Influence of carrying heavy loads on soldiers' posture, movements and gait

Military personnel are required to carry heavy loads whilst marching; this load carriage represents a substantial component of training and combat. Studies in the literature mainly concentrate on physiological effects, with few biomechanical studies of military load carriage systems (LCS). This study examines changes in gait and posture caused by increasing load carriage in military LCS. The four conditions used during this study were control (including rifle, boots and helmet carriage, totalling 8 kg), webbing (weighing 8 kg), backpack (24 kg) and a light antitank weapon (LAW; 10 kg), resulting in an incremental increase in load carried from 8, 16, 40 to 50 kg. A total of 20 male soldiers were evaluated in the sagittal plane using a 3-D motion analysis system. Measurements of ankle, knee, femur, trunk and craniovertebral angles and spatiotemporal parameters were made during self-paced walking. Results showed spatiotemporal changes were unrelated to angular changes, perhaps a consequence of military training. Knee and femur ranges of motion (control, 21.1 degrees +/- 3.0 and 33.9 degrees +/- 7.1 respectively) increased (p < 0.05) with load (LAW, 25.5 degrees +/- 2.3 and 37.8 degrees +/- 1.5 respectively). The trunk flexed significantly further forward, confirming results from previous studies. In addition, the craniovertebral angle decreased (p < 0.001) indicating a more forward position of the head with load. It is concluded that the head functions in concert with the trunk to counterbalance load. The higher muscular tensions necessary to sustain these changes have been associated with injury, muscle strain and joint problems.     

Effects of military load carriage on kinematics of gait

Manual load carriage is a universal activity and an inevitable part of the daily schedule of a soldier. Indian Infantry soldiers carry loads on the waist, back, shoulders and in the hands for a marching order. There is no reported study on the effects of load on gait in this population. It is important to evaluate their kinematic responses to existing load carriage operations and to provide guidelines towards the future design of heavy military backpacks (BPs) for optimising soldiers' performance. Kinematic changes of gait parameters in healthy male infantry soldiers whilst carrying no load (NL) and military loads of 4.2–17.5 kg (6.5–27.2% body weight) were investigated. All comparisons were conducted at a self-selected speed. Soldier characteristics were: mean (SD) age 23.3 (2.6) years; height 172.0 (3.8) cm; weight 64.3 (7.4) kg. Walk trials were collected using a 3-D Motion Analysis System. Results were subjected to one-way ANOVA followed by Dunnett post hoc test. There were increases in step length, stride length, cadence and midstance with the addition of a load compared to NL. These findings were resultant of an adaptive phenomenon within the individual to counterbalance load effect along with changes in speed. Ankle and hip ranges of motion (ROM) were significant. The ankle was more dorsiflexed, the knee and hip were more flexed during foot strike and helped in absorption of the load. The trunk showed more forward leaning with the addition of a load to adjust the centre of mass of the body and BP system back to the NL condition. Significant increases in ankle and hip ROM and trunk forward inclination (≥10°) with lighter loads, such as a BP (10.7 kg), BP with rifle (14.9 kg) and BP with a light machine gun (17.5 kg), may cause joint injuries. It is concluded that the existing BP needs design improvisation specifically for use in low intensity conflict environments.

Statement of Relevance:The present study evaluates spatial, temporal and angular changes at trunk and limb joints during military load carriage of relatively lighter magnitude. Studies on similar aspects on the specific population are limited. These data can be used for optimising load carriage and designing ensembles, especially a heavy BP, for military operations.     

Low back pain: Some real answers

The aim of this study was to simultaneously assess the changes in physiology, and kinematic and spatiotemporal features of gait, during prolonged load carriage in individuals without load carriage experience. Eleven males, representative of new military recruits, walked for 120 min at 5.5 km h^? 1, 0% grade, on a motorised treadmill while carrying a 22 kg load. The load ( ≤ 30% body mass) was distributed over a weighted vest, combat webbing and replica model firearm, to reflect a patrol order load. Oxygen consumption and heart rate increased throughout the trial; however, apart from a minor increase in step length, there were no changes in the kinematic or spatiotemporal parameters, despite an increase in perceived exertion and discomfort. These data suggest that individuals with no experience in load carriage are able to maintain normal gait during 2 h of fixed speed walking, while carrying a patrol order load ≤ 30% body mass.     

The effect of load distribution within military load carriage systems on the kinetics of human gait

Military personnel carry their equipment in load carriage systems (LCS) which consists of webbing and a Bergen (aka backpack). In scientific terms it is most efficient to carry load as close to the body's centre of mass (CoM) as possible, this has been shown extensively with physiological studies. However, less is known regarding the kinetic effects of load distribution. Twelve experienced load carriers carried four different loads (8, 16, 24 and 32 kg) in three LCS (backpack, standard and AirMesh). The three LCS represented a gradual shift to a more even load distribution around the CoM. Results from the study suggest that shifting the CoM posteriorly by carrying load solely in a backpack significantly reduced the force produced at toe-off, whilst also decreasing stance time at the heavier loads. Conversely, distributing load evenly on the trunk significantly decreased the maximum braking force by 10%. No other interactions between LCS and kinetic parameters were observed. Despite this important findings were established, in particular the effect of heavy load carriage on maximum braking force. Although the total load carried is the major cause of changes to gait patterns, the scientific testing of, and development of, future LCS can modify these risks.     

The effect of military load carriage on 3-D lower limb kinematics and spatiotemporal parameters

The 3-D gait analysis of military load carriage is not well represented, if at all, within the available literature. This study collected 3-D lower limb kinematics and spatiotemporal parameters in order to assess the subsequent impact of carrying loads in a backpack of up to 32 kg. Results showed the addition of load significantly decreased the range of motion of flexion/extension of the knee and pelvic rotation. Also seen were increases in adduction/abduction and rotation of the hip and pelvis tilt. No changes to ankle kinematics were observed. Alterations to the spatiotemporal parameters of gait were also of considerable interest, namely, an increase in double support and a decrease in preferred stride length as carried load increased. Analysing kinematics during military or recreational load carriage broadens the knowledge regarding the development of exercise-related injuries, while helping to inform the human-centred design process for future load carrying systems. The importance of this study is that limited available research has investigated 3-D lower limb joint kinematics when carrying loads.     

A comparison of economy and sagittal plane trunk movements among back-, back/front- and head-loading

It has been suggested that freedom of movement in the trunk could influence load carriage economy. This study aimed to compare the economy and sagittal plane trunk movements associated with three load carriage methods that constrain posture differently. Eighteen females walked at 3?km^.h^?1 with loads of 0, 3, 6, 9, 12, 15 and 20?kg carried on the back, back/front and head. Load carriage economy was assessed using the Extra Load Index (ELI). Change in sagittal plane trunk forward lean and trunk angle excursion from unloaded to loaded walking were assessed. Results show no difference in economy between methods (p?=?.483), despite differences in the change in trunk forward lean (p?=?.001) and trunk angle excursion (p?=?.021) from unloaded to loaded walking. We conclude that economy is not different among the three methods of load carriage, despite significant differences in sagittal plane trunk movements.

Practitioner summary: This article shows, based on mean data, that there is no difference in economy among back, back/front and head-loading, despite differences in trunk movement. It is possible a combination of factors align to influence individual economy, rather than a single set of factors, applicable to all individuals for each method.     

The reliability of the Extra Load Index as a measure of relative load carriage economy

Abstract

The aim of this study was to measure the reliability of the extra load index (ELI) as a method for assessing relative load carriage economy. Seventeen volunteers (12 males, 5 females) performed walking trials at 3 km·h^?1, 6 km·h^?1 and a self-selected speed. Trial conditions were repeated 7 days later to assess test–retest reliability. Trials involved four 4-minute periods of walking, each separated by 5 min of rest. The initial stage was performed unloaded followed in a randomised order by a second unloaded period and walking with backpacks of 7 and 20 kg. Results show ELI values did not differ significantly between trials for any of the speeds (p = 0.46) with either of the additional loads (p = 0.297). The systematic bias, limits of agreement and coefficients of variation were small in all trial conditions. We conclude the ELI appears to be a reliable measure of relative load carriage economy.

Practitioner Summary: This paper demonstrates that the ELI is a reliable measure of load carriage economy at a range of walking speeds with both a light and heavy load. The ELI, therefore, represents a useful tool for comparing the relative economy associated with different load carriage systems.     

Standard and alternative methods of stretcher carriage: performance,human factors,and cardiorespiratory responses

Transporting a casualty on a stretcher is a common task for medical and military personnel. Stretchers are usually carried by hand, but distributing the load to other parts of the body may have advantages. To examine alternative carriage methods, 11 soldiers walked on a treadmill at 4.8 km/h while performing two person carries of a stretcher containing an 80-kg manikin. In separate trials, soldiers carried the stretcher using: (1) hand carriage, (2) shoulder straps, (3) a specially designed harness that allowed load shifting between the hips and shoulders (hip-shoulder system), and (4) a clip that fitted on the belt of standard military load carrying equipment (LCE) and placed the stretcher mass mainly on the hips. With each system, subjects walked until volitional fatigue or 30 min. While walking, expired gases and heart rates were obtained and subjects rated their perceived exertion (Borg Scale). At the conclusion of all four trials, subjects rated each system on a number of subjective measures. Results showed that average (±SD) carriage times were 2.7±1.4, 14.5±8.3, 25.4±8.1, and 21.7±9.9 min with the hand, shoulder, hip-shoulder and LCE systems respectively (p<0.01). Hand carriage resulted in considerably more cardiorespiratory stress (higher heart rate and minute ventilation, p<0.05) than the other three systems, but there were few consistent differences among the other three systems. Perceived exertion in the upper body was less with the hip-shoulder and LCE systems than with the other two systems (p<0.05). Subjects preferred the hip-shoulder and LCE systems overall and for specific subjective characteristics such as comfort, ease of use and stability (p<0.01). These data indicate that moving the stretcher load from the hands and placing that load on the shoulders and/or hips results in improved performance, reduced cardiorespiratory stress and favourable subjective evaluations. Further developmental work should focus on the hipshoulder and LCE systems.     

Gender difference in mobile phone use and the impact of digital device exposure on neck posture

This cross-sectional study aimed to identify gender differences in the cervical postures when young adults were using mobile phones, as well as the correlations between the postures and the digital devices use (computer and mobile phone). Questionnaires regarding the habits of computer and mobile phone use were administrated to 429 subjects aged from 17 to 33 years old (19.75 ± 2.58 years old). Subjects were instructed to stand habitually and use a mobile phone as in daily life; the sagittal head and cervical postures were measured by head flexion, neck flexion angle and gaze angle. Male participants had a significantly larger head flexion angle (96.41° ± 12.23° vs. 93.57° ± 12.62°, p = 0.018) and neck flexion angle (51.92° ± 9.55° vs. 47.09° ± 9.45°, p < 0.001) than females. There were significant differences in head (F = 3.62, p = 0.014) and neck flexion (F = 3.99, p = 0.009) between different amounts of computer use.

Practitioner Summary: We investigated possible gender differences in head and neck postures of young adults using mobile phones, as well as the potential correlations between these postures and digital device use. We found that males displayed larger head and neck flexion angles than females, which were associated with the amount of computer use.     

A review of: “Visual Display Terminals and Workers' Health”, WHO Offset Publications 99, WHO,Geneva (1987), pp. vi + 206, Sw. F32, $19.20, ISBN 92 4 170099 8

Abstract

Military training aims to improve load carriage performance and reduce risk of injuries. Data describing the lumbar spine (LS) postural response to load carriage throughout training are limited. We hypothesised that training would reduce the LS postural response to load. The LS posture of 27 Marines was measured from upright MR images: with and without load (22.6 kg) at the beginning, middle, and end of School of Infantry (SOI) training. Disc degeneration was graded at L5–S1. No changes in posture and disc degeneration were found throughout training. During load carriage the LS became less lordotic and the sacrum more horizontal. Marines with disc degeneration had larger sacral postural perturbations in response to load. Our findings suggest that the postural response to load is defined more by the task needs than by the physical condition of the Marine.

Practitioner Summary: The effect of military training on lumbar spine posture is unknown. The lumbar posture of 27 Marines was measured from upright MR images, with and without load throughout infantry training. No changes in posture or IVD degeneration were found across training. Marines with degeneration at the L5–S1 level had larger sacral postural perturbations in response to load.     

Maximal manual stretcher carriage: performance and recovery of male and female ambulance workers

The effects of a maximal duration stretcher carriage on heart rate (HR), lactate concentration, hand steadiness and hand-grip strength were studied up to 72 h post-exercise in 17 male and 15 female military ambulance personnel. Using both hands for transport, the participants walked on a treadmill ergometer at a speed of 4.5 km/h. Force measurements at the handlebars yielded mean loads of 245 N (25 kg) on each side. Each step on the treadmill induced additional force oscillations with peak forces up to 470 N corresponding to 130% (women) and 98% (men) of maximal voluntary contraction (MVC). In the males the maximal transport time was about twice the time in women (mean ± SD: 184 ± 51 s vs. 98 ± 34 s). These differences had no significant effect on HR and lactate values. The same applies to hand steadiness, which showed only a transient deterioration immediately after exercise. In contrast to these parameters, substantial differences were seen in hand-grip strength recovery. Immediately after exercise, maximal hand-grip strength decreased by 150 N (25% MVC) in the males vs. 50 N (14%) in the females. Irrespective of gender, individuals with larger hand-grip strength and longer carriage durations (range 120 s–280 s) showed the slowest strength recoveries (up to 72 h) as compared to 1 h of recovery in participants with short transport durations (range 27 s–120 s). These findings suggest that the increasing number of eccentric strains during uninterrupted stretcher carriage induces cumulative muscle damages that may require some days for complete recovery.     

Strategies for increasing evaporative cooling during simulated desert patrol mission

The study evaluated the efficiency of two heat dissipation strategies under simulated desert patrol missions. Ten men participated in four trials, during which they walked on a treadmill (45°C, 20% relative humidity), carrying a load of 35 kg; two 50-min walks were separated by a 20-min rest. Cooling strategies, provided by an ambient air-ventilated vest (active cooling condition, AC), or water spraying of the skin during the rest (passive cooling condition, PC), in addition to reduced clothing and open zippers, were compared to conditions with full protective (FP) clothing and naked condition (NC). Skin temperature was higher during NC (37.9 ± 0.4°C; p < 0.001), and rectal temperature and heart rate were higher during FP (38.6 ± 0.4°C, p < 0.001 and 145 ± 12, p < 0.001, respectively), compared to other conditions. Four subjects terminated the trial prematurely due to signs of heat exhaustion in FP. Both cooling strategies substantially improved evaporative cooling.     

DEXA-assessed regional body composition changes in young female military soldiers following 12-weeks of periodised training

Dual-energy X-ray absorptiometry (DEXA) was used to assess whole body and regional soft tissue mass, fat mass and lean body mass compositional changes in 68 female recruits (age 20.8 ± 1.14 years; body mass 59.5 ± 8.79 kg; stature 159.57 ± 5.53 cm) pre- and post 12-weeks of military basic training. A decrease in total body fat tissue mass (10.2%) and regional percent fat (10.9%) was measured with an increase in total lean body mass (8.7%). Of interest were the differences in the responses in the tissue composition of the arms (16.2% loss in fat mass with an 11.6% gain in lean mass), trunk (17.0% decrease in fat mass with a 10.4% increase in lean mass) and the legs (10.5% increase in lean mass but no change in fat mass). These findings show the importance of considering regional rather than whole body composition changes when assessing the effects of a training programme.

Statement of Relevance: Female soldiers experienced a change in total body fat tissue (?10.2%) and lean body mass (+8.7%) after basic training; however, no significant fat mass decrease was evident in the leg region. Regional rather than whole body composition changes need to be considered when assessing the effects of a training programme.     

The effects of horizontal load speed and lifting frequency on lifting technique and biomechanics

Lifting loads that have a horizontal velocity (e.g. lifting from a conveyor) is often seen in industry and it was hypothesised that the inertial characteristics of these loads may influence lifting technique and low back stress. Seventeen male participants were asked to perform lifting tasks under conditions of four horizontal load speeds (0 m/s, 0.7 m/s, 1.3 m/s and 2.4 m/s) and two lifting frequencies (10 and 20 lifts/min) while trunk motions and trunk muscle activation levels were monitored. Results revealed that increasing horizontal load speed from 0 m/s to 2.4 m/s resulted in an increase in peak sagittal angle (73° vs. 81°) but lower levels of peak sagittal plane angular acceleration (480°/s² vs. 4°/s²) and peak transverse plane angular acceleration (200°/s per s vs. 140°/s per s) and a consistent increase in trunk muscle co-activation. Participants used the inertia of the load to reduce the peak dynamics of the lifting motion at a cost of increased trunk flexion and higher muscle activity.

Statement of Relevance: Conveyors are ubiquitous in industry and understanding the effects of horizontal load speed on the lifting motions performed by workers lifting items from these conveyors may provide some insight into low back injury risk posed by these tasks.     

Metabolic and perceptual responses while carrying external loads on the head and by yoke

Abstract

The purpose of this study was to determine the metabolic efficiency and perceptual acceptability of transporting external loads on the head and by yoke. Ten young males (24·2 ±3·9 years) of average physical fitness ([Vdot]O_2max=49·8 ± 6·5ml kg^-1 min^-1) walked for 6min on a level motor-driven treadmill at 53·6, 73·8 and 93·9m min^-1. Subsequently, all subjects carried external loads (11·6, 16·1 and 20·6 kg) at the same speeds using the headpack (HP), transverse yoke (TY) and frontal yoke (FY) modes of load carriage. Measurements were obtained for oxygen uptake ([Vdot]O₂ l min^-1), local ratings of perceived exertion (RPE-L) and the overall perceived exertion (RPE-O). The [Vdot]O₂ was used in the computation of the metabolic efficiency ([Vdot]O₂ ml kg total weight^-1 min^-1).

Significant main effects (mode, load and speed) and three interaction effects (mode × load, mode × speed and load × speed) were obtained for metabolic efficiency. Scheffé post hoc analysis revealed that the metabolic efficiency for the TY and HP were greater than the FY while transporting the 16·1 and 20·6kg loads at all walking speeds (p <0·05). No significant loss in metabolic efficiency was found while carrying the 20·6kg load at 53·6 m min^-1. At 93·9 m min^-1, all external loads transported were associated with a loss in metabolic efficiency. The RPE-L for the HP was lower than the FY (p < 0·05). Both the RPE-0 and RPE-L increased as the walking speeds and external loads were increased. The findings suggest that load transportation using the FY system is both physiologically and perceptually unacceptable.     

Kinetic changes associated with load carriage using two rucksack designs

This study assessed changes in kinetics from unloaded walking associated with load carriage using both a traditional and a new rucksack design that incorporates front balance pockets (AARN). Nine subjects walked at 3(±0.05) km.h^-1 over a force plate unloaded and carrying 25.6 kg in each of the rucksacks. The order of trials was randomized and speed-controlled by use of photoelectric cells and a millisecond timer. Anteroposterior and vertical ground reaction forces were analyzed using repeated measures ANCOVA (speed covariate). There was a trend for the AARN pack to elicit a shorter support time than the traditional pack, 1.025±0.049 versus 1.037±0.06 s (p = 0.056), while the unloaded condition produced the shortest support time, 1.016±0.04 s. Both braking and propulsive forces for the rucksacks were significantly greater than for unloaded walking. While there was no significant difference between the packs for the braking force, the AARN pack produced a significantly lower (p < 0.05) propulsive force than the traditional rucksack, 0.79±0.2 versus 0.94±0.16 N.kg bodyweight^-1. Both rucksacks produced significantly greater (p < 0.001) vertical force peaks than unloaded walking, the increases being proportional to the increase in system weight. These findings indicate that there may be some advantage in terms of propulsive force production for the front/back system.     

Impact of military type footwear and load carrying workload on postural stability

Postural stability has been shown to be impacted by footwear and task performed. This study analysed the impact of two military footwear, standard boot (STB) and minimalist boot (MTB) on postural stability, before (PRE) and after (POST) a load carriage task. Sixteen participants were tested for postural stability using sensory organisation and motor control tests on Neurocom Equitest?. Postural sway, equilibrium scores and postural latencies were analysed using a two-factor repeated measures ANOVA: boot type (STB-MTB)?×?time (PRE-POST) load carriage task. Significantly greater postural sway variables, lower balance scores and slower postural latencies were seen in STB and POST load carriage conditions (p?<?.05). The results suggest that MTB exhibited greater balance compared to STB in balance conditions that rely on somatosensory feedback and that balance is lowered after a load carriage task. Decrements in postural stability could be attributed to boot design characteristics and muscular exertion due to the load carriage task.

Practitioner Summary: Maintaining optimal postural stability is crucial in military. Impact of military footwear types and load carriage task on postural stability are addressed. Findings provide footwear design and physical exertion implications on postural stability leading to potential interventions that reduce postural stability decrements; thereby, reducing potential falls and fall related injuries.     

Maximal and sub-maximal functional lifting performance at different platform heights

Introducing valid physical employment tests requires identifying and developing a small number of practical tests that provide broad coverage of physical performance across the full range of job tasks. This study investigated discrete lifting performance across various platform heights reflective of common military lifting tasks. Sixteen Australian Army personnel performed a discrete lifting assessment to maximal lifting capacity (MLC) and maximal acceptable weight of lift (MAWL) at four platform heights between 1.30 and 1.70 m. There were strong correlations between platform height and normalised lifting performance for MLC (R² = 0.76 ± 0.18, p < 0.05) and MAWL (R² = 0.73 ± 0.21, p < 0.05). The developed relationship allowed prediction of lifting capacity at one platform height based on lifting capacity at any of the three other heights, with a standard error of < 4.5 kg and < 2.0 kg for MLC and MAWL, respectively.     

The interrelationship of the thorax and pelvis under varying task constraints

The purpose of this study was to investigate the interrelationship between the thorax and pelvis during coupled movement patterns. Fifty-seven participants were assessed using an infrared motion analysis system to track trunk movement during maximal pelvis and thorax rotations over four trunk inclinations and two pelvic constraint conditions. A repeated-measures multivariate analysis of variance investigated the effects of forward trunk inclination and pelvic constraint on thorax and pelvic rotation. Forward trunk inclination from neutral to 45° resulted in a 46% (p < 0.001) decrease in axial pelvic rotation and a 15% (p < 0.001) decrease in axial thorax rotation with an unconstrained pelvis. A constrained pelvis resulted in a 15% (p < 0.001) decrease in axial thorax rotation. An externally constrained pelvis allowed the thorax to achieve an average of 18° (SD = 2°) greater rotational range of motion across all angles. This study reinforced the importance of allowing the pelvis to rotate during whole body axial rotation tasks.

Practitioner Summary: Results indicated that maximum axial trunk rotation is best achieved in a neutral posture, when the pelvis is allowed to contribute and flexion at the hips should be minimised. For example, if a recumbent task requires rotation of the torso, then the chair seat should be allowed to swivel.     

The effect on sitting posture of a desk with a 10° inclination for reading and writing

Abstract

A pilot study was carried out on 10 subjects to examine the effect that a desk with a 10° inclination had on their sitting posture while reading and writing. A continuous recording of the subjects head and trunk positions was made. Each subject was studied during two periods of 1·5 h on different days. The subject worked at a flat desk on the first day and at a desk with a 10° inclination on the second. On average, the position of the head in the sagittal plane was found to be 6° more erect and the position of the trunk 7° more erect when working at a desk with a 10° inclination than when working at a flat desk. The maximal decrease in load observed on the cervical spine was 35% and on the thoracic spine 95%. The angle between the head and the trunk did not change significantly when using an inclined desk. Differences in posture in the frontal plane were not observed in this study.