Effect of single and double strap backpacks on lung function

Carrying heavy and moderate military loads in backpacks or as body armour compresses the chest, causing a change in lung function that is typical of a restrictive ventilatory impairment. It is not known if a lighter backpack load of only 6?kg, such as is typical of loads carried by students, will have a similar effect on lung function. There have been no studies examining whether backpacks of different strapping styles have an effect on lung function. Several designs of student backpack have recently been introduced to the market. One of the most popular is a single-strap backpack. This study examined Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV₁), FEV₁.FVC^???1% and Peak Expiratory Flow (PEF) in 13 participants (4 males, 9 females) wearing each of two 6?kg backpacks, one with two shoulder straps (a Double Strap Backpack (DSB)) and the other with a single strap (a Single Strap Backpack (SSB)) worn across the shoulder and chest. In comparison with the control of no pack (N), SSB significantly reduced FVC (by 3.94%, p?=?0.006) but there were no significant differences in FEV₁, FEV₁. FVC^???1% and PEF. The DSB also significantly reduced FVC (by 1.97%, p?=?0.034) but no significant differences were found in FEV₁, FEV₁. FVC^???1% and PEF measures. In comparison with DSB, the SSB was associated with a significantly lower FVC (by 2.05%, p?=?0.049) and FEV₁ (by 1.88%, p?=?0.029) but there were no significant changes in FEV₁. FVC^???1% and PEF. It is concluded that a backpack load of 6?kg could produce a mild restrictive type of ventilatory impairment in lung function. This effect was greater for a single cross-chest strap than for a more conventional double strap harness.     

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.     

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.     

Load carriage induced alterations of pulmonary function

Load carriage systems supported by the trunk have been shown to decrease certain indices of pulmonary function. We investigated the hypothesis that these pulmonary function reductions are directly related to the backpack load carrier due to the mechanical constraint to imposes on the thoracic cage. To investigate this hypothesis, 5 young males with no pulmonary disorders were tested while standing upright carrying well-fitted 0, 10 or 30 kg loaded U.S. Army ALICE backpacks. Forced vital capacity (FVC), forced expiratory volume (FEV₁) and 15 s maximal voluntary ventilation (MVV₁₅) were measured. With increasing load, FVC and FEV₁ progressively decreased reaching 6 and 6.7% decrements (p < 0.05), respectively, with the 30 kg load. The MVV₁₅ was decreased (p <0.05) by about 8.4% with the 10 kg load, but did not demonstrate any further decrement with the 30 kg load. Analysis of flow-volume loops obtained with the 0 and 30 kg loads showed that the reduction of FVC was not associated with any decrement of peak inspiratory or expiratory flows. These results indicate a limitation on the ventilatory pump caused by load carriage which is directly related to the load carried and characteristic of restrictive disease of the respiratory system (reduced FVC and FEV₁ with no decrement in FEV₁/FVC).     

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 (FEF_0.2?–?1.2) after the start of expiration and between 25 and 75% of each FVC (FEF_25?–?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 FEF_25?–?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 FEF_0.2?–?1.2 (by 7.3%, p?<?0.05) and FEF_25?–?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), FEF_25?–?75% (by 13.8%, p?<?0.01) and a fall in FEF_0.2?–?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.     

The effect of simulated school load carriage configurations on shoulder strap tension forces and shoulder interface pressure

Recently, several studies have addressed the physical demands of school student's load carriage, in particular the load weight carried, using physical demands indicators such as oxygen consumption, gait, and posture. The objective of this study was to determine the effects of different load carriage configurations on shoulder strap tension forces and shoulder interface pressure during simulated school student's load carriage. A load carriage simulator was used to compare shoulder strap forces and shoulder pressure for 32 combinations of gait speed, backpack weight, load distribution, shoulder strap length and use of a hip-belt. The results showed that the manipulation of backpack weight, hip-belt use and shoulder strap length had a strong effect on shoulder strap tension and shoulder pressure. Backpack weight had the greatest influence on shoulder strap tension and shoulder pressure, whereas hip-belt use and then shoulder strap adjustment had the next greatest effects, respectively. While it is clear that researchers and practitioners are justified in focusing on load magnitude in backpack studies as it has the greatest effect on shoulder forces, hip-belt use and shoulder strap adjustment should also be examined further as they too may have significant effects on the demands placed on backpack users. Based on the present findings, school students should wear their backpacks with the least weight possible, use the hip-belt if present, allow a reasonable amount of looseness in the shoulder straps and should position the heaviest items closest to their back. However, more detailed work using human participants needs to be undertaken before these recommendations can be confirmed.     

Impact of backpack type on respiratory muscle strength and lung function in children

We examine the influence of backpack type on lung function and respiratory muscle strength in children. Thirty-seven children were assessed for lung function and inspiratory and expiratory muscle strength under four randomly determined conditions: unloaded erect standing and three conditions carrying 15% of the child's body weight. In these three conditions, children carried the weight on a backpack with bilateral shoulder straps carried over both shoulders, on a backpack with bilateral shoulder straps carried over one shoulder and on a backpack with a mono shoulder strap. Significantly lower forced vital capacity, forced expiratory volume in one second and maximal expiratory pressure were observed when children carried a backpack with a mono shoulder strap compared to the unloaded standing position. In conclusion, the restrictive effect and the decrease in expiratory muscle strength were more pronounced for the backpack with a mono shoulder strap, suggesting that a double strap backpack is preferable to a mono shoulder strap backpack.

Practitioner summary: There is little known about the effect of schoolbags on respiratory muscle function. We investigated the influence of backpack type on lung function and respiratory muscle strength. A backpack with a mono shoulder strap created a restrictive effect and a decrease in strength, suggesting that a double strap backpack is preferable to a mono shoulder strap backpack.     

School backpack design: A systematic review and a summary of design items

The purpose of this paper is to systematically review the recent literatures to obtain a summary of significant items (see Table B1) for better student backpack design for health improvement, as well as to identify gaps for further research. A systematic review was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), targeting papers of the last 20 years. Thirty-six studies were included, assessed and synthesised. Four categories of design-related items were summarised: Biomechanical consideration, Strap, Dimension and Carrying method. Quality assessments were completed for the included studies by utilising different tools. The major health outcomes associated with the design-related items were posture, perception, metabolic cost, lung function, contact pressure of foot or shoulder, and muscle activity. An optimal location for the centre of mass of a backpack could not be ascertained from this review in the aspect of spinal curvature and postural displacement, and there was usually no best input that induced the best outcome in every dimension. Oscillation in the medial-lateral direction should be minimised, and wider shoulder strap should be utilised, together with hip straps. Different carrying methods, such as double pack, BackTpack, modified backpack, and frontpack, were superior to the traditional backpack, whereas the single-strap pack should be avoided. Some gaps, such as lack of standardised protocol and evidence for clinical significance, were identified. Meanwhile, the risk of bias is commonly high for recent studies.     

Subjective perceptual methods for comparing backpacks in the field

Subjective perceptual methods have provided useful information in the laboratory about small differences in backpack design when physiological and biomechanical comparisons are ineffective, but have never been used in the field. This study therefore evaluated, in a controlled field trial with 10 male participants, the suitability of quantitative and qualitative subjective perceptual approaches to distinguish between subtle design differences in two backpacks, each loaded to 15 kg. In addition, initial quantitative subjective impressions about the two backpacks during a 15 min simulated 'in-shop' trial were compared with post-field trial backpack preference. In the simulated 'in-shop' trial the participants 'tried out' the backpack in a manner that was very similar to the way that they would normally try out a backpack as if they were considering buying one in an 'outdoor' shop. It included donning and doffing the pack several times and walking around the room wearing the backpack. In the controlled field trial, participants carried the two backpacks for approximately 15 min around a 1313 m hilly outdoor track at a self-selected walking pace which elicited a moderate exercise intensity. Seven participants preferred backpack A. Three preferred backpack B. The qualitative approach, which required participants to provide free-format written responses to semi-structured open-ended questions immediately after the field trial, successfully identified specific reasons underlying participants' preferences. The main reasons for preferring backpack A were better balance, weight distribution, stability up and down hill and over obstacles, fewer pressure points on their back and easier strap location and adjustment. The quantitative approach, which involved participants responding to written post-field trial questions on visual analogue or category ratio rating scales, was generally unsuccessful in distinguishing between backpacks. Thus, qualitative subjective perceptual methods appeared to be more useful than quantitative ones in distinguishing between backpacks and in identifying positive and negative design features under controlled field conditions in which participants carry a backpack at a moderately intense self-selected exercise level. However, since the quantitative approach had been successful in distinguishing between backpacks in an earlier similar study, in which participants exercised more intensely by walking uphill on a treadmill at a fixed pace, it is possible that the quantitative subjective perceptual approach may be capable of distinguishing between backpacks in the field if a fixed pace eliciting higher exercise intensity were to be used. Finally, since quantitative responses to questions about the backpacks after a short simulated 'in-shop' trial closely agreed with participants' post-field trial overall backpack preference, it is concluded that initial subjective impressions may be a good guide to backpack preference after limited field usage.     

Subjective perceptual methods for comparing backpacks in the field

Subjective perceptual methods have provided useful information in the laboratory about small differences in backpack design when physiological and biomechanical comparisons are ineffective, but have never been used in the field. This study therefore evaluated, in a controlled field trial with 10 male participants, the suitability of quantitative and qualitative subjective perceptual approaches to distinguish between subtle design differences in two backpacks, each loaded to 15 kg. In addition, initial quantitative subjective impressions about the two backpacks during a 15 min simulated ‘in-shop’ trial were compared with post-field trial backpack preference. In the simulated ‘in-shop’ trial the participants ‘tried out’ the backpack in a manner that was very similar to the way that they would normally try out a backpack as if they were considering buying one in an ‘outdoor’ shop. It included donning and doffing the pack several times and walking around the room wearing the backpack. In the controlled field trial, participants carried the two backpacks for approximately 15 min around a 1313 m hilly outdoor track at a self-selected walking pace which elicited a moderate exercise intensity. Seven participants preferred backpack A. Three preferred backpack B. The qualitative approach, which required participants to provide free-format written responses to semi-structured open-ended questions immediately after the field trial, successfully identified specific reasons underlying participants' preferences. The main reasons for preferring backpack A were better balance, weight distribution, stability up and down hill and over obstacles, fewer pressure points on their back and easier strap location and adjustment. The quantitative approach, which involved participants responding to written post-field trial questions on visual analogue or category ratio rating scales, was generally unsuccessful in distinguishing between backpacks. Thus, qualitative subjective perceptual methods appeared to be more useful than quantitative ones in distinguishing between backpacks and in identifying positive and negative design features under controlled field conditions in which participants carry a backpack at a moderately intense self-selected exercise level. However, since the quantitative approach had been successful in distinguishing between backpacks in an earlier similar study, in which participants exercised more intensely by walking uphill on a treadmill at a fixed pace, it is possible that the quantitative subjective perceptual approach may be capable of distinguishing between backpacks in the field if a fixed pace eliciting higher exercise intensity were to be used. Finally, since quantitative responses to questions about the backpacks after a short simulated ‘in-shop‘ trial closely agreed with participants' post-field trial overall backpack preference, it is concluded that initial subjective impressions may be a good guide to backpack preference after limited field usage.     

Comparison of four different backpacks intended for school use

Four backpacks were evaluated for their desireability for use as school bags. Three of the four backpacks were specifically designed for school use based on previous research and ergonomic principles while the fourth (standard) backpack was chosen from two backpacks that their manufacturer considered to be the most likely to be used as a school bag. Twelve school students evaluated each of the backpacks firstly by examining them, again after donning them and again after walking with them on a treadmill by completing a questionnaire asking about the appearance, function and comfort of each backpack. On initial examination, the standard backpack was the most favoured but as functionality became increasingly important during the treadmill walk, the backpack which was designed specifically for school use and had two major compartments, substantial back padding and side compression straps became the most favoured. This particular design of backpack was reported as having the greatest practicality, being the least physically demanding and allowing the greatest balance and ease of walking. The results of this study suggest that school student's preference of backpack may change from when they first examine a prospective backpack to when they have used it. The study also shows that school students' preferred attributes in a backpack may shift over this time from 'style and image' to 'function and fit'.     

一种保护青少年脊柱健康的减重背包设计与研究

目前市面上的青少年背包主要通过肩部来进行载荷,而忽略了腰部载荷的作用。背包长期负重 不当会影响脊柱生长。为了平衡肩部、腰部和臀部的载荷,设计一种通过臀部带和弹性杆结构改变重力传递方 式的减重背包。首先对人体背包进行生物力学分析,提出设计方案;然后借助 ADAMS 对传统背包与减重背包 在平地、上坡、下坡 3 种路况下进行人体肩部、腰部和臀部载荷的动力学仿真,并利用 MATLAB 对 2 种背包 的肩部、腰部和臀部的力矩进行分析。结果表明减重背包减轻了肩部 6.1%和腰部 5.4%力矩;减重背包肩部力 矩与腰臀部合力矩的比值是 4.17,而传统背包的比值是 6.58。减重背包减少了肩部和腰部的载荷,同时发现肩 部力矩与腰、臀部合力矩的比值越小,转移到臀部的力矩越大,背包的平衡性越好,表明了减重背包优于传统 背包。     

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.     

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.     

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.     

A modified backpack design for male school children

The purpose of this paper is to test the suitability of a modified backpack that distributes the carrying loads on the school children's chest and back. Sixty one (7.4 yr ± 0.97), sixty (11.7 yr ± 1.05), fifty eight (15.7 yr ± 1.18) and fifty nine (18.9 yr ± 1.45) school children were participated in the study representing the first, second, third and fourth group, respectively. They carried 0%, 5%, 10%, 15%, 20% and 25% of body weight in both commercial and modified backpacks while walking for 5 min. Main response measures were normalized rectus abdominus and erector spinae muscular activities, exertion ratings and cardiac cost, which is defined as the difference between heart rate of last walking minute and standing heart rate. The stresses on rectus abdominus and erector spinae muscles while wearing commercial backpack were significantly higher than those when participants worn modified backpack. Cardiac costs were significantly less in the case of the modified backpack compared to the commercial backpack case. Also, participants felt more comfortable while wearing the modified backpack compared to wearing commercial backpack. This paper showed that modified backpack was superior to commercial backpack in terms of less muscular activities, less cardiac costs and less exertion ratings. Moreover, the proposed design prevents the students from carrying their loads in one side. This study provides the community with a modified backpack that increases comfort and decreases pain. The student's preference of backpack may change when they use it.     

便携式哮喘检测系统的研究

针对现有的机械式峰流速仪的不足和哮喘病人医院肺功能检查费用昂贵、不方便的特点,设计了一种便携式的家用电子哮喘检测系统,能够实现对哮喘患者呼气峰流速（PEF）和一秒呼气量（FEV1）的测量。整个检测系统由文丘里流量传感器、差压传感器、信号调理模块、TFT显示模块、SD卡存储模块和微控制器等部分构成。对设计的呼气流量传感器进行了标定,对整个系统进行了测试,测试结果表明该检测系统能够实现对呼气峰流速和一秒呼气量的快速测量,这对于哮喘患者进行日常测量和发病前的监测预报具有实际应用价值。     

The effects of backpack type on lumbo-pelvic coordination during trunk bending and return tasks

Abstract

Backpacks with ergonomic features are recommended to mitigate the risk of developing low back pain due to carrying a heavy school backpack. A repeated measure study was conducted on 40 college-age students to investigate the immediate changes in magnitude and timing aspects of lumbo-pelvic coordination when carrying an ergonomically modified vs. a normal backpack relative to no backpack condition during trunk forward bending and backward return tasks. We found a smaller reduction in the thoracic range of rotation, an increase vs. a decrease in pelvic range of rotation and a larger reduction in lumbar flexion for a modified vs. a normal backpack. Furthermore, during the forward bending, a less in-phase motion for the modified backpack was observed. Our results suggest that participants have likely experienced larger spinal loads with the modified backpack; a conclusion that should be investigated in future to determine whether ergonomic backpacks can reduce the risk of low back pain in children.

Practitioner summary: Research participants performed trunk bending and return closer to their habitual way under modified versus normal school backpack. From an equilibrium point of view, therefore, individuals are likely experiencing larger spinal loads during activities of daily living with a modified backpack. However, such a conclusion may change when considering stability requirements.     

Effects of backpack and double pack loads on postural stability

Measurement of postural stability is crucial for identifying predictors of performance, determining the efficacy of physical training and rehabilitation techniques and evaluating and preventing injuries, particularly for heavy load carriage in hikers, mountain search and rescue personnel and soldiers. This study investigated the effect of load distribution on postural stability in an upright stance using backpack and double pack loads under conflicting or impaired somatosensory, visual and vestibular conditions. The sensory organisation tests were conducted on 20 young adults before and after a 10-min level walking exercise. Young adults’ ability to use inputs from somatosensory and visual systems to maintain postural stability was significantly reduced following a 10-min walking exercise with a heavy backpack (30% of body weight), whereas no significant changes were observed for double pack carriage. Thus, the distribution of heavy loads to the front and back provides superior balance control compared with back-only loading.

Practitioner summary: This study investigated the effects of heavy (30% of body weight) load distribution on postural stability after a 10-min walking exercise. Backpack carriage significantly reduced postural stability, whereas there was no significant effect under double pack loads. Distribution of heavy loads on the front-and-back is desirable for superior balance control.     

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.