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

Walking Slope and Heavy Backpacks Affect Peak and Impulsive Lumbar Joint Contact Forces

Heavy load carriage is associated with musculoskeletal overuse injury, particularly in the lumbar spine. In addition, steep walking slopes and heavy backpacks separately require adaptation of torso kinematics, but the combined effect of sloped walking and heavy backpack loads on lumbar joint contact forces is unclear. Backpacks with hip belt attachments can reduce pressure under the shoulder straps; however, it is unknown if wearing a hip belt reduces lumbar spine forces. We used a musculoskeletal modeling and simulation approach to quantify peak and impulsive L1L2 and L4L5 lumbar joint contact forces in the anterior/posterior shear and compressive directions during walking on 0 deg and ±10 deg slopes, with no backpack and with 40% body weight backpack load using two different backpack configurations (hip belt assisted and shoulder-borne). Both walking slope and backpack load significantly affected shear and compressive peak and impulsive forces. The largest peak shear and compressive forces of 1.57 and 5.23 body weights, respectively, exceed recommended limits and were observed during uphill walking with shoulder-borne loads. However, only impulsive force results revealed differences due to the backpack configuration, and this effect depended on walking slope. During downhill walking only, the hip belt-assisted configuration resulted compressive impulses lower than during shoulder borne by 0.25 body weight seconds for both L1L2 and L4L5. These results indicate that walking uphill with heavy loads causes high shear and compressive lumbar forces that may increase overuse injury risk. In addition, our results suggest it is especially important to wear a hip belt when walking downhill.

Should individuals with unilateral transtibial amputation carry a load on their intact or prosthetic side?

Carrying side loads often occurs during activities of daily living. As walking is most unstable mediolaterally, side load carriage may further compromise gait biomechanics, especially for transtibial amputees (TTAs). This study investigated the effects of side load carriage on gait kinetics during steady-state walking to determine which side, intact or prosthetic, TTAs should carry a load. Twelve unilateral TTAs wore a passive-elastic foot and carried a side load of 13.6 kg while walking at their self-selected speed. Kinetic metrics, including ground reaction force peaks and impulses, loading and unloading rates, and joint moments and powers, were analyzed. TTAs had smaller propulsive forces on their intact limb during the prosthetic side load condition. During the intact side load condition, they had smaller hip flexor moment in late stance and smaller knee flexor moment at the end of swing on their intact limb. They had higher hip and knee abductor moments on their intact limb and prosthetic limb in early and late stance during the contralateral side load condition. TTAs generated higher hip extensor power at weight acceptance during the ipsilateral side load. Significant interactions were observed in hip extensor power and abductor moment, suggesting strong associations between hip extensor power generation and the ipsilateral side load and between hip abductor moment and the contralateral side load. These mixed results demonstrate some kinetic changes due to side load carriage and suggest that the side TTAs should carry a load depends on the desired effects, primarily on their intact limb.

Evaluating the Accuracy of Virtual Reality in Replicating Real-Life Human Postures and Forces for Injury Risk Assessment

The objective of this study was to assess the accuracy of virtual reality (VR) technology in replicating real-life environments for the adoption of appropriate human postures and forces. Despite the widespread implementation of VR in various applications, there is a lack of research evaluating the accuracy of human postures and sensory aspects in the VR environment compared to real-life scenarios. A total of twenty-two student participants were recruited for this study, which involved a common lifting task. Two specific poses were identified as having potentially excessive forces exerted on the lower back. By comparing the angles of seven anatomical joints in both the real environment and the VR environment at each pose, we observed that depth perception may influence posture adoption in the VR setting. Moreover, the presence of a physical load applied to both hands significantly influenced the postures adopted by participants compared to those in the VR environment. These deviations in postures directly led to significant differences in predicted spinal forces exerted on the lower back, which in turn could result in inaccurate assessments of injury risks and the design of injury prevention programs. Therefore, it is crucial to understand the accuracy of VR technology as a substitute for real-life environments.

Validation of Markerless Motion Capture for Soldier Movement Patterns Assessment Under Varying Body-Borne Loads

Field performance of modern soldiers is affected by an increase in body-borne load due to technological advancements related to their armour and equipment. In this project, the Theia3D markerless motion capture system was compared to the marker-based gold standard for capturing movement patterns of participants wearing various body-borne loads. The aim was to estimate lower body joint kinematics, gastrocnemius lateralis and medialis muscle activation patterns, and lower body joint reaction forces from the two motion capture systems. Data were collected on 16 participants performing three repetitions of walking and running under four body-borne load conditions by both motion capture systems simultaneously. A complete musculoskeletal analysis was completed in OpenSim. Strong correlations ( r > 0.8 ) and acceptable differences were observed between the kinematics of the marker-based and markerless systems. Timing of muscle activations of the gastrocnemius lateralis and medialis, as estimated through OpenSim from both systems, agreed with the ones measured using electromyography. Joint reaction force results showed a very strong correlation ( r > 0.9 ) between the systems; however, the markerless model estimated greater joint reaction forces when compared the marker-based model due to differences in muscle recruitment strategy. Overall, this research highlights the potential of markerless motion capture to track participants wearing body-borne loads.

A Review of Natural Fiber-Reinforced Composites for Lower-Limb Prosthetic Designs

This paper presents a comprehensive review of natural fiber-reinforced composites (NFRCs) for lower-limb prosthetic designs. It covers the characteristics, types, and properties of natural fiber-reinforced composites as well as their advantages and drawbacks in prosthetic designs. This review also discusses successful prosthetic designs that incorporate NFRCs and the factors that make them effective. Additionally, this study explores the use of computational biomechanical models to evaluate the effectiveness of prosthetic devices and the key factors that are considered. Overall, this document provides a valuable resource for anyone interested in using NFRCs for lower-limb prosthetic designs.

Influences of backpack loading on recovery from anterior and posterior losses of balance: An exploratory investigation

Backpacks are common devices for carrying external posterior loads. However, relatively little is known about how these external loads affect the ability to recover from balance loss. In this exploratory investigation, 16 young adults (8 female, 8 male) performed forward and backward lean-and-release balance recovery trials, while wearing a backpack that was unloaded or loaded (at 15% of individual body weight). We quantified the effects of backpack loading on balance recovery in terms of maximum recoverable lean angles, center-of-mass kinematics, and temporal-spatial stepping characteristics. Mean values of maximum lean angles were 20° and 9° in response to forward and backward perturbations, respectively. These angles significantly decreased when wearing the additional load for only backward losses of balance. During backward losses of balance, the additional load decreased peak center-of-mass velocity and increased acceleration by ∼10 and 18% respectively, which was accompanied by ∼5% faster stepping responses and steps that were ∼9% longer, 11% higher, and had an ∼10% earlier onset. Thus, wearing a backpack decreases backward balance recovery ability and changes backward recovery stepping characteristics.

Load carriage changes tibiofemoral arthrokinematics during ambulatory tasks in recruit-aged women

The introduction of women into U.S. military ground close combat roles requires research into sex-specific effects of military training and operational activities. Knee osteoarthritis is prevalent among military service members; its progression has been linked to occupational tasks such as load carriage. Analyzing tibiofemoral arthrokinematics during load carriage is important to understand potentially injurious motion and osteoarthritis progression. The study purpose was to identify effects of load carriage on knee arthrokinematics during walking and running in recruit-aged women. Twelve healthy recruit-aged women walked and ran while unloaded (bodyweight [BW]) and carrying additional + 25%BW and + 45%BW. Using dynamic biplane radiography and subject-specific bone models, tibiofemoral arthrokinematics, subchondral joint space and center of closest contact location between subchondral bone surfaces were analyzed over 0-30% stance (separate one-way repeated measures analysis of variance, load by locomotion). While walking, medial compartment contact location was 5% (~ 1.6 mm) more medial for BW than + 45%BW at foot strike (p = 0.03). While running, medial compartment contact location was 4% (~ 1.3 mm) more lateral during BW than + 25%BW at 30% stance (p = 0.04). Internal rotation was greater at + 45%BW compared to + 25%BW (p < 0.01) at 30% stance. Carried load affects tibiofemoral arthrokinematics in recruit-aged women. Prolonged load carriage could increase the risk of degenerative joint injury in physically active women.

Load carriage physiology in normoxia and hypoxia

PURPOSE

To determine the effects of load carriage in normoxia and normobaric hypoxia on ventilatory responses, hemodynamics, tissue oxygenation, and metabolism.

METHODS

Healthy males (n = 12) completed 3 randomly ordered baseline graded exercise tests in the following conditions: (1) unloaded normoxic (U: FIO2 = 20.93%), (2) loaded (~ 30 kg) normoxic (LN), and (3) loaded hypoxic simulating ~ 3650 m (LH: FIO2 =  ~ 13%). Thereafter, experimental exercise trials were completed in quasi-randomized order (i.e., U completed first) consisting of 3 × 10 min of walking (separated by 5 min seated rest) with stages matched with the U condition (in ascending order) for relative intensity, absolute oxygen consumption ([VO2]; 1.7 L min-1), and walking speed (1.45 ± 0.15 m s-1).

RESULTS

Load carriage increased perceived exertion and reduced VO2max (LN: - 7%; LH: - 32%; p < 0.05). At matched VO2, stroke volume and tidal volume were reduced and maintained with LN and LH vs. U, respectively (p < 0.05). Increases in cardiac output and minute ventilation at matched VO2 (with LH) and speed (with LN and LH), were primarily accomplished via increases in heart rate and breathing frequency (p < 0.05). Cerebral oxygenated hemoglobin (O2HHb) was increased at all intensities with LN, but deoxygenated hemoglobin and total hemoglobin were increased with LH (p < 0.05). Muscle oxygen kinetics and substrate utilization were similar between LN and U, but LH increased CHO dependence and reduced muscle O2HHb at matched speed (p < 0.05).

CONCLUSION

Load carriage reduces cardiorespiratory efficiency and increases physiological strain, particularly in hypoxic environments. Potential load carriage-induced alterations in cerebral blood flow may increase the risk for altitude illnesses and requires further study.

Continuous Locomotion Mode and Task Identification for an Assistive Exoskeleton Based on Neuromuscular-Mechanical Fusion

Human walking parameters exhibit significant variability depending on the terrain, speed, and load. Assistive exoskeletons currently focus on the recognition of locomotion terrain, ignoring the identification of locomotion tasks, which are also essential for control strategies. The aim of this study was to develop an interface for locomotion mode and task identification based on a neuromuscular-mechanical fusion algorithm. The modes of level and incline and tasks of speed and load were explored, and seven able-bodied participants were recruited. A continuous stream of assistive decisions supporting timely exoskeleton control was achieved according to the classification of locomotion. We investigated the optimal algorithm, feature set, window increment, window length, and robustness for precise identification and synchronization between exoskeleton assistive force and human limb movements (human-machine collaboration). The best recognition results were obtained when using a support vector machine, a root mean square/waveform length/acceleration feature set, a window length of 170, and a window increment of 20. The average identification accuracy reached 98.7% ± 1.3%. These results suggest that the surface electromyography-acceleration can be effectively used for locomotion mode and task identification. This study contributes to the development of locomotion mode and task recognition as well as exoskeleton control for seamless transitions.

Head-torso coordination in police officers wearing loaded tactical vests during running

BACKGROUND

The influence of load carriage in operational police officers is not well understood despite a relatively high injury rate. Assessing load related changes in head and torso coordination may provide valuable insight into plausible injury mechanisms.

RESEARCH QUESTION

Do typical police tactical vest loads alter head and torso coordination during running?

METHODS

Thirty-eight UK police officers ran at a self-selected pace (>2 ms-1) on a non-motorised treadmill in four vest load conditions (unloaded, and low, high and evenly distributed loads). Peak head and torso tilt, and peak vest displacement were compared between all four conditions. Timings between vest and torso change of direction were compared between the three loaded conditions. The coupling angle between the head and torso calculated using modified vector coding were compared between unloaded and each loaded conditions using Statistical Parametric Mapping.

RESULTS

No significant differences were found between conditions for peak head or torso tilt alone (p > 0.05). Loading equipment low on the vest led to significantly greater mediolateral vest displacements (38 mm) away from the torso than a high (34 mm) or evenly distributed (30 mm) conditions. The vest was found to change direction vertically before the torso in the anterior-posterior direction, and then influence torso motion. The loaded conditions changed the head-torso coupling from in-phase (with head-dominancy) to anti-phase (with torso dominancy) between 55% and 77% stance. Anti-phase with a relatively stationary head and the torso rotating forward likely places a greater concentric demand on the posterior neck muscles relative to unloaded running.

SIGNIFICANCE

Current tactical vest designs allow significant extra displacement of load away from the body during running, altering coordination at the head and torso.

Thermoregulatory and perceptual implications of varying torso soft armour coverage during treadmill walking in dry heat

Modular armour allows soldiers to adjust the level of coverage according to the threat level. We hypothesized that armour configurations with lower levels of torso soft armour coverage attenuate physiological and perceptual responses during exercise in the heat. Fifteen adults (5 females/10 males, 26 ± 5 years) walked (5 km/h, 1% incline, 1h) in dry heat (38 °C, 20% humidity) while wearing body armour that provided; i) high coverage (HC: 0.57 ± 0.09 m2, 18.5 ± 0.3 kg), ii) moderate coverage (MC: 0.44 ± 0.07 m2, 18.1 ± 0.3 kg), iii) low coverage (LC1: 0.21 ± 0.03 m2, 17.4 ± 0.1 kg), or iv) low coverage with weight equalization (LC2: 0.21 ± 0.03 m2, 18.6 ± 0.2 kg). Core temperature (Tcore), heart rate (HR), metabolic heat production (M-W), whole-body sweat rate (WBSR), and perceptual responses were measured. M-W during exercise (629 ± 126 W) did not differ between configurations (p = 0.30). The change in Tcore (HC: 0.88 ± 0.37 °C, MC: 0.85 ± 0.32 °C, LC1: 0.91 ± 0.38 °C, LC2: 0.89 ± 0.42 °C, p = 0.93), HR (HC: 97 ± 14 bpm, MC: 103 ± 16 bpm, LC1: 96 ± 15 bpm, LC2: 97 ± 20 bpm, p = 0.08), and WBSR (HC: 10.2 ± 3.4 g/min, MC: 10.3 ± 4.3 g/min, LC1: 9.9 ± 4.7 g/min, LC2: 10.4 ± 4.5 g/min, p = 0.84) did not differ between configurations. Perceptual responses did not differ between configurations (all p ≥ 0.15). Reducing torso soft armour coverage, with minimal reductions in armour load, does not reduce physiological or perceptual strain during walking in dry heat.

Tibiofemoral Load Magnitude and Distribution During Load Carriage

Chronic exposure to high tibiofemoral joint (TFJ) contact forces can be detrimental to knee joint health. Load carriage increases TFJ contact forces, but it is unclear whether medial and lateral tibiofemoral compartments respond similarly to incremental load carriage. The purpose of our study was to compare TFJ contact forces when walking with 15% and 30% added body weight. Young healthy adults (n = 24) walked for 5 minutes with no load, 15% load, and 30% load on an instrumented treadmill. Total, medial, and lateral TFJ contact peak forces and impulses were calculated via an inverse dynamics informed musculoskeletal model. Results of 1-way repeated measures analyses of variance (α = .05) demonstrated total, medial, and lateral TFJ first peak contact forces and impulses increased significantly with increasing load. Orthogonal polynomial trends demonstrated that the 30% loading condition led to a curvilinear increase in total and lateral TFJ impulses, whereas medial first peak TFJ contact forces and impulses responded linearly to increasing load. The total and lateral compartment impulse increased disproportionally with load carriage, while the medial did not. The medial and lateral compartments responded differently to increasing load during walking, warranting further investigation because it may relate to risk of osteoarthritis.

Spacesuit Center of Gravity Assessments for Partial Gravity EVA Simulation in an Underwater Environment

OBJECTIVE

The objective is to analytically determine the expected CG and build hardware to measure and verify the suited subject's CG for lunar extravehicular activity (EVA) training in an underwater environment.

BACKGROUND

For lunar EVAs, it is necessary for astronauts to train with a spacesuit in a simulated partial gravity environment. NASA's Neutral Buoyancy Laboratory (NBL) can provide these conditions by producing negative buoyancy for a submerged suited subject. However, it is critical that the center of gravity (CG) for the human-spacesuit system to be accurate for conditions expected during planetary EVAs.

METHODS

An underwater force-transducer system and individualized human-spacesuit model was created to provide real-time measurement of CG, including recommendations for weight placement locations and quantity of weight needed on the spacesuit to achieve a realistic lunar spacesuit CG. This method was tested with four suited subjects.

RESULTS

Across tested weighout configurations, it was observed that an aft and high CG location will have large postural differences when compared to low and fore CG locations, highlighting the importance of having a proper CG. The system had an accuracy of ±5lbs of the total lunar weight and within ± 15 cm for fore-aft and left-right CG directions of the model predictions.

CONCLUSION

The developed method offers analytical verification of the suited subject's CG and improves simulation quality of lunar EVAs. Future suit design can also benefit by recommending hardware changes to create ideal CG locations that improve balance and mobility.

APPLICATION

The developed methodology can be used to verify a proper CG location in future planetary EVA simulations such as different reduced gravity training analogs (e.g. active cable offloading systems).

Beyond Nature Versus Nurture: the Emergence of Emotion

Affective science is stuck in a version of the nature-versus-nurture debate, with theorists arguing whether emotions are evolved adaptations or psychological constructions. We do not see these as mutually exclusive options. Many adaptive behaviors that humans have evolved to be good at, such as walking, emerge during development - not according to a genetically dictated program, but through interactions between the affordances of the body, brain, and environment. We suggest emotions are the same. As developing humans acquire increasingly complex goals and learn optimal strategies for pursuing those goals, they are inevitably pulled to particular brain-body-behavior states that maximize outcomes and self-reinforce via positive feedback loops. We call these recurring, self-organized states emotions. Emotions display many of the hallmark features of self-organized attractor states, such as hysteresis (prior events influence the current state), degeneracy (many configurations of the underlying variables can produce the same global state), and stability. Because most bodily, neural, and environmental affordances are shared by all humans - we all have cardiovascular systems, cerebral cortices, and caregivers who raised us - similar emotion states emerge in all of us. This perspective helps reconcile ideas that, at first glance, seem contradictory, such as emotion universality and neural degeneracy.

Influences of dynamic load phase shifts on the energetics and biomechanics of humans

Using load-suspended backpacks to reduce vertical peak dynamic load exerted on humans can reduce metabolic costs. However, is it possible to further reduce metabolic cost by modulating dynamic load phase shift? If so, is anti-phase better than the others? In this study, we investigated the biomechanics, energetics and trunk response under phase shifts. Nine subjects wearing an active backpack with 19.4 kg loads walked on a treadmill at 5 km h-1 with four phase shift trials (T1-T4) and a load-locked trial (LK). Our results show that anti-phase trial (T3) assists ankle more and reduces the moment and gastrocnemius medialis activity, while T4 assists knee more and reduces the moment and rectus femoris activity. Due to the load injecting more mechanical energy into human in T3 and T4, the positive centre-of-mass work is significantly reduced. However, the gross metabolic rate is lowest in T4 and 4.43% lower than in T2, which may be because the activations of erector spinae and gluteus maximus are reduced in T4. In addition, T3 increases trunk extensor effort, which may weaken the metabolic advantage. This study provides guidance for improving assistance strategies and human-load interfaces and deepens the understanding of the energetics and biomechanics of human loaded walking.

Effects of Law Enforcement Load Carriage Systems on Muscle Activity and Coordination during Walking: An Exploratory Study

Law enforcement officers (LEOs) commonly wear a duty belt (DB) or tactical vest (TV) and from prior findings, these forms of load carriage (LC) likely alter muscular activity. However, studies on the effects of LEO LC on muscular activity and coordination are limited in the current literature. The present study examined the effects of LEO load carriage on muscular activity and coordination. Twenty-four volunteers participated in the study (male = 13, age = 24.5 ± 6.0 years). Surface electromyography (sEMG) sensors were placed on the vastus lateralis, biceps femoris, multifidus, and lower rectus abdominus. Participants completed treadmill walking for two load carriage conditions (duty belt and tactical vest) and a control condition. Mean activity, sample entropy and Pearson correlation coefficients were computed for each muscle pair during the trials. The duty belt and tactical vest resulted in an increase in muscle activity in several muscles; however, no differences between the duty belt and tactical vest were found. Consistently across the conditions, the largest correlations were observed between the left and right multifidus (r = 0.33-0.68) and rectus abdominus muscles (0.34-0.55). There were statistically small effects (p < 0.05, η² = 0.031 to 0.076) of the LC on intermuscular coordination. No effect (p > 0.05) of the LC on sample entropy was found for any muscle. The findings indicate that LEO LC causes small differences in muscular activity and coordination during walking. Future research should incorporate heavier loads and longer durations.

Kinematical effects of rifle carriage on roller skiing in well-trained female and male biathletes

PURPOSE

This study aimed to investigate how rifle carriage and skiing speed during biathlon roller skiing affect range of motion (ROM) in joint angles and equipment (skis and poles), the vertical distance between shoulders and treadmill (vert_dist ), as well as possible sex differences associated with rifle carriage.

METHODS

Fourteen biathletes (6 women, 8 men) roller-skied on a treadmill at submaximal and simulated race speeds, with (WR) and without (NR) a rifle, using gears 3 and 2. Kinematical data for the whole body, poles, roller-skis, rifle, and treadmill were monitored using a 3D motion capture system. Movements determined as flexion/extension (x), abduction/adduction (y), and/or internal/external rotation (z) were analyzed for the hip, shoulder, thorax, knee, ankle, elbow, poles, and roller skis. ROM (the difference between maximal and minimal angles) in joints and equipment, and vert_dist were analyzed over six skiing cycles during each condition (WR and NR) and speed.

RESULTS

The maximal vert_dist was lower for WR compared with NR (gear 3: 1.53 ± 0.06 vs 1.54 ± 0.06 m; gear 2: 1.49 ± 0.06 vs 1.51 ± 0.06 m; both p < 0.001). ROM in the upper body was altered when roller skiing WR (movements decreased in thorax and shoulder (x) and increased in elbow (only gear 3) (x), thorax (only gear 2), and shoulder (y) and (z); all p < 0.05) and increased with speed, without differences between sexes (p > 0.05).

CONCLUSION

Since rifle carriage and speed appear to affect the kinematics of roller skiing, coaches, and biathletes are advised to perform skiing technique training under competition-like conditions (i.e., at race speeds while carrying the rifle).

Effect of Load Carriage Lifestyle on Kinematics and Kinetics of Gait

Backpacks are commonly worn by many people for multiple purposes. This study investigated the effects of habitual wearing of backpacks on lower limb kinematics and kinetics. Fourteen participants were recruited for analysis. All participants performed four randomly assigned scenarios, including running and walking at speeds of 3.5 and 1.5 m/s, respectively, with and without load carriage. The motion analysis system and force plate were used to investigate the lower limb kinematics and kinetics. A paired sample t-test was performed for statistical measurement with a significance level of α = .05. The results indicated that active force, breaking force, impact peak, loading rate, active peak, maximum braking, hip flexion, and hip range of motion were substantially higher under load carriage conditions than under walking condition, however, time to peak was lower. Conversely, during load carriage running, active force, braking impulse, time to peak, ankle plantarflexion, and ankle range of motion were all higher than those during running. Carrying a backpack weighing 10% of the body weight induced different foot strike patterns at both speeds; during load carriage walking, the hip tended to flex more; whereas, during load carriage running, the ankle tended to flex more. In conclusion, human body seems to adopt different gait strategies during load carriage walking and running. That is, the hip strategy is used during walking, while the ankle strategy is used during running.

The effect of backpack weight on the performance of basic short-term/working memory tasks while walking along a pre-determined route

This study investigated possible backpack weight effects on the performance of three basic short-term/working memory (STM/WM) tasks conducted concurrently with the physical task of route walking. The STM/WM tasks were the Corsi block-tapping, digit span, and 3-back tasks, and, were employed to examine the visuo-spatial sketchpad, phonological loop and central executive components of the WM system. Four backpack weight levels (0%, 15%, 25% and 40% of body mass) were considered. Thirty participants conducted the three experimental tasks requiring physical-cognitive multitasking. Data analyses revealed that: (1) increased backpack weight resulted in decreases in the performance of the Corsi block-tapping and the 3-back task, but (2) backpack weight did not significantly affect the digit span task performance. The study results suggest that reducing backpack weight could benefit the performance of various cognitive tasks during route walking. The study findings may be useful for the ergonomics design of body-worn equipment and human-system interfaces.Practitioner summary: This study examined the backpack weight effects on the performance of three basic short-term/working memory tasks conducted concurrently with the physical task of route walking. The study revealed that reducing backpack weight could benefit various cognitive tasks during physical-cognitive multitasking, especially cognitive tasks that require visuospatial processing and executive control.

Role of sex and stature on the biomechanics of normal and loaded walking: implications for injury risk in the military

Load carriage and marching 'in-step' are routine military activities associated with lower limb injury risk in service personnel. The fixed pace and stride length of marching typically vary from the preferred walking gait and may result in overstriding. Overstriding increases ground reaction forces and muscle forces. Women are more likely to overstride than men due to their shorter stature. These biomechanical responses to overstriding may be most pronounced when marching close to the preferred walk-to-run transition speed. Load carriage also affects walking gait and increases ground reaction forces, joint moments and the demands on the muscles. Few studies have examined the effects of sex and stature on the biomechanics of marching and load carriage; this evidence is required to inform injury prevention strategies, particularly with the full integration of women in some defence forces. This narrative review explores the effects of sex and stature on the biomechanics of unloaded and loaded marching at a fixed pace and evaluates the implications for injury risk. The knowledge gaps in the literature, and distinct lack of studies on women, are highlighted, and areas that need more research to support evidence-based injury prevention measures, especially for women in arduous military roles, are identified.

Effects of load carriage on measures of postural sway in healthy, young adults: A systematic review and meta-analysis

Load carriage (LC) is a contributing factor to musculoskeletal injury in many occupations. Given that falls are a common mechanism of injury for those frequently engaging in LC, understanding the effects of LC on postural stability (PS) is necessary. A systematic review and meta-analysis was conducted to examine effects of LC on PS. Sixteen and 9 studies were included in the qualitative and quantitative synthesis, respectively. In most studies, it was found that LC leads to a decrease in PS with significant effects on center of pressure (COP) sway area (standardized mean difference = 0.45; p < 0.005) and COP anterior-posterior excursion (standardized mean difference = 0.52; p < 0.05). Furthermore, load magnitude and load placement are factors which can significantly affect COP measures of PS. It is recommended to minimize load magnitude and equally distribute load when possible to minimize LC effects on PS. Future research should examine additional factors contributing to differences in individual PS responses to LC such as changes in muscle activation and prior LC experience.

Biomechanical and physiological effects of female soldier load carriage: A scoping review

Loads carried by military populations can affect those of smaller stature, such as the average female, due to the higher percentage of body weight the loads represent. Despite this, most load carriage research is performed on males. Peer reviewed articles were collected from four databases to summarize available research on biomechanical and physiological effects of load carriage on females in the military. Extraction and thematic analysis were performed on 18 articles. 39% looked at biomechanical differences between loads in females, 61% looked at how the same load affected males and females, 44% looked at sex-by-load interaction effects, and 72% discussed impacts of load on females. The research revealed that military load carriage affects the biomechanics and physiology differently in females and to a greater extent than in males. Several gaps in available literature were found. Very few studies used military participants, military equipment, and/or employed occupationally relevant data collection methodologies.

Characterizing the Effects of Explosive Ordnance Disposal Operations on the Human Body While Wearing Heavy Personal Protective Equipment

OBJECTIVE

To provide a comprehensive characterization of explosive ordnance disposal (EOD) personal protective equipment (PPE) by evaluating its effects on the human body, specifically the poses, tasks, and conditions under which EOD operations are performed.

BACKGROUND

EOD PPE is designed to protect technicians from a blast. The required features of protection make EOD PPE heavy, bulky, poorly ventilated, and difficult to maneuver in. It is not clear how the EOD PPE wearer physiologically adapts to maintain physical and cognitive performance during EOD operations.

METHOD

Fourteen participants performed EOD operations including mobility and inspection tasks with and without EOD PPE. Physiological measurement and kinematic data recording were used to record human physiological responses and performance.

RESULTS

All physiological measures were significantly higher during the mobility and the inspection tasks when EOD PPE was worn. Participants spent significantly more time to complete the mobility tasks, whereas mixed results were found in the inspection tasks. Higher back muscle activations were seen in participants who performed object manipulation while wearing EOD PPE.

CONCLUSION

EOD operations while wearing EOD PPE pose significant physical stress on the human body. The wearer's mobility is impacted by EOD PPE, resulting in decreased speed and higher muscle activations.

APPLICATION

The testing and evaluation methodology in this study can be used to benchmark future EOD PPE designs. Identifying hazards posed by EOD PPE lays the groundwork for developing mitigation plans, such as exoskeletons, to reduce physical and cognitive stress caused by EOD PPE on the wearers without compromising their operational performance.

A data-driven framework for assessing soldier performance, health, and survivability

Presented is a framework that uses pattern classification methods to incrementally morph whole-body movement patterns to investigate how personal (sex, military experience, and body mass) and load characteristics affect the survivability tradespace: performance, musculoskeletal health, and susceptibility to enemy action. Sixteen civilians and 12 soldiers performed eight military-based movement patterns under three body-borne loads: ∼5.5 kg, ∼22 kg, and ∼38 kg. Our framework reduces dimensionality using principal component analysis and uses linear discriminant analysis to classify groups and morph movement patterns. Our framework produces morphed whole-body movement patterns that emulate previously published changes to the survivability tradespace caused by body-borne loads. Additionally, we identified that personal characteristics can greatly impact the tradespace when carrying heavy body-borne loads. Using our framework, military leaders can make decisions based on objective information for armour procurement, employment of armour, and battlefield performance, which can positively impact operational readiness and increase overall mission success.

Evaluating the human capacity of carrying loads without costs: A scoping review of the Free-Ride phenomenon

OBJECTIVES

Several researchers have obtained discordant results testing the human capability to transport loads without added locomotion costs. Carrying loads has an extended relevance to human ecology, thus a review of the Free-Ride phenomenon detection according to the existing literature is needed.

METHOD

A search was made in November 2021 in SCOPUS, Google Scholar, and Web of Science to identify studies comparing the energy expenditure of loaded and unloaded locomotion. Descriptive percentages were calculated with the data obtained from each study, and a Chi-squared (χ2 ) independency test and a contingency table were applied to observe the relationship between sample characteristics, experimental procedures, and the detection of the Free-Ride.

RESULTS

A total of 45 studies met the inclusion criteria. Eighty two percent do not detect the Free-Ride phenomenon. The general detection is independent of sex, experience, load position, load size, and speed (p value >.05) although the papers detecting the Free-Ride have some common characteristics.

CONCLUSION

The literature does not support a Free-Ride capacity, but future research testing this phenomenon should consider the load size, the load position, the level of expertise, or the speed. As the Free-Ride is not generalizable, it can be hypothesized that other mechanisms may have emerged during human evolution to buffer the energetic demands of load carrying.

6DOF knee kinematic alterations due to increased load levels

Whether load carriage leads to six-degrees-of-freedom (6DOF) knee kinematic alterations remains unclear. Exploring this mechanism may reveal meaningful knee kinematic information that can be used to improve load carriage conditions, the design of protective devices, and the knowledge of the effects of load carriage on knees. We recruited 44 subjects to explore kinematic alterations from an unloaded state to 60% bodyweight (BW) load carriage. A three-dimensional gait analysis system was used to collect the knee kinematic data. One-way repeated analysis of variance (ANOVA) was used to explore the effects of load levels on knee kinematics. The effects of increasing load levels on knee kinematics were smooth with decreased or increased trends. We found that knees significantly exhibited increased lateral tibial translation (up to 1.2 mm), knee flexion angle (up to 1.4°), internal tibial rotation (up to 1.3°), and tibial proximal translation (up to 1.0 mm) when they went from an unloaded state to 60%BW load carriage during the stance phase (p < 0.05). Significant small knee adduction/abduction angle and posterior tibial translation alterations (<1°/mm) were also identified (p < 0.05). Load carriage can cause significant 6DOF knee kinematic alterations. The results showed that knee kinematic environments are challenging during increased load. Our results contain kinematic information that could be helpful for knee-protection-related activities, such as target muscle training to reduce abnormal knee kinematics and knee brace design.

Can increased load carriage affect lower limbs kinematics during military gait?

The aim of this study was to investigate if increased load carriage, in male military personnel, can affect the lower limbs kinematics. Twelve male military volunteers from the Portuguese Army were recruited and evaluated in an unloaded and loaded gait condition. Linear kinematics and lower limbs joint angle at heel strike, midstance and toe off were calculated. The stance, swing and double support times were found to be different between load conditions (p < 0.05). There was an interaction between load and limb (p < 0.05) for joint angles, during midstance, with limbs performing different movements in the frontal plane during loaded gait. Load increase had a different effect on the right knee, with a reduction in the abduction (valgus). This study may be beneficial in offering suggestion to improve the performance of gait with load and in an attempt to help prevent possible injuries. Practitioner summary: Increased load can affect lower limbs of male soldiers at the pelvic, hip and knee angles on the frontal plane, which can alter the joint force distribution. While these alterations may indicate protective mechanics, load management procedures should be implemented along with gait monitoring to avoid negative effects in performance.

Mechanical Differences between Men and Women during Overground Load Carriage at Self-Selected Walking Speeds

Few studies have directly compared physical responses to relative loading strategies between men and women during overground walking. This study aimed to compare gait mechanics of men and women during overground load carriage. A total of 30 participants (15 male, 15 female) completed three 10-min walking trials while carrying external loads of 0%, 20% and 40% of body mass at a self-selected walking speed. Lower-body motion and ground reaction forces were collected using a three-dimensional motion capture system and force plates, respectively. Female participants walked with a higher cadence (p = 0.002) and spent less absolute time in stance (p = 0.010) but had similar self-selected walking speed (p = 0.750), which was likely due to the female participants being shorter than the male participants. Except for ankle plantarflexion moments, there were no sex differences in spatiotemporal, kinematic, or kinetic variables (p > 0.05). Increasing loads resulted in significantly lower self-selected walking speed, greater stance time, and changes in all joint kinematics and kinetics across the gait cycle (p < 0.05). In conclusion, there were few differences between sexes in walking mechanics during overground load carriage. The changes identified in this study may inform training programs to increase load carriage performance.

Effects of backpack-induced fatigue on gait ground reaction force characteristics in primary school children with flat-foot deformity

This study aimed to assess the effects of backpack carriage in different weights and muscle fatigue on the GRF components in primary school children with flat-foot deformity. The GRF components from 42 primary school children (21 with low arch, and 21 with normal) were collected before and after backpack-induced fatigue protocol during shod walking with backpacks in weight 7.5, 10, 12.5 and 15% of the child's bodyweight. The amplitudes of Fx2 of 10%BW and Fz3 of 7.5%BW in the flatfeet group were less than in the healthy group without fatigued condition. (P < 0.05). After fatiguing, the amplitudes of Fx2 of 7.5%BW, Fz3 of 12.5 and 15%BW were significantly decreased in the low arch group than those in the healthy subjects (P < 0.05). Within-group comparisons of measured Fx2 of 10%BW, Fy1 (7.5,10 and 15%BW), Fy2 of 7.5%BW, FZ1 (7.5,10 and 15%BW), FZ2 (7.5,10 and 15%BW), and TTP of TFz1 of 7.5%BW, TFz3 (7.5,10 and 12.5%BW), Loading rate (7.5,10 and 15%BW) were significantly different from pre- to post-fatigue in the flatfeet group(P < 0.05). Within-group comparisons of measured Fy1 of 10%BW, Fy2 (7.5% and 10%BW), FZ1 (7.5% and 10%BW), FZ2 (7.5% and 10%BW), and TTP of TFz3 of 7.5%BW, Loading rate (7.5% and 10%BW) were significantly different from pre- to post-fatigue in the healthy group (P < 0.05). It seems that TTP of GRF variables does have clinical importance for rehabilitation of flatfeet deformity. Carrying heavy backpacks and backpack-induced fatigue had different effects on GRF characteristics among children with low and normal foot arch.

Association between the Use of Backpack and Static Foot Posture in Schoolchildren with Static Pronated Foot Posture: A 36-Month Cohort Study

Background: Schoolchildren often spend a lot of time carrying a backpack with school equipment, which can be very heavy. The impact a backpack may have on the pronated feet of schoolchildren is unknown. Aims: The objective of this study was to evaluate the association of the backpack use on static foot posture in schoolchildren with a pronated foot posture over 36 months of follow-up. Methods: This observational longitudinal prospective study was based on a cohort of consecutive healthy schoolchildren with pronated feet from fifteen different schools in Plasencia (Spain). The following parameters were collected and measured in all children included in the study: sex, age, height, weight, body mass index, metatarsal formula, foot shape, type of shoes, and type of schoolbag (non-backpack and backpack). Static foot posture was determined by the mean of the foot posture index (FPI). The FPI was assessed again after 36 months. Results: A total of 112 participants used a backpack when going to school. Over the 36-month follow-up period, 76 schoolchildren who had a static pronated foot posture evolve a neutral foot posture. Univariate analysis showed that the schoolchildren using backpacks were at a greater risk of not developing neutral foot (odds ratio [OR]: 2.09; 95% CI: 1.08–4.09). The multivariate analysis provided similar results, where the schoolchildren using a backpack (adjusted OR [aOR]: 1.94; 95% CI: 1.02–3.82) had a significantly greater risk of not developing a neutral foot posture. Conclusions: A weak relationship was found between backpack use and schoolchildren aged from five to eleven years with static pronated feet not developing a neutral foot posture over a follow-up period of 36 months.

Effect of very large body mass loss on energetics, mechanics and efficiency of walking in adults with obesity: mass-driven versus behavioural adaptations

Abstract

Understanding the mechanisms involved in the higher energy cost of walking (NC_w: the energy expenditure above resting per unit distance) in adults with obesity is pivotal to optimizing the use of walking in weight management programmes. Therefore, this study aimed to investigate the mechanics, energetics and mechanical efficiency of walking after a large body mass loss induced by bariatric surgery in individuals with obesity. Nine adults (39.5 ± 8.6 year; BMI: 42.7 ± 4.6 kg m^–2) walked at five fixed speeds before (baseline) and after the bariatric surgery (post 1 and post 2). Gas exchanges were measured to obtain NC_w. A motion analysis system and instrumented treadmill were combined to assess total mechanical work (W_tot). Mechanical efficiency (W_tot NC_w^–1) was also calculated. Participants lost 25.7 ± 3.4% of their body mass at post 1 (6.6 months; P < 0.001) and 6.1 ± 4.9% more at post 2 (12 months; P = 0.014). Mass‐normalized NC_w was similar between baseline and post 1 and decreased at post 2 compared to that at baseline (−6.2 ± 2.7%) and post 1 (−8.1 ± 1.9%; P ≤ 0.007). No difference was found in mass‐normalized W_tot during follow‐up (P = 0.36). Mechanical efficiency was similar at post 1 and post 2 when compared to that at baseline (P ≥ 0.19), but it was higher (+14.1 ± 4.6%) at post 2 than at post 1 (P = 0.013). These findings showed that after a very large body mass loss, individuals with obesity may reorganize their walking pattern into a gait more similar to that of lean adults, thus decreasing their NC_w by making their muscles work more efficiently.

Key points

A higher net (above resting) energy cost of walking (lower gait economy) is observed in adults with obesity compared to lean individuals.

Understanding the mechanisms (i.e. mass driven, gait pattern and behavioural changes) involved in this extra cost of walking in adults with obesity is pivotal to optimizing the use of walking to promote daily physical activity and improve health in these individuals.

We found that very large weight loss induced by bariatric surgery significantly decreased the energy cost of walking per kg of body mass after 1 year with similar total mechanical work per kg of body mass, resulting in an increased mechanical efficiency of walking.

Individuals with obesity may reorganize their walking pattern into a gait more similar to that of adults of normal body mass, thus decreasing their energy cost of walking by making their muscles work more efficiently.

The Added Value of Musculoskeletal Simulation for the Study of Physical Performance in Military Tasks

The performance of military tasks is often exacerbated by additional load carriage, leading to increased physical demand. Previous studies showed that load carriage may lead to increased risk of developing musculoskeletal injuries, a reduction in task speed and mobility, and overall performance degradation. However, these studies were limited to a non-ambulatory setting, and the underlying causes of performance degradation remain unclear. To obtain insights into the underlying mechanisms of reduced physical performance during load-carrying military activities, this study proposes a combination of IMUs and musculoskeletal modeling. Motion data of military subjects was captured using an Xsens suit during the performance of an agility run under three different load-carrying conditions (no load, 16 kg, and 31 kg). The physical performance of one subject was assessed by means of inertial motion-capture driven musculoskeletal analysis. Our results showed that increased load carriage led to an increase in metabolic power and energy, changes in muscle parameters, a significant increase in completion time and heart rate, and changes in kinematic parameters. Despite the exploratory nature of this study, the proposed approach seems promising to obtain insight into the underlying mechanisms that result in performance degradation during load-carrying military activities.

Impact of Weight Carriage on Joint Kinematics in Asian Elephants Used for Riding

Simple Summary

Riding elephants is one of the most controversial activities in the tourist industry, with concerns over whether load carrying is physically harmful. Here, we used an empirical approach to test how carrying loads up to 15% of the elephant’s body mass affected gait parameters. The maximal angles of fore- and hindlimb joints of elephants walking at a normal, self-selected speed carrying a mahout only were first evaluated and then compared to those walking with a saddle carrying two people plus added weight to reach a 15% body mass load. Data were analyzed using a computerized three-dimensional inertial measurement system. There were no significant differences between movement angles, including flexion, extension, abduction, and adduction of the fore- or hindlimbs between these two riding conditions. Thus, we found no evidence that carrying two people in a saddle causes significant changes in gait patterns or potentially affects musculoskeletal function. More studies are needed to further test longer durations of riding on different types of terrain to develop appropriate working guidelines for captive elephants. Nevertheless, elephants appear capable of carrying significant amounts of weight on the back without showing signs of physical distress.

Abstract

Background: Elephants in Thailand have changed their roles from working in the logging industry to tourism over the past two decades. In 2020, there were approximately 2700 captive elephants participating in activities such as riding and trekking. During work hours, riding elephants carry one or two people in a saddle on the back with a mahout on the neck several hours a day and over varying terrain. A concern is that this form of riding can cause serious injuries to the musculoskeletal system, although to date there have been no empirical studies to determine the influence of weight carriage on kinematics in elephants. Methods: Eight Asian elephants from a camp in Chiang Mai Province, Thailand, aged between 21 and 41 years with a mean body mass of 3265 ± 140.2 kg, were evaluated under two conditions: walking at a normal speed without a saddle and with a 15% body mass load (saddle and two persons plus additional weights). Gait kinematics, including the maximal angles of fore- and hindlimb joints, were determined using a novel three-dimensional inertial measurement system with wireless sensors. Results: There were no statistical differences between movement angles and a range of motion of the fore- and hindlimbs, when an additional 15% of body mass was added. Conclusion: There is no evidence that carrying a 15% body mass load causes significant changes in elephant gait patterns. Thus, carrying two people in a saddle may have minimal effects on musculoskeletal function. More studies are needed to further test longer durations of riding on different types of terrain to develop appropriate working guidelines for captive elephants. Nevertheless, elephants appear capable of carrying significant amounts of weight on the back without showing signs of physical distress.

Experimental study protocol of the project "MOtor function and VItamin D: Toolkit for motor performance and risk Assessment (MOVIDA)"

Musculoskeletal injuries, a public health priority also in the military context, are ascribed to several risk factors, including: increased reaction forces; low/reduced muscle strength, endurance, body mass, Vitamin D level, and bone density; inadequate lifestyles and environment. The MOVIDA Project-funded by the Italian Ministry of Defence-aims at developing a transportable toolkit (assessment instrumentation, assessment protocols and reference/risk thresholds) which integrates motor function assessment with biological, environmental and behavioural factors to help characterizing the risk of stress fracture, stress injury or muscle fatigue due to mechanical overload. The MOVIDA study has been designed following the STROBE guidelines for observational cross-sectional studies addressing healthy adults, both militaries and civilians, with varying levels of physical fitness (sedentary people, recreational athletes, and competitive athletes). The protocol of the study has been designed and validated and is hereby reported. It allows to collect and analyse anamnestic, diagnostic and lifestyle-related data, environmental parameters, and functional parameters measured through portable and wearable instrumentation during adapted 6 minutes walking test. The t-test, one and two-way ANOVA with post-hoc corrections, and ANCOVA tests will be used to investigate relevant differences among the groups with respect to biomechanical parameters; non-parametric statistics will be rather used for non-normal continuous variables and for quantitative discrete variables. Generalized linear models will be used to account for risk and confounding factors.

Effects from loaded walking with polyurethane and styrene-butadiene rubber midsole military boots on kinematics and external forces: A statistical parametric mapping analysis

This study compared ground reaction forces (GRF) and lower limb two-dimensional (2D) kinematic waveforms, with and without load carriage, in military personnel walking in two different types of boots. Data were measured in 24-soldiers walking on a 10-m walkway under four randomized crossover trials: wearing two military boots (styrene-butadiene rubber midsole - SBR - 63 Shore A; and polyurethane midsole - PU - 48 Shore A); with and without a 15-kg backpack. GRF traditional parameters were evaluated by two-way ANOVAs. GRF and kinematic waveforms were assessed using a statistical parametric mapping (SPM) method (two-way ANOVA). No interaction effects were observed between footwear and load. GRF at the beginning of stance was lower while wearing the SBR boot condition compared to the PU boot condition. Load carriage increased trunk, hip, and knee flexion. The analyzed military boots did not affect movement patterns during loaded walking and the military boot with SBR midsole material reduced impact to a greater extent. The study demonstrated that the design and materials (e.g., midsole material and thickness) used in boot manufacturing can influence military boot performance.

Increased velocity at VO2max and load carriage performance in army ROTC cadets: prescription using the critical velocity concept

The purpose of this study was to evaluate the effects of using the critical velocity (CV) concept to prescribe two separate high-intensity interval training (HIT) exercise programs aimed at enhancing CV and load carriage performance. 20 young adult participants (male = 15, female = 5) underwent a 4-week training period where they exercised 2 d wk^-1. Participants were randomly assigned into two groups: (1) HIT or (2) Load Carriage-HIT (LCHIT). Pre- and post-training assessments included running 3-minute All-Out Test (3MT) to determine critical velocity (CV) and distance prime (D') and two load carriage tasks (400 and 3200 m). There were significant increases in CV (p = 0.005) and velocity at V˙ O_2max (vV˙ O_2max) (p = 0.037) among the sample but not between training groups. Improvements were observed in 3200 m load carriage performance time (p < 0.001) with a 9.8 and 5.4% decrease in the LCHIT and HIT groups, respectively. Practitioner summary: Critical velocity has shown efficacy as a marker for performance in tactical populations. With the addition of load carriage, there is a reduction in the individual's CV. The CV-concept-prescribed exercises (HIT and LCHIT) 2 days per week for 4 weeks showed improvements in CV, vV˙ O_2max and load carriage performance. The use of the CV concept provides a method to prescribe HIT to increase running and load carriage performances in tactical populations.

Military load carriage effects on the gait of military personnel: A systematic review

Carrying heavy loads results in biomechanical changes to gait and to an increased risk of injury in soldiers. The aim of this review is to examine the effects of military specific load carriage on the gait of soldiers. The Web of Science, PubMed and CINAHL databases were searched, a total of 1239 records were screened and 20 papers were included in the review. Participant, load and task characteristics and a summary of key findings were extracted. Due to heterogeneity in the reviewed studies, analysis was restricted to qualitative synthesis. There were limited effects on spatio-temporal variables but consistently reported increased trunk, hip and knee flexion and increased hip and knee extension moments. Muscle activation of lower limb and trunk muscles were also increased with loads. However, there were some conflicting findings for most parameters reviewed and apart from spatio-temporal parameters the findings of this review were in line with previous reviews of combined military and civilian populations.

Spatiotemporal and Kinematic Comparisons Between Anthropometrically Paired Male and Female Soldiers While Walking With Heavy Loads

INTRODUCTION

Limited work comparing the effect of heavier carried loads (greater than 30 kg) between men and women has attributed observed differences to sex with the possibility that anthropometric differences may have contributed to those discrepancies. With the recent decision permitting women to enter Combat Arms roles, knowledge of sex-based differences in gait response to load carriage is more operationally relevant, as military loads are absolute and not relative to body weight. The purpose of this study was to describe differences in gait parameters at light to heavy loads between anthropometrically similar male and female soldiers.

MATERIALS AND METHODS

Eight female and 8 male soldiers, frequency-matched (1-to-1) on height (±0.54 cm) and mass (±0.52 kg), walked at 1.34 m∙s-1 for 10-min bouts on a level treadmill while unloaded (BM) and then carrying randomized vest-borne loads of 15, 35, and 55 kg. Spatiotemporal and kinematic data were collected for 30 s after 5 min. Two-way repeated measures analyses of variance were conducted to compare the gait parameter variables between sexes at each load.

RESULTS

As load increased, overall, the percent double support increased, step frequency increased, stride length decreased, hip and ankle range of motion (ROM) increased, and vertical center of mass (COM) displacement increased. Sex-based significant differences were observed in knee ROM and mediolateral COM displacement. Among the male participants, knee ROM increased significantly for all loads greater than BM. For mediolateral COM displacement, male remained constant as load increased, whereas female values decreased between BM and 35 kg.

CONCLUSIONS

Spatiotemporal and kinematic differences in gait parameters were primarily because of increases in load magnitude. The observed sex-related differences with increasing loads suggest that women may require a more stable gait to support the additional load carried.

Soldier Load Carriage, Injuries, Rehabilitation and Physical Conditioning: An International Approach

Soldiers are often required to carry heavy loads that can exceed 45 kg. The physiological costs and biomechanical responses to these loads, whilst varying with the contexts in which they are carried, have led to soldier injuries. These injuries can range from musculoskeletal injuries (e.g., joint/ligamentous injuries and stress fractures) to neurological injuries (e.g., paresthesias), and impact on both the soldier and the army in which they serve. Following treatment to facilitate initial recovery from injuries, soldiers must be progressively reconditioned for load carriage. Optimal conditioning and reconditioning practices include load carriage sessions with a frequency of one session every 10-14 days in conjunction with a program of both resistance and aerobic training. Speed of march and grade and type of terrain covered are factors that can be adjusted to manipulate load carriage intensity, limiting the need to adjust load weight alone. Factors external to the load carriage program, such as other military duties, can also impart physical loading and must be considered as part of any load carriage conditioning/reconditioning program.

Treadmill load carriage overestimates energy expenditure of overground load carriage

This study compared physiological and biomechanical responses between treadmill and overground load carriage. Thirty adults completed six 10-minute walking trials across three loads (0, 20, and 40% body mass) and two surfaces (treadmill and overground). Relative oxygen consumption was significantly greater on the treadmill for 20% (1.54 ± 0.20 mL⋅kg^-1⋅min^-1) and 40% loads (1.08 ± 0.20 mL⋅kg^-1⋅min^-1). All other physiological and perceptual responses were significantly higher in the treadmill condition and with increases in load. Stance time was longer (0%: 0.05 s; 20%: 0.02 s, 40%: 0.05 s, p < 0.001) and cadence was lower (0%: 1 step·min^-1; 20%: 2 steps·min^-1; 40%: 3 steps·min^-1, p < 0.05) on the treadmill. Peak lower limb joint angles were similar between surfaces except for ankle plantar flexion, which was 8˚ greater on the treadmill. The physiological responses to treadmill-based load carriage are generally not transferable to overground load carriage and caution must be taken when conducting treadmill-based load carriage research to inform operational-based scenarios. Practitioner Summary: Literature is limited when comparing the physiological and biomechanical responses to treadmill and overground load carriage. Using a repeated measures design, it was shown that although walking kinematics are generally similar between surfaces, there was a greater physiological demand while carrying a load on a treadmill when compared with overground. Abbreviations: BM: body mass; e.g: for example; HR: heart rate; HR_max: heart rate maximum; Hz: hertz; kg: kilograms; km·h^-1: kilometres per hour; L⋅min^-1: litres per minute; m: metres; MD: mean difference; mL·kg^-1·min^-1: millilitres per kilogram per minute; mL⋅min^-1: millilitres per minute; η²p: partial-eta squared; OG: overground; RPE: rating of perceived exertion; s: seconds; SD: standard deviation; SE: standard error; steps·min^-1: steps per minute; TM: treadmill; V̇CO₂: volume of carbon dioxide; V̇E: ventilation; V̇O₂: volume of oxygen; V̇O_2max: maximum volume of oxygen; y: years.

Overuse-Related Injuries of the Musculoskeletal System: Systematic Review and Quantitative Synthesis of Injuries, Locations, Risk Factors and Assessment Techniques

Overuse-related musculoskeletal injuries mostly affect athletes, especially if involved in preseason conditioning, and military populations; they may also occur, however, when pathological or biological conditions render the musculoskeletal system inadequate to cope with a mechanical load, even if moderate. Within the MOVIDA (Motor function and Vitamin D: toolkit for risk Assessment and prediction) Project, funded by the Italian Ministry of Defence, a systematic review of the literature was conducted to support the development of a transportable toolkit (instrumentation, protocols and reference/risk thresholds) to help characterize the risk of overuse-related musculoskeletal injury. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach was used to analyze Review papers indexed in PubMed and published in the period 2010 to 2020. The search focused on stress (overuse) fracture or injuries, and muscle fatigue in the lower limbs in association with functional (biomechanical) or biological biomarkers. A total of 225 Review papers were retrieved: 115 were found eligible for full text analysis and led to another 141 research papers derived from a second-level search. A total of 183 papers were finally chosen for analysis: 74 were classified as introductory to the topics, 109 were analyzed in depth. Qualitative and, wherever possible, quantitative syntheses were carried out with respect to the literature review process and quality, injury epidemiology (type and location of injuries, and investigated populations), risk factors, assessment techniques and assessment protocols.

Lower Limb Biomechanical Responses During a Standardized Load Carriage Task are Sex Specific

INTRODUCTION

The purpose of this study was to investigate sex-specific lower limb biomechanical adaptations during a standardized load carriage task in response to a targeted physical training program.

MATERIALS AND METHODS

Twenty-five healthy civilians (males [n = 13] and females [n = 12]) completed a load carriage task (5 km at 5.5 km·h-1, wearing a 23 kg vest) before and after a 10-week lower-body-focused training program. Kinematics and ground reaction force data were collected during the task and were used to estimate lower limb joint kinematics and kinetics (i.e., moments and powers). Direct statistical comparisons were not conducted due to different data collection protocols between sexes. A two-way repeated measures ANOVA tested for significant interactions between, and main effects of training and distance marched for male and female data, respectively.

RESULTS

Primary kinematic and kinetic changes were observed at the knee and ankle joints for males and at the hip and knee joints for females. Knee joint moments increased for both sexes over the 5 km distance marched (P > .05), with males demonstrating significant reductions in peak knee joint extension after training. Hip adduction, internal rotation, and knee internal rotation angles significantly increased after the 5 km load carriage task for females but not males.

CONCLUSION

Differences in adaptive gait strategies between sexes indicate that physical training needs to be tailored to sex-specific requirements to meet standardized load carriage task demands. The findings highlighted previously unfound sex-specific responses that could inform military training and facilitate the integration of female soldiers into physically demanding military roles.

Effects of body size and load carriage on lower-extremity biomechanical responses in healthy women

BACKGROUND

Musculoskeletal injuries, such as stress fractures, are the single most important medical impediment to military readiness in the U.S. Army. While multiple studies have established race- and sex-based risks associated with a stress fracture, the role of certain physical characteristics, such as body size, on stress-fracture risk is less conclusive.

METHODS

In this study, we investigated the effects of body size and load carriage on lower-extremity joint mechanics, tibial strain, and tibial stress-fracture risk in women. Using individualized musculoskeletal-finite-element-models of 21 women of short, medium, and tall statures (n = 7 in each group), we computed the joint mechanics and tibial strains while running on a treadmill at 3.0 m/s without and with a load of 11.3 or 22.7 kg. We also estimated the stress-fracture risk using a probabilistic model of bone damage, repair, and adaptation.

RESULTS

Under all load conditions, the peak plantarflexion moment for tall women was higher than those in short women (p < 0.05). However, regardless of the load condition, we did not observe differences in the strains and the stress-fracture risk between the stature groups. When compared to the no-load condition, a 22.7-kg load increased the peak hip extension and flexion moments for all stature groups (p < 0.05). However, when compared to the no-load condition, the 22.7-kg load increased the strains and the stress-fracture risk in short and medium women (p < 0.05), but not in tall women.

CONCLUSION

These results show that women of different statures adjust their gait mechanisms differently when running with external load. This study can educate the development of new strategies to help reduce the risk of musculoskeletal injuries in women while running with external load.

Insoles of uniform softer material reduced plantar pressure compared to dual-material insoles during regular and loaded gait

There is limited evidence on the efficacy of insole materials to reduce plantar pressure during regular walking and loaded walking. In-shoe plantar pressures and subjective footwear comfort were recorded in twenty healthy participants at a self-selected treadmill walking speed in six conditions: two commercial insoles or no insole, and with or without carrying a load in a backpack. A single-material insole, comprised of polyurethane, had reduced density and compressive stiffness compared to a dual-material insole with added viscoelastic material in rearfoot and forefoot regions. Load carriage increased peak pressure across the foot. Both insoles reduced plantar pressure in the rearfoot. Yet, the softer single-material insole also attenuated forefoot pressure and loaded walking did not appear to cause bottoming-out of the polyurethane. Plantar pressure changes did not affect perceived footwear comfort. The softer single-material insole was more effective in reducing plantar pressure, further research would confirm if this influences injury prevalence.

Physiological interactions with personal-protective clothing, physically demanding work and global warming: An Asia-Pacific perspective

The Asia-Pacific contains over half of the world's population, 21 countries have a Gross Domestic Product <25% of the world's largest economy, many countries have tropical climates and all suffer the impact of global warming. That 'perfect storm' exacerbates the risk of occupational heat illness, yet first responders must perform physically demanding work wearing personal-protective clothing and equipment. Unfortunately, the Eurocentric emphasis of past research has sometimes reduced its applicability to other ethnic groups. To redress that imbalance, relevant contemporary research has been reviewed, to which has been added information applicable to people of Asian, Melanesian and Polynesian ancestry. An epidemiological triad is used to identify the causal agents and host factors of work intolerance within hot-humid climates, commencing with the size dependency of resting metabolism and heat production accompanying load carriage, followed by a progression from the impact of single-layered clothing through to encapsulating ensembles. A morphological hypothesis is presented to account for inter-individual differences in heat production and heat loss, which seems to explain apparent ethnic- and gender-related differences in thermoregulation, at least within thermally compensable states. The mechanisms underlying work intolerance, cardiovascular insufficiency and heat illness are reviewed, along with epidemiological data from the Asia-Pacific. Finally, evidence-based preventative and treatment strategies are presented and updated concerning moisture-management fabrics and barriers, dehydration, pre- and post-exercise cooling, and heat adaptation. An extensive reference list is provided, with >25 recommendations enabling physiologists, occupational health specialists, policy makers, purchasing officers and manufacturers to rapidly extract interpretative outcomes pertinent to the Asia-Pacific.

Effects of two passive back-support exoskeletons on postural balance during quiet stance and functional limits of stability

While occupational back-support exoskeletons (BSEs) are considered as potential workplace interventions, BSE use may compromise postural control. Thus, we investigated the effects of passive BSEs on postural balance during quiet upright stance and functional limits of stability. Twenty healthy adults completed trials of quiet upright stance with differing levels of difficulty (bipedal and unipedal stance; each with eyes open and closed), and executed maximal voluntary leans. Trials were done while wearing two different BSEs (SuitX™, Laevo™) and in a control (no-BSE) condition. BSE use significantly increased center-of-pressure (COP) median frequency and mean velocity during bipedal stance. In unipedal stance, using the Laevo™ was associated with a significant improvement in postural balance, especially among males, as indicated by smaller COP displacement and sway area, and a longer time to contact the stability boundary. BSE use may affect postural balance, through translation of the human + BSE center-of-mass, restricted motion, and added supportive torques. Furthermore, larger effects of BSEs on postural balance were evident among males. Future work should further investigate the gender-specificity of BSE effects on postural balance and consider the effects of BSEs on dynamic stability.

Development of the Biomechanical Technologies for the Modeling of Major Segments of the Human Body: Linking the Past with the Present

Simple Summary

The procedures of body measurement are as old as the inception of the scientific method. The human being has always had the necessity to shape the environment to its own needs, to care for the body and to improve quality of life. Over the centuries, several methods have been developed to measure body size. With the development of measurement sciences, technological tools as well as computational tools have become increasingly precise. This review paper aims to historically review the development of methods for the measurement of body segments from a biomechanical point of view, highlighting the link with the technologies available today.

Abstract

The knowledge of human body proportions and segmental properties of limbs, head and trunk is of fundamental importance in biomechanical research. Given that many methods are employed, it is important to know which ones are currently available, which data on human body masses, lengths, center of mass (COM) location, weights and moment of inertia (MOI) are available and which methods are most suitable for specific research purposes. Graphical, optical, x-ray and derived techniques, MRI, laser, thermography, has been employed for in-vivo measurement, while direct measurements involve cadaveric studies with dissection and various methods of acquiring shape and size of body segments. The present review examines the literature concerning human body segments’ properties for biomechanical purposes starting with a historical examination. It emerges that data obtained in studies on cadaveric specimens are still accurate in comparison to more recent technologies, whilst technological tools currently available are manifolds, each one with proper advantages and disadvantages. Classical studies were focused mainly on white men, while in recent years, the available data on body segments have been extended to children, women, and other races. Additionally, data on special populations (obese, pregnant women) are starting to appear in the scientific literature.

Backpacks Effect on Foot Posture in Schoolchildren with a Neutral Foot Posture: A Three-Year Prospective Study

Background: There is a paucity of data on the relationship between backpack use and foot posture in children. The aim of this study was to assess the effects of a backpack on foot posture in children with neutral foot posture during three years of follow-up. Methods: A prospective longitudinal observational study was conducted in a sample of 627 children with neutral foot. For each participant included in the study, age, sex, weight, height, body mass index, type of schoolbag (backpack or non-backpack), foot shape, metatarsal formula and type of shoes were recorded. Foot posture was described by the mean of the foot posture index (FPI) and reassessed after three years in a follow-up study. Results: The average age of the children was 8.32 ± 1.32 years. A total of 458 used a backpack when going to school. Over the three-year follow-up period, 50 children who had neutral foot developed supinated foot (n = 18) or pronated foot (n = 32). Univariate and multivariate analysis showed that the children using a backpack were at a higher risk of developing pronated foot (adjusted Odds Ratio (aOR) = 2.05, 95% IC: 1.08–3.89, p = 0.028). Backpack use was not associated with the change from neutral foot to supinated foot. Conclusions: We found a positive association between using a backpack and the risk of developing pronated but not supinated foot. Clinical trials should be conducted to analyze the effect of backpack use on the foot among schoolchildren.

Conservative Interventions for Non-Specific Low Back Pain in Tactical Populations: A Systematic Review of Randomized Controlled Trials

Limited evidence exists about non-specific low back pain (NSLBP) interventions among tactical personnel (police officers, firefighters, or army forces). The aim was to identify and systematically review the findings of randomized control trials (RCTs) investigating conservative interventions for the treatment NSLBP in tactical personnel. A search of seven databases for randomized controlled trials RCTs were conducted. Two independent reviewers extracted data and assessed the risk of bias (PEDro scale). Five RCTs (n = 387 military subjects; median PEDro score = 7/10) were included. The trials were highly heterogeneous, differing in pain and disability outcome measures, duration of NSLBP symptoms (acute, nonacute, nonchronic, and chronic), types of intervention (exercise, manual therapy, and physical therapy), types of control groups, and intervention durations (4–12 weeks). Two studies reported that strengthening exercise interventions were not effective for reducing pain or disability in military personnel with chronic or nonacute NSLBP. Manual therapy treatment was more effective than usual activities in current pain and pain typical symptoms in soldiers with acute NSLBP after four weeks. A multidimensional intervention reduced disability in military personnel with non-chronic NSLBP after four weeks. Strong evidence does not exist for the efficacy of any conservative interventions in the reduction of pain and disability in tactical populations with NSLBP.

Load Magnitude and Locomotion Pattern Alter Locomotor System Function in Healthy Young Adult Women

Introduction

During cyclical steady state ambulation, such as walking, variability in stride intervals can indicate the state of the system. In order to define locomotor system function, observed variability in motor patterns, stride regulation and gait complexity must be assessed in the presence of a perturbation. Common perturbations, especially for military populations, are load carriage and an imposed locomotion pattern known as forced marching (FM). We examined the interactive effects of load magnitude and locomotion pattern on motor variability, stride regulation and gait complexity during bipedal ambulation in recruit-aged females.

Methods

Eleven healthy physically active females (18–30 years) completed 1-min trials of running and FM at three load conditions: no additional weight/bodyweight (BW), an additional 25% of BW (BW + 25%), and an additional 45% of BW (BW + 45%). A goal equivalent manifold (GEM) approach was used to assess motor variability yielding relative variability (RV; ratio of “good” to “bad” variability) and detrended fluctuation analysis (DFA) to determine gait complexity on stride length (SL) and stride time (ST) parameters. DFA was also used on GEM outcomes to calculate stride regulation.

Results

There was a main effect of load (p = 0.01) on RV; as load increased, RV decreased. There was a main effect of locomotion (p = 0.01), with FM exhibiting greater RV than running. Strides were regulated more tightly and corrected quicker at BW + 45% compared (p < 0.05) to BW. Stride regulation was greater for FM compared to running. There was a main effect of load for gait complexity (p = 0.002); as load increased gait complexity decreased, likewise FM had less (p = 0.02) gait complexity than running.

Discussion

This study is the first to employ a GEM approach and a complexity analysis to gait tasks under load carriage. Reduction in “good” variability as load increases potentially exposes anatomical structures to repetitive site-specific loading. Furthermore, load carriage magnitudes of BW + 45% potentially destabilize the system making individuals less adaptable to additional perturbations. This is further evidenced by the decrease in gait complexity, which all participants demonstrated values similarly observed in neurologically impaired populations during the BW + 45% load condition.