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.     

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.     

Does load position affect gait and subjective responses of females during load carriage?

Recreational hikers carry heavy loads while often walking long distances over uneven terrain. Previous studies have suggested that not only the load mass but also the position of the load may influence load carriage. The purpose of this study was to determine the effect of vertical load position on gait and subjective responses of female recreational hikers. Fifteen experienced female hikers walked for 2 km over a simulated hiking trail carrying 30% BW in three vertical load positions (high, medium and low). Lower limb and trunk kinematic, electromyography (EMG) and ground reaction force (GRF) data were collected together with heart rate (HR), ratings of perceived exertion (RPE) and discomfort measures. Although HR, RPE and discomfort measures were not able to discern statistical differences between load positions, the high load position was the most preferred by participants. The high load position also resulted in a more upright posture (p < 0.001), decreased gastrocnemius integrated EMG compared to the medium (p = 0.005) and low load positions (p = 0.02) and a higher first peak deceleration vertical GRF compared to the low load position (p = 0.011). However, the absolute differences were small and unlikely to be functionally relevant in load carriage studies. Based on the findings of this study, a high, medium or low load position cannot be preferentially recommended for healthy, experienced, female hikers carrying 30% BW.     

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.     

A suite of objective biomechanical measurement tools for personal load carriage system assessment

For application to military and civilian needs, Defence Research and Development Canada--Toronto contracted Queen's University, Kingston to develop a suite of biomechanical assessment and analytical tools to supplement human-based load carriage system assessment methods. This suite of tools permitted efficient objective evaluation of biomechanical aspects of load-bearing webbing, vests, packs and their components, and therefore contributed to early system assessment and a rapid iterative design process. This paper is a summary of five assessment and analytical tools. A dynamic load carriage simulator was developed to simulate cadence of walking, jogging and running. The simulator comprised a computer-controlled pneumatic platform that oscillated anthropometrically weighted mannequins of varying dimensions from which measures of skin contact pressure, hip reaction forces and moments and relative pack-person displacements were taken. A stiffness tester for range of motion provided force-displacement data on pack suspension systems. A biomechanical model was used to determine forces and moments on the shoulders and hips, and validated using a static load distribution mannequin. Subjective perceptual rating systems were used gather soldier feedback during a standardized mobility circuit. Objective outcome measures were validated by means of other objective measures (e.g., Optotrak, video, Instron, etc.) and then compared to subjective ratings. This approach led to development of objective performance criteria for load carriage systems and to improvements in load carriage designs that could be used both in the military and in general.     

A suite of objective biomechanical measurement tools for personal load carriage system assessment

For application to military and civilian needs, Defence Research and Development Canada—Toronto contracted Queen's University, Kingston to develop a suite of biomechanical assessment and analytical tools to supplement human-based load carriage system assessment methods. This suite of tools permitted efficient objective evaluation of biomechanical aspects of load-bearing webbing, vests, packs and their components, and therefore contributed to early system assessment and a rapid iterative design process. This paper is a summary of five assessment and analytical tools. A dynamic load carriage simulator was developed to simulate cadence of walking, jogging and running. The simulator comprised a computer-controlled pneumatic platform that oscillated anthropometrically weighted mannequins of varying dimensions from which measures of skin contact pressure, hip reaction forces and moments and relative pack-person displacements were taken. A stiffness tester for range of motion provided force-displacement data on pack suspension systems. A biomechanical model was used to determine forces and moments on the shoulders and hips, and validated using a static load distribution mannequin. Subjective perceptual rating systems were used gather soldier feedback during a standardized mobility circuit. Objective outcome measures were validated by means of other objective measures (e.g., Optotrak®, video, Instron®, etc.) and then compared to subjective ratings. This approach led to development of objective performance criteria for load carriage systems and to improvements in load carriage designs that could be used both in the military and in general.     

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.     

Physical work and strain involved in manual sorting of postal parcels

A field study was conducted to assess cardiorespiratory and musculoskeletal stress and strain and work output during manual sorting of postal parcels, and to detect the effects of parcel sorting on the maximal muscle strength and endurance. The volunteer subjects comprised 32 healthy male sorters with mean (+/- s.d.) age of 34 +/- 7 years at five different sorting sites. Each subject was studied during one evening work shift. During the shift of 391 +/- 46 min the subjects manually sorted 1173 +/- 630 parcels and walked 4.7 +/- 2.3 km with and without the load. While sorting, heart rate was 101 +/- 18 beats min-1. In the heaviest tasks the oxygen consumption was 1.2 +/- 0.41 min-1, and no elevated blood lactate concentrations were found. Work postures in which the back was bent forward averaged 24% of the time for sorting. The overall cardiorespiratory rating and local ratings of perceived exertion for arms, back, and legs did not exceed the 'somewhat strong' level during the work shift. The maximal static strength both for the right and left hand-grip muscles was, on average, 3% lower (p less than 0.05) after the work shift than before the shift. No significant differences were found in the static or dynamic endurance times for the hand-grip muscles when the results obtained after the work shift were compared to the baseline values. At sorting centres the stress and strain on the cardiorespiratory and musculoskeletal system was evaluated to remain within acceptable limits for healthy male sorters.     

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.     

Comparison of five modes of carrying a load close to the trunk†

Abstract

This study was designed to investigate the cardiorespiratory, metabolic, and subjective responses to carrying a load close to the trunk in five different ways. Each of five subjects carried a load equivalent to 35% body weight (BW) for one hour at 4-5 km hr^?1 and 0%grade on a motor driven treadmill using each of the following modes of load carriage: (1) the total load carried in a backpack with frame (BP/F), (2) the total load carried in a backpack with no frame (BP/NF), (3) half the load in a backpack (with frame) and half in pouches attached to a waist belt (BP/WB), (4) half the load in a backpack (with frame) and half in a front pack on the chest (BP/FP), and (5) the total load carried as a trunk jacket (TJ), i.e. a military type ‘flak’ jacket with weights inserted in pockets evenly distributed about the trunk. There were no statistically significant differences in the mean cardiorespiratory and metabolic costs associated with each of the five modes of load carriage. However, BP/FP and TJ were subjectively rated as significantly (P < 001) more comfortable than BP/F and BP/NF, suggesting that there may be physiological differences between the five modes of load carriage which were not detected by the cardiorespiratory and metabolic measurements used in this study (i.e. heart rate, oxygen consumption and minute ventilation). In contrast, the BP/FP was reported to be the hardest to don and doff and was associated with a statistically significant (P <0-05) restrictive type of ventilatory impairment. In conclusion, in practical terms there may seldom be a single ‘best’ way to carry a 35% BW load close to the trunk.     

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.     

Integrating a hip belt with body armour reduces the magnitude and changes the location of shoulder pressure and perceived discomfort in soldiers*

Soldiers carry heavy loads that may cause general discomfort, shoulder pain and injury. This study assessed if new body armour designs that incorporated a hip belt reduced shoulder pressures and improved comfort. Twenty-one Australian soldiers completed treadmill walking trials wearing six different body armours with two different loads (15 and 30 kg). Contact pressures applied to the shoulders were measured using pressure pads, and qualitative assessment of comfort and usability were acquired from questionnaires administered after walking trials. Walking with hip belt compared to no hip belt armour resulted in decreased mean and maximum shoulder pressures (p < 0.005), and 30% fewer participants experiencing shoulder discomfort (p < 0.005) in best designs, although hip discomfort did increase. Laterally concentrated shoulder pressures were associated with 1.34-times greater likelihood of discomfort (p = 0.026). Results indicate body armour and backpack designs should integrate a hip belt and distribute load closer to shoulder midline to reduce load carriage discomfort and, potentially, injury risk.

Practitioner Summary: Soldiers carry heavy loads that increase their risk of discomfort and injury. New body armour designs are thought to ease this burden by transferring the load to the hips. This study demonstrated that designs incorporating a hip belt reduced shoulder pressure and shoulder discomfort compared to the current armour design.     

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)     

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.     

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° ± 3.0 and 33.9° ± 7.1 respectively) increased (p < 0.05) with load (LAW, 25.5° ± 2.3 and 37.8° ± 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.     

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.     

Load carriage using packs: a review of physiological, biomechanical and medical aspects

This paper reviews the biomedical aspects of transporting loads in packs and offers suggestions for improving load-carriage capability. Locating the load mass as close as possible to the body center of gravity appears to result in the lowest energy cost when carrying a pack. Thus, the double pack (half the load on the front of the body and half the load on the back) has a lower energy cost than the backpack. However, backpacks provide greater versatility in most situations. The energy cost of walking with backpack loads increases progressively with increases in load mass, body mass, walking speed or grade; type of terrain also influences energy cost. Predictive equations have been developed for estimating the energy cost of carrying loads during locomotion but these may not be accurate for prolonged (>2 h) or downhill carriage. Training with loads can result in greater energy efficiency since walking with backpack loads over several weeks decreases energy cost. Load-carriage speed can be increased with physical training that involves regular running and resistance training. Erector spinae electrical activity (EMG) is lower during load carriage than in unloaded walking until loads exceed 30-40 kg, at which point erector spinae EMG activity is higher than during unloaded walking. EMGs of the quadriceps and gastrocnemius, but not the tibialis anterior or hamstrings, increase with load. Framed packs with hip belts reduce the electrical activity of the trapezius muscles, presumably by shifting forces from the shoulders to the hips. Increases in the backpack load mass result in increases in forces exerted on the grounds, amount of knee flexion and the forward inclination of the trunk. Compared to backpacks, double packs produce fewer deviations from normal walking. Common injuries associated with prolonged load carriage include foot blisters, stress fractures, back strains, metatarsalgia (foot pain), rucksack palsy (shoulder traction injury) and knee pain. Closed-cell neoprene insoles and use of an acrylic or nylon sock, combined with a wool sock, reduce blister incidence. A framed pack with a hip belt reduces the incidence of rucksack palsy. Backpack load carriage can be facilitated by lightening loads, optimizing equipment, improving load distribution and by preventive action aimed at reducing the incidence of injury.     

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 x 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 x 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.     

Effect of uphill walking with varying grade and speed during load carriage on muscle activity

Indian soldiers, while guarding the mountainous border areas, often carry loads in steep uphill gradients. This activity may predispose the risk of muscle injury. The present study aimed to examine the effects of an increasing load, speed and gradient during incremental uphill treadmill walking on different muscles. Twelve infantry soldiers walked on a treadmill at two speeds (2.5 and 4 km/h) with no load, and carrying 10.7, 17 and 21.4 kg loads at 0, 5, 10, 15, 20, 25% gradients. Electromyographic responses of erector spinae (>240%) and vastus medialis (>240%) were mostly affected, followed by soleus (>125%) and gastrocnemius medialis (>100%) at maximum speed, load and gradient combination compared to 0% gradient. Carrying 10.7 kg at 15% gradient and above was found to be highly strenuous and fatiguing with the risk of muscle injury. Uphill load carriage in slower speed is recommended for the maintenance of combat fitness of the individual at higher gradients.

Practitioner Summary:

The present article has evaluated the stress encountered by soldiers during load carriage at incremental uphill gradients while walking at different speeds by recording the muscular activities. Load carriage in steep uphill gradients is highly strenuous and may lead to muscle injury thus compromising the combat fitness.     

Effect of load mass on posture, heart rate and subjective responses of recreational female hikers to prolonged load carriage

Load carriage has been associated with a risk of upper and lower limb musculoskeletal disorders with women suffering significantly higher injury rates than their male counterparts. Despite this injury risk, there are limited evidence-based guidelines for recreational hikers, particularly female recreational hikers, regarding safe backpack loads. The purpose of the present study was to determine how variations in load mass affected the heart rate, posture and subjective responses of women during prolonged walking to provide evidence for a load mass limit for female recreational hikers. Heart rate (HR), posture and ratings of perceived exertion (RPE) and discomfort were collected for 15 female experienced recreational hikers (22.3 ± 3.9 years) while they hiked for 8 km at a self-selected pace under four different load conditions (0%, 20%, 30% and 40% of body weight (BW)). Although HR was not significantly affected by load mass or walking distance, increasing load mass and distance significantly affected posture, RPE and discomfort of the upper body. Carrying a 20% BW load induced significant changes in trunk posture, RPE and reported shoulder discomfort compared to the unloaded condition. The 20% BW load also resulted in a mean RPE rating of ‘fairly light’, which increased to ‘hard’ when carrying a 40% BW load. As load carriage distance increased participants reported significantly increased shoulder, neck and upper back discomfort. Based on the changes to posture, self-reported exertion and discomfort when carrying loads of 20%, 30% and 40% BW over 8 km, it was concluded that a backpack load limit of 30% BW should be recommended for female recreational hikers during prolonged walking.