The effect of backpack load on the gait of normal adolescent girls

Concerns regarding the effects of load carriage have led to recommendations that backpacks be limited to 10?–?15% of body weight, based on significant changes in physical performance. However, gait responses to backpack loads are not entirely consistent and there is a particular lack of data regarding load-bearing gait in adolescent females. Gait patterns of 22 normal adolescent girls were recorded at backpack loads of 0, 7.5, 10.0, 12.5 and 15.0% body weight. Temporal-distance, ground reaction force and joint kinematic, moment and power parameters were analysed by repeated measures ANOVA with factors of backpack load and side (left or right).

Walking speed and cadence decreased significantly with increasing backpack load, while double support time increased. Kinematic changes were most marked at the proximal joints, with a decreased pelvic motion but a significant increase in the hip sagittal plane motion. Increased moments and power at the hip, knee and ankle showed increasing demand with backpack load. Parameters showed different responses to increasing load, and those that suggested a critical load indicated this to be approximately 10% body weight. While this may be due to a change in gait due to increased demand, further work is required to verify this and also to examine the cumulative effects of backpack load on the musculoskeletal system, which may be more appropriate in determining recommended load limits.     

Effects of backpack load and positioning on nonlinear gait features in young adults

Overloaded backpacks can cause changes in posture and gait dynamic balance. Therefore, the aim of this study was to assess gait regularity and local dynamic stability in young adults as they carried a backpack in different positions, and with different loads. Twenty-one healthy young adults participated in the study, carrying a backpack that was loaded with 10 and 20% of their body weight (BW). The participants walked on a level treadmill at their preferred walking speeds for 4 min under different conditions of backpack load and position (i.e. with backpack positioned back bilaterally, back unilaterally, frontally or without a backpack). Results indicate that backpack load and positioning significantly influence gait stability and regularity, with the exception of the 10% BW bilateral back position. Therefore, the recommended safe load for school-age children and adolescents (10% of BW) should also be considered for young adults.

Practitioner summary: Increase in load results in changes in posture, muscle activity and gait parameters, so we investigated the gait adaptations related to regularity and stability. Conditions with high backpack loads significantly influenced gait stability and regularity in a position-dependent manner, except for 10% body weight bilateral back position.     

Effect of backpack load on the head,cervical spine and shoulder postures in children during gait termination

Twelve boys with an average age of 9.9 years were instructed to carry backpacks that weighed 0%, 10% and 15% of their body weights (BWs) to complete planned and unplanned gait termination experiments. The craniohorizontal, craniovertebral and sagittal shoulder posture angles at the sagittal plane as well as the anterior head alignment and coronal shoulder posture angles at the coronal plane were analysed. Results revealed significantly smaller craniohorizontal and sagittal shoulder posture angles during planned gait termination and a significantly smaller sagittal shoulder posture angle during unplanned gait termination under loaded conditions compared with those at 0% BW backpacks. Furthermore, the coronal shoulder posture angles at 10% and 15% BW during planned and unplanned gait terminations were significantly larger than those at 0% BW. Therefore, subjects were more likely to have a forward head posture, rounded shoulder posture and increased lateral tilting of the shoulders during gait termination as backpack loads were increased. However, gait termination, whether planned or unplanned, did not elicit a remarkable effect on posture.     

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.     

Effects of backpack load placement on pulmonary capacities of normal schoolchildren during upright stance

Backpack carriage affects posture, physiological costs and physical performance. Limited literature concerning the effects of backpack load placement on pulmonary capacities of schoolchildren has been reported. The objective was to assess the effects of backpack load placement on pulmonary capacities of normal schoolchildren. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁), peak expiratory flow (PEF), and forced expiratory flow (FEF_25–75%) were measured in 22 normal schoolchildren with a mean age of 12 years during free standing and when carrying a backpack of 15% bodyweight with its center of gravity positioned at T7, T12 and L3. The main effect of load was found to be significant for FVC and FEV₁. However, no significant effect of load placements on the pulmonary function of schoolchildren was found. Manipulation of load placements may not alleviate the restrictive effects exerted on the pulmonary function resulted from backpack load carriage.

Relevance to industry

Daily carriage of a school backpack on the musculoskeletal health of children and adolescents has become an area of concern. Restrictive effects on the pulmonary function due to backpack carriage were reported and it is useful to explore whether these effects could be alleviated by manipulating the backpack center of gravity level.     

Evaluation of book backpack load during walking

This investigation evaluated accumulated mean and peak impact forces per stride and per metre associated with two book backpack loads and two cadences during single and double support phases of walking. Thirty college participants randomly performed three trials while either walking a self-selected cadence or fixed cadence without (empty pack) or with a load (15% body mass) carried in a bookbag. The fixed cadence (55.5 steps/min) was regulated by a metronome. A computerized Kistler force platform system (phase-locked timing device) recorded (200 Hz) three-dimensional reaction forces, impulses, and time in single and double support phases. A Panasonic video camera AG-450 was set perpendicular to the plane of walking motion to film (60 Hz) the walking pattern from which stride length and selected kinematic data were determined. Repeated measure ANOVA (p ^< 0.05) determined differences of loads and cadences in walking. Accumulated force was evaluated as impulses per stride and impulses per metre (stress index). When carrying the 15% load, there was a decrease in speed, a decrease in single support time (SST), and an increase in double support time (DST). The impulses per stride significantly increased in DST, and significantly decrease in SST. When impulses were analysed per metre, the stress index signficantly increased in DST, but not during SST. These differences in SST may be important when load stress is applied to the single support leg/foot in any given distance of walking. While stride analysis identifies accumulative forces resulting from varying stride lengths, the stress index provides a standardized measure per metre of the accumulative forces that negate the variances of individual stride lengths, and the index measure can easily represent data for any given distance traversed.     

Evaluation of book backpack load during walking

This investigation evaluated accumulated mean and peak impact forces per stride and per metre associated with two book backpack loads and two cadences during single and double support phases of walking. Thirty college participants randomly performed three trials while either walking a self-selected cadence or fixed cadence without (empty pack) or with a load (15% body mass) carried in a bookbag. The fixed cadence (55.5 steps/min) was regulated by a metronome. A computerized Kistler force platform system (phase-locked timing device) recorded (200 Hz) three-dimensional reaction forces, impulses, and time in single and double support phases. A Panasonic video camera AG-450 was set perpendicular to the plane of walking motion to film (60 Hz) the walking pattern from which stride length and selected kinematic data were determined. Repeated measure ANOVA (p<0.05) determined differences of loads and cadences in walking. Accumulated force was evaluated as impulses per stride and impulses per metre (stress index). When carrying the 15% load, there was a decrease in speed, a decrease in single support time (SST), and an increase in double support time (DST). The impulses per stride significantly increased in DST, and significantly decrease in SST. When impulses were analysed per metre, the stress index signficantly increased in DST, but not during SST. These differences in SST may be important when load stress is applied to the single support leg/foot in any given distance of walking. While stride analysis identifies accumulative forces resulting from varying stride lengths, the stress index provides a standardized measure per metre of the accumulative forces that negate the variances of individual stride lengths, and the index measure can easily represent data for any given distance traversed.     

The metabolic cost of backpack and shoulder load carriage.

Eleven healthy male volunteer soldiers (mean [SD] age 24.0 [2.8] years, stature 174.1 [5.2] cm, body weight 73.2 [10.8] kg, body fat 14.2 [5.0]% and maximal oxygen uptake 4.1 [0.4] 1 min-1) walked at 4.8 km h-1 on a motor driven treadmill for 5 min at each of three gradients (0, 2.5 and 5%) whilst carrying a two-part 26 kg load either on each shoulder or strapped to a backpack frame. The load was made up of two cylinders, one weighing 18.4 kg and the other weighing 7.6 kg. For all treadmill gradients the mean (SD) backpacking heart rates and oxygen uptakes (0% gradient, 122 [10] beats min-1, 1.51 [0.11] 1 min-1; 2.5% gradient, 135 [10] beats min-1, 1.81 [0.13] 1 min-1; 5% gradient, 155 [7] beats min-1, 2.21 [0.11] 1 min-1) were significantly (p less than 0.001) lower than for shoulder load carriage (0% gradient, 130 [9] beats min-1, 1.70 [0.12] 1 min-1, 2.5% gradient, 147 [8] beats min-1; 2.01 [0.10] 1 min-1; 5% gradient 164 [9] beats min-1, 2.39 [0.11] 1 min-1). The relative oxygen cost of backpacking was 4.3-4.7% VO2 max lower than for shoulder load carriage. It is concluded that the metabolic cost of backpacking an asymmetric two part 26 kg load was significantly less than for shoulder load carriage when walking at 4.8 km h-1 on a treadmill over gradients of 0-5%.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of load position on physiological and perceptual responses during load carriage with an internal frame backpack

The purpose of this study was to determine the effect of load position in an internal frame backpack on physiological and perceptual variables. Ten female participants walked on a level treadmill for 10?min carrying 25% of their body weight in a high, central, or low position. The variables measured included oxygen consumption (VO₂), heart rate (HR), respiratory exchange ratio (R), respiratory rate (RR), minute ventilation (VE), and rating of perceived exertion (RPE). VO₂, VE, and RPE were significantly lower in the high position (18.6?±?2.3?ml/kg/min, 31.7?±?5.0?l/min, 2.8?±?0.8, respectively) compared to the low position (22.2?±?3.0?ml/kg/min, 38.6?±?7.5?l/min, 3.7?±?1.0, respectively). HR, R, and RR did not change significantly as the load was moved from the high (129.8?±?16.8, 0.89?±?0.06, 30.3?±?4.2, respectively) to the low position (136.0?±?25.3, 0.92?±?0.04, 33.8?±?5.2, respectively). The results of this study suggest that load placement is an important factor in the physiological and perceptual responses to load carriage, and that packing heavy items high in the backpack may be the most energy efficient method of carrying a load on the back.     

Effect of load position on physiological and perceptual responses during load carriage with an internal frame backpack

The purpose of this study was to determine the effect of load position in an internal frame backpack on physiological and perceptual variables. Ten female participants walked on a level treadmill for 10 min carrying 25% of their body weight in a high, central, or low position. The variables measured included oxygen consumption (VO2), heart rate (HR), respiratory exchange ratio (R), respiratory rate (RR), minute ventilation (VE), and rating of perceived exertion (RPE). VO2, VE, and RPE were significantly lower in the high position (18.6 +/- 2.3 ml/kg/min, 31.7 +/- 5.0 l/min, 2.8 +/- 0.8, respectively) compared to the low position (22.2 +/- 3.0 ml/kg/min, 38.6 +/- 7.5 l/min, 3.7 +/- 1.0, respectively). HR, R, and RR did not change significantly as the load was moved from the high (129.8 +/- 16.8, 0.89 +/- 0.06, 30.3 +/- 4.2, respectively) to the low position (136.0 +/- 25.3, 0.92 +/- 0.04, 33.8 +/- 5.2, respectively). The results of this study suggest that load placement is an important factor in the physiological and perceptual responses to load carriage, and that packing heavy items high in the backpack may be the most energy efficient method of carrying a load on the back.     

Protocols used to determine the influence of backpack load on physiological variables. Systematic review

Professional mountain rescue mountain groups use backpack equipment in their professional activities. The velocity of ambulation, gradient, load and the participant's physical characteristics have been described in the scientific literature as influential factors on response to exercise. The purpose of the present systematic review is to assess the protocols used to investigate the effects of backpacks and their influence on physiological responses at laboratory. A total of 14 articles were included in the review. Most research studies indicated participants were not experienced with backpack carriage. We observed a certain threshold on physiological changes in response to exercise was between 20 and 40 kg of backpack load. In conclusion, there is a heterogeneity of protocols used at the laboratory, hampering the comparison between different results. Future research should focus on the design of protocols that reproduce real scenarios of targeted populations.Relevane to industryRescue groups, firefighters and military personnel carry load with backpack in emergency interventions. This review analyzes different types of methodological protocols that investigate the influence of backpack load on physiological responses during exercise. The result will help manufacturer design backpacks considering the physiological burden of backpack carriage.     

The effect of wearing high-heels and carrying a backpack on trunk biomechanics

Carrying a bag while wearing high-heels during daily life could potentially cause back pain. No study has investigated the combined effects of wearing a backpack and high-heels on trunk biomechanics from a system-level interaction viewpoint. Consequently, this study aimed to investigate the effects of high-heel height, backpack weight, and habituation in high-heels use on upper body biomechanics. Sixteen female study participants, all in their 20s, were divided into high-heel USER and NON-USER groups, and asked to carry a backpack with 0%, 5% and 10% of their body weight while either not wearing or wearing (0 cm and 9 cm) high-heels. Trunk kinematics and muscle activations were measured under the neutral standing posture while gazing straight ahead in experimental trials. First, the USERS tended to show hyper-lumbar lordosis when wearing high-heels, but the NON-USERS experienced lumbar kyphosis. In line with this, the USERS showed significantly greater recruitment of back muscles (35.5%), but the NON-USERS tended to recruit significantly more abdominal muscles (80%) to control their posture. Second, carrying a backpack sequentially induced posterior pelvic tilting, lumbar kyphosis, and forward head posture which is a stereotype posture of the hyper-kyphotic back and which suggests a system-level interaction from the lower extremity to the head. Third, the backpack weight eliminated the effect of wearing high-heels in the lumbar flexion angle, which may act as a counterbalance to pull the center of gravity (CoG) posteriorly.Relevance to industryCaution must be taken in the long-term use of high-heels and a backpack. Carrying a backpack weighing about 5% of the body weight is recommended to counterbalance the hyper-lordotic lumbar posture when wearing high-heels if unavoidable.     

Short-term effects of backpack load placement on spine deformation and repositioning error in schoolchildren

Backpack weight of 10–15% has been recommended as an acceptable limit for schoolchildren. However, there is still no clear guideline regarding where the backpack centre of gravity (CG) should be positioned. The changes of spinal curvature and repositioning error when carrying a backpack loaded at 15% of body weight at different CG locations (anterior or posterior at T7, T12 or L3) in schoolchildren were analysed. Both spinal curvature and repositioning error were found to be affected by backpack anterior–posterior position and CG level. A relatively smaller change was observed during anterior carriage with the least change when the backpack CG was positioned at T12. The results also suggested that alternative carriage by changing the backpack position occasionally between anterior and posterior positions might help to relieve the effects of backpack on spine. However, future study is recommended to further substantiate the beneficial effects of alternative carriage on children.

Statement of Relevance: Anteriorly carried backpack with centre of gravity positioned at T12 was shown to induce relatively less effect on spinal deformation and repositioning error in schoolchildren. Changing backpack carriage position occasionally may help to relieve its effects on spinal deformation. The findings are important for ergonomic schoolbag design and determining a proper load carriage method.     

Evaluation of the effect of backpack load and position during standing and walking using biomechanical, physiological and subjective measures

Recommendations on backpack loading advice restricting the load to 10% of body weight and carrying the load high on the spine. The effects of increasing load (0%-5%-10%-15% of body weight) and changing the placement of the load on the spine, thoracic vs. lumbar placement, during standing and gait were analysed in 20 college-aged students by studying physiological, biomechanical and subjective data. Significant changes were: (1) increased thorax flexion; (2) reduced activity of M. erector spinae vs. increased activation of abdominals; (3) increased heart rate and Borg scores for the heaviest loads. A trend towards increased spinal flexion, reduced pelvic anteversion and rectus abdominis muscle activity was observed for the lumbar placement. The subjective scores indicate a preference for the lumbar placement. These findings suggest that carrying loads of 10% of body weight and above should be avoided, since these loads induce significant changes in electromyography, kinematics and subjective scores. Conclusions on the benefits of the thoracic placement for backpack loads could not be drawn based on the parameter set studied.     

Evaluation of the effect of backpack load and position during standing and walking using biomechanical,physiological and subjective measures

Recommendations on backpack loading advice restricting the load to 10% of body weight and carrying the load high on the spine. The effects of increasing load (0%–5%–10%–15% of body weight) and changing the placement of the load on the spine, thoracic vs. lumbar placement, during standing and gait were analysed in 20 college-aged students by studying physiological, biomechanical and subjective data. Significant changes were: (1) increased thorax flexion; (2) reduced activity of M. erector spinae vs. increased activation of abdominals; (3) increased heart rate and Borg scores for the heaviest loads. A trend towards increased spinal flexion, reduced pelvic anteversion and rectus abdominis muscle activity was observed for the lumbar placement. The subjective scores indicate a preference for the lumbar placement. These findings suggest that carrying loads of 10% of body weight and above should be avoided, since these loads induce significant changes in electromyography, kinematics and subjective scores. Conclusions on the benefits of the thoracic placement for backpack loads could not be drawn based on the parameter set studied.     

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.     

Effects of backpack load on critical changes of trunk muscle activation and lumbar spine loading during walking

This study investigated the effects of carrying a backpack while walking. Critical changes featuring the disproportionality of increases in trunk muscle activation and lumbar joint loading between light and heavy backpack carriage weight may reveal the load-bearing strategy (LBS) of the lumbar spine. This was investigated using an integrated system equipped with a motion analysis, a force platform and a wireless surface electromyography (EMG) system to measure the trunk muscle EMG amplitudes and lumbar joint component forces. A predictive goal programming model was developed to determine the most critical changes in trunk muscle activation and lumbar joint loading. Results suggested that lightweight backpack carriage at approximately 3% of body weight (BW) might reduce the peak lumbosacral compression force by 3% during walking compared with no load condition. The most critical changes in both trunk muscle activation and lumbosacral joint loading were found at a backpack load of 10% of BW.

Practitioner Summary: This study investigated the effects of backpack load on the LBS of lumbar spine while walking. A backpack load of 3% of BW might reduce the peak lumbosacral compression force by 3 and 10% of BW induced the most critical changes in LBS of lumbar spine.     

Influence of the load modelling during gait on the stress distribution in a femoral implant

Introduction

When designing and installing implants, stress analyses should be performed in conditions close to those of everyday use. Specifically, for femoral implants, cyclic loading during gait has been demonstrated to produce fatigue failure. However, there is still no consensus in the literature regarding which modelling procedure is the most appropriate to simulate implant working conditions. This work proposes a method for realistic load modelling of the human body during gait based on flexible multibody dynamics.

Method

The proposed dynamic method was applied to a case study of a lower limb implant that failed by fatigue. The computed stresses were compared to the stresses obtained using the other three methods found in the literature, which are principally based on static or quasi-static load modelling.

Results

For all compared methods, the maximum computed stress was located in the same region of the implant. The maximum stress provided using flexible multibody dynamics was equal to 346 MPa, which was 355% greater than the maximum value given by the static method and 18% greater than the value given by the quasi-static method.

Discussion and conclusion

The proposed dynamic method was in agreement with the conclusions of the previous failure analysis performed on the broken implant. Conversely, the static and quasi-static methods were not representative of the real loading conditions induced by gait. Moreover, the dynamic method emphasizes the pertinence of evaluating the fluctuations in the critical stress during the gait cycle, which is mandatory when studying fatigue failures.

     

Effect of backpack fit on lung function

Carrying loads close to the trunk with a backpack causes a restrictive type of change in lung function in which Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 s (FEV1) are reduced without a corresponding decrement in the FEV1.FVC( - 1) %. It is not known whether this is due to the weight of the load acting on the chest or to the tightness of fit of the shoulder and chest straps and waist belt of the pack harness. This study examined FVC, FEV1, FEV1.FVC( - 1) %, peak expiratory flow (PEF), forced expiratory flow between 0.2 and 1.2 s (FEF0.2 - 1.2) after the start of expiration and between 25 and 75% of each FVC (FEF25 - 75%) in 12 healthy males wearing a 15 kg backpack in which the shoulder and chest straps and hip belt were loosened by 3 cm from a 'comfort fit' to achieve a 'loose pack' fit (LPF) and tightened by 3 cm from CF to achieve a 'tight pack' fit (TPF). In comparison with the control condition of no pack, a loose pack fit significantly reduced FVC (by 3.6%, p < 0.01), FEV1 (by 4.3%, p < 0.01) and FEF25 - 75% (by 8.4%, p < 0.01). A tight pack fit significantly reduced FVC (by 8.1%, p < 0.01) and FEV1 (by 9.1%, p < 0.001). It also significantly reduced FEF0.2 - 1.2 (by 7.3%, p < 0.05) and FEF25 - 75% (by 21%, p < 0.01). In comparison with a loose pack fit, the tight pack fit was associated with a significantly lower FVC (by 4.6%, p < 0.01), FEV1 (by 5.0%, p < 0.01), FEF25 - 75% (by 13.8%, p < 0.01) and a fall in FEF0.2 - 1.2 (by 5.5%). The latter was approaching significance (p = 0.077). There were no significant changes in FEV1.FVC( - 1)% and PEF. It is concluded that tightening the fit of a backpack significantly affects lung function in a manner that is typical of a restrictive change in lung function and is very similar in pattern to that of wearing a loosely fitted loaded backpack. The effect of tightness of fit is additional to that due to the weight of the load alone and may also reduce expiratory flow at low lung volumes.