the Roland Morris Disability Questionnaire (RMDQ), assessing disability. The shoes used in the study were rocker sole shoes (Masai Barefoot Technology [MBT] Chapa Caviar, Masai GB Limited, London, United Kingdom) or trainers (Gel 1140, ASICS, Warrington, United Kingdom).
In addition, those involved in the study attended an exercise and education programme once a week for four weeks and wore their assigned shoes during these sessions. Participants were assessed without their knowledge of group allocation (prior to being randomly assigned to one of the two groups), and at six weeks, six months, and one year.
Data was available at the end of the study for 44 of 58 (77%) of the rocker sole group and 49 of 57 (85%) of the trainers group. In the rocker sole group, mean reduction in RMDQ was - 3.1, and in the trainers group, it was - 4.4, with the greater negative value representing a greater reduction in disability in the trainers group. At 6 months, more than half of people (53%) wearing trainers demonstrated a minimal clinically important improvement in disability compared with less than a third (31%) of those wearing rocker sole shoes. Between-group differences were not statistically significant for RMDQ or any other study outcomes, such as pain, anxiety levels, depression, or time off work due to back pain at any reassessment point.
People reporting pain when standing and walking at the start of the study (total 59) reported a greater reduction in disability in the trainers group (RMDQ change - 4.4, 29 users) at 12 months than in the rocker sole group (- 2.0, 30 users).
Dr MacRae, a musculoskeletal physiotherapist, says: "Rocker sole shoes seem to be no more beneficial than trainers in affecting disability and pain outcomes in people with chronic LBP. Furthermore, our study shows that trainers appear to be more beneficial for lower back pain aggravated by standing or walking than rocker sole shoes."
She adds: "Rocker sole footwear has been marketed with persuasive advertising suggesting that use of this footwear leads to a reduction in LBP. Manufacturers claim that the unstable curved sole can positively influence mechanisms associated with chronic lower back pain, such as poor balance, substandard muscle function, poor posture, and reduced ability to absorb shock while walking. However, there is no evidence in the literature supporting these claims."
She concludes: "On the basis of the findings of this randomised clinical trial, clinicians should be confident in advising patients with chronic lower back pain that wearing either rocker sole shoes or trainers may offer similar outcomes in disability and pain. However, if a patient reports lower back pain when standing or walking, it may be more beneficial to wear trainers than rocker sole shoes."