Load Carriagepdf

3/6/2017 Loadcarriagepdf
Loadcarriagepdf
1.bordeninstitutemonographseriesLoadCarriagein
MilitaryOperationsJosephKnapik,ScD,andKatyReynolds,MDedi
tedbyWilliamR.Santee,PhDKarlE.Friedl,PhD,Colonel,US
ArmyAREVIEWOFHISTORICAL,PHYSIOLOGICAL,
BIOMECHANICAL,ANDMEDICALASPECTS
2.bordeninstitutemonographseriesbordeninstitute
LoadCarriageinMilitaryOperationsAReviewOFHISTORICAL,
PHYSIOLOGICAL,BIOMECHANICAL,ANDMEDICALASPECTS
JosephKnapik,ScD,andKatyReynolds,MDeditedbyWilliamR.
Santee,PhDKarlE.Friedl,PhD,Colonel,USArmy
3.Makingloadslighter,improvingloaddistribution,usingappropriatephysicaltraining,
selectingproperequipment,andchoosingspecifictechniquesdirected
atinjurypreventionwillallfacilitateloadcarriage.Suitablechanges
willallowservicememberstocontinuemissionsatlowerenergycosts
andwithfewerinjuries,andbebetterabletoperformothertasks.This
monographwaspreparedformilitarymedicaleducationaluse.The
focusoftheinformationistofosterdiscussionthatmayformthe
basisofdoctrineandpolicy.Theopinionsorassertionscontained
hereinaretheprivateviewsoftheauthorsandarenottobeconstrued
asofficialorasreflectingtheviewsoftheDepartmentoftheArmyor
theDepartmentofDefense.DosageSelection:Theauthorsand
publisherhavemadeeveryefforttoensuretheaccuracyofdosages
citedherein.However,itistheresponsibilityofeverypractitionerto
consultappropriateinformationsourcestoascertaincorrectdosages
foreachclinicalsituation,especiallyforneworunfamiliardrugsand
procedures.Theauthors,editors,publisher,andtheDepartmentof
Defensecannotbeheldresponsibleforanyerrorsfoundinthisbook.
UseofTradeorBrandNames:Useoftradeorbrandnamesinthis
publicationisforillustrativepurposesonlyanddoesnotimply
endorsementbytheDepartmentofDefense.NeutralLanguage:
Unlessthispublicationstatesotherwise,masculinenounsand
pronounsdonotreferexclusivelytomen.Certainpartsofthis
publicationpertaintocopyrightrestrictions.ALLRIGHTSRESERVED.
Nocopyrightedpartsofthispublicationmaybereproducedor
transmittedinanyformorbyanymeans,electronicormechanical
(includingphotocopy,recording,oranyinformationstorageand
retrievalsystem),withoutpermissioninwritingfromthepublisheror
copyrightowner.BordenInstituteWalterReedArmyMedicalCenter
USArmyMedicalDepartmentCenter&SchoolThismonographwas
originallysubmittedtotheBordenInstituteasachapterintendedfor
publicationinMilitaryQuantitativePhysiology,abookintheTextbooks
ofMilitaryMedicineseries.Becausechangesmaybemadebefore
publication,thismonographismadeavailablewiththeunderstanding
thatitwillnotbecitedorreproducedwithoutthepermissionofthe
publisher.
4.CONTENTSForewordvAcknowledgmentsvii
Introduction1HistoricalPerspective5LoadsCarriedDuring
VariousHistoricalPeriods519thand20thCenturyEffortstoStudy
LoadCarriage5LoadCarriageThroughoutHistory12Body
StatureandBodyMassasFactorsinLoadCarriage14
PhysiologicalandBiomechanicalAspectsofLoadCarriage15Load
Distribution15BackpacksandDoublePacks20LoadCarriage
ontheFeet,Thighs,andintheHands24RifleCarriage25Body
Armor25LoadCarriageUsingCartsandMotorizedVehicles27
PhysiologicalFactorsAssociatedWithLoadCarriage28Physical
TrainingandLoadCarriage29GenderDifferences31Predicting
theEnergyCostofCarryingMilitaryLoads31
5.MedicalProblemsAssociatedWithLoadCarriage35Foot
Blisters35Metatarsalgia43StressFractures43KneePain
45LowBackInjuries46RucksackPalsy47Meralgia
https://es.slideshare.net/James8981/loadcarriagepdf 1/26
Paresthetica48InfluenceofLoadCarriageonthePerformanceof
OtherTasks49Summary51References53Coverphoto:
CourtesyofUSAirForce,TSgtEfrenLopez,photographerJoseph
KnapikisaMajor(Ret),MedicalServiceCorps,USArmyResearch
Physiologist,InjuryPreventionProgram,USArmyPublicHealth
Command(Provisional),5158BlackhawkRoad,AberdeenProving
Ground,Maryland210055425.KatyReynoldsisaColonel(Ret),
MedicalCorps,USArmy8820BurningTreeRoad,Pensacola,
Florida32514.
6.ForewordThismonographpresentsacomprehensiveoverviewof
researchonsoldierloadcarriage.Theauthorsdemonstratebroad
personalresearchandreportingexperiencefrombothfieldand
laboratoryperspectives.Thisknowledgehelpsprovideanimplicit
frameworkforcategorizingandevaluatingpastresearch,aswellas
forplanningfutureresearchefforts.Loadscarriedbysoldiershave
beenofscientificconcernsincearoundthe18thcenturyandisa
continuingproblem,asrecognizedbysoldiersoperatinginrugged
terraininAfghanistantoday.Itisperhapsshockingthat,with
technologicaladvances,theproblemshaveworsenedratherthan
improved.Improvementsinweaponry,surveillance,communications,
andpersonalprotectiveequipmenthaveaddedtothesoldierload,
andthishasonlypartiallybeencompensatedbyenhancedstrategies
tosafelyandeffectivelymanagethoseloads.Theproblemofload
carriagehasbeenreviewedbyanumberofmilitarycommitteesand
organizationsthathaveprovidedsuggestionsforreducingthestress
ofloads.Generally,thesegroupsweretaskedwithnarrowlyfocusing
onaparticular,thentimelyperspectivefindingsweredirectly
applicabletotheissuesdirectlyathand,butwerenotalwaysof
strategicvalueappropriatetobroaderscientificconcerns.Thus,to
somedegree,developedknowledgebasedonloadcarriagehasnot
beenfullyexplored.Missing,toalargeextent,isresearchonthe
relationshipbetweentheknownstateofloadcarriagecomfort,energy
cost,andergonomicfit,andtheongoingintroductionofancillary
technologies(eg,robotics,automation,andrealtime
7.communicationsdevices),aswellasvisionandhearing
enhancements.Thismonographprovidesaconcrete,databased
frameworkneededtoguidetheintroductionofsuchevolvingtopics
intotheloadcarriageresearcharena.Thesectiononphysiologyand
biomechanicsprovidesanoverviewofcurrentloadcarriagesystems
andhighlightsinformationonloadplacement,packframes,hipbelts,
andstrapadjustments.Althoughmaterielandcombatdevelopers
haveconsideredsomeinformationnotedherein,otherresearchis
relativelyneworhasnotbeenadequatelypromulgatedtothese
developers.Astarkexampleofpotentialimprovementsistakenfrom
gainsinfemaleloadcarriageperformanceandcomfort,onceload
carriageequipmentwasfinallyupdatedinthepastdecadeto
accommodatesmallerframedwomenwithdifferentanthropometric
dimensionsthantheaveragemale.Anothersectionreviewsthe
equationsthatquantifytheimpactofloaddistributiononthe
mechanicsandenergycostofloadcarriage.Thisdetailedcontribution
totheknowledgebasepermitstheexplorationofnewtechnologies,
suchasvirtualprototypingofnewsystems,toproducesaferandmore
effectiveloadcarriagethaneverbefore.Theliteratureonriflecarriage
andbodyarmoriscovered,aswellasalternativemethodsofload
carriage(eg,cartsandmotorizedvehicles).Unfortunately,itisstill
necessarytodiscussinjuriesassociatedwithloadcarriage,andthis
monographprovidespracticalinformationonthesignsandsymptoms
oftheseinjuries,aswellastreatmentandevidencebased
suggestionsforinjuryprevention.Theauthorsworkedformanyyears
attheUSArmyResearchInstituteofEnvironmentalMedicine
(USARIEM),wheremuchoftheUSresearchonloadcarriagehas
beenconducted.Theyhavegainedbroaderperspectivesservingwith
organizationssuchastheUSArmyResearchLaboratoryandtheUS
ArmyCenterforHealthPromotionandPreventiveMedicine(nowthe
USArmyPublicHealthCommand).KarlE.Friedl,PhD,Colonel,US
ArmyDirector,TelemedicineandAdvancedTechnologyResearch
CenterUSArmyMedicalResearchandMaterielCommandRenede
Pontbriand,PhDAssociateDirectorforScienceandTechnology(Ret)
HumanResearchandEngineeringDirectorateUSArmyResearch
Laboratoryvi|Foreword
8.AcknowledgmentsTheauthorsthankMajorJamesNagel,Mr
WilliamHarper,andDrRenedePontbriandfortheirhelpful
comments.ColonelKarlFriedl,DrWilliamSantee,andMrRyan
Steelmanassistedwithmanyofthephotosandinbringingthis
monographtofruition.
9.IntroductionBecauseofmissionrequirementsorthelimited
transportationassetsofsometypesofunits,servicemembersmust
oftendependontheirpersonalmobilitytomoveindividualequipment.
Thecarryingofloadsbytroopsisanimportantaspectofmilitary
operationsthatcanbecomecriticalinsomesituations.Overloading
withammunitionandequipmentcanleadtoexcessivefatigueand
impairtheabilitytofight.Militaryhistorianscancitenumerous
exampleswhenheavyloadsdirectlyorindirectlyresultedinreduced
performance,unnecessarydeaths,andlostbattles(Exhibit1).14The
experienceofBritishtroopsintheFalklandIslandsWar(1982)and
USArmytroopsinbothGrenada(1983)andAfghanistan(1999
2010)emphasizesthatoverloadingtroopsisstillaprobleminmodern
warfare.57Thepurposeofthismonographistoreviewthehistorical,
physiological,biomechanical,andmedicalaspectsofloadcarriage.
Practicalsuggestionsareofferedforreducingthestressofloadson
servicemembersandforpreventingandtreatingcommonload
carriagerelatedinjuries.Reviewsonotheraspectsofloadcarriage
areavailableintheworksofHaisman8andKnapiketal.9,10
10.Exhibit1.HeavyLoadsinMilitaryHistoryOmahaBeach,France
(1944)(1)IntheinitialassaultwavesatOmahaBeachheadthere
werecompanieswhosemenstartedashore,eachwithfourcartonsof
cigarettesinhispackasiftheobjectoftheoperationwastrading
withtheFrench.Somenevermadetheshorebecauseofthe
cigarettes.Theydroppedintodeepholesduringthewadein,orfell
intothetidenickedbyabullet.Thentheysoakedupsomuchweight
theycouldnotriseagain.Theydrowned.Somewerecarriedoutto
seabutthegreatnumberwerecastuponthebeach.Itimpressedthe
survivorsunforgettablythatlineofdeadmenalongthesand,many
ofwhomhadreceivedbuttriflingwounds....Noonecansaywith
authoritywhethermoremendieddirectlyfromenemyfirethan
perishedbecauseoftheexcessweightthatmadethemeasyvictims
ofthewater....Thisalmostcostusthebeachhead.Sinceitisthe
samekindofmistakethatarmiesandtheircommandershavebeen
makingforcenturies,thereiseveryreasontobelieveitwillhappen
again.Grenada(1986)(2)Unfortunatelytoofewcommanders
enforcedloaddiscipline.Considerthissoldiersobservation:We
attackedtosecuretheairhead.Wewerelikeslowmovingturtles.My
rucksackweighed120pounds.Iwouldgetupandrushfor10yards,
throwmyselfdownandcouldntgetup.Idrestfor10or15minutes,
struggletogetup,go10moreyards,andcollapse.Afterafewrushes,
IwasphysicallyunabletomoveandIamingreatshape.Finally,after
Igottotheassemblyarea,Ishuckedmyrucksackandwasableto
fight,butIwastotallydrained.Consideranothersoldierstelling
comment:IwasscaredIwasgoingtogetkilledbecauseIcouldnt
reallyrunwiththatrucksackon.Evenallowingforsomeexaggeration
bythesoldiers,noonecandoubttheywereoverloaded.Saudi
ArabiaandIraq(1990)(3)DuringOperationDesertShield,abrigade
conductedalivefiretrainingassaulttoseizeabridge.Thebrigade
commandernoticedthattheequipmentthesoldierswerecarryingwas
interferingwiththemission.Attheafteractionreviewhedirectedthe
battalioncommanderstoinvestigatetheweightthesoldierscarriedin
theirbattalions.Atthebriefbackonecommanderindicatedthatthe
averagesoldierinhisbattalioncarriedmorethan100pounds.At
Christmas1990the[2dBrigade,82dAirborneDivision]was
conductingtrainingfartotheSouthofthefront.Duringthisrelatively
peacefultime,andespeciallyasaresultoftheholiday,thesoldiers
hadaccumulatedmanyitemstheycouldnottakeintocombat.When
theordercameforthebrigadetospearheadtheFrench6thLight
ArmoredDivisionsattackintoIraq,thechainofcommandtook
(Exhibit1continues)2|LoadCarriageinMilitaryOperations
11.stepstocareforthesoldierspersonaleffectsandexcess
baggage.Theymadealistofwhatasoldierwouldcarryonhisperson
(fightingload),whathewouldcarryinhisrucksack(approachmarch
load),whathewouldcarryinhisAbag(sustainmentload),andwhat
wouldgoinhisBbag(contingencyload).Itemsthatdidnotfitinthese
categories,thesoldiershippedhome....Thebattalionsthatentered
theEuphratesRiverValleyhadlearnedavaluablelessonasaresult
oftheirearliertrainingattackonthebridge.Althoughtheirfightingand
approachmarchloadswerestillheavy,theyknewbetterhowto
managethem.Whenunitsarrivedattheirlandingzones,the
battalionssecuredtheirrucksacks(approachmarchload)witha
minimumguardforcewhiletherestofthesoldiersoccupiedtheir
positions.Assoonaspracticable,soldierswentback,afewatatime,
toretrievetherucksacks.Inatleastoneinstance,aunitplaced
excessammunitionandwaterinkickoutbundlesthatcouldthenbe
takenforwardandstoredinacentrallocationforfurtherdistribution.
Afghanistan(2002)(4)Wehadextremedifficultymovingwithallofour
weight.Ifourmovementwouldhavebeentorelieveaunitincontact
oratimesensitivemissionwewouldnothavebeenabletomoveina
timelymanner.Ittookus8hourstomove5clicks.Withjustthevest
[Interceptorhardbodyarmor]andLBV[EnhancedTacticalLoad
BearingVestortheMOLLEvest]wewereeasilycarrying80lbs.
Throwontheruckandyouresucking.Datasources:(1)Marshall
SLA.TheSoldiersLoadandtheMobilityofaNation.Quantico,Va:
MarineCorpsAssociation1950.(2)DubikJM,FullertonTD.Soldier
overloadinginGrenada.MilRev.198767:3847.(3)PorterSC.The
soldiersload.Infantry.1992MayJune:1922.(4)Commentsfrom
the187thRegimentFirstSergeant,OperationAnaconda.Exhibit1
continuedIntroduction|3
12.HistoricalPerspectiveLoadsCarriedDuringVariousHistorical
PeriodsFigure1showsloadsthatwerecarriedbyvariousmilitary
unitsinhistory,withemphasisonmorerecenttimes.Lothian11
provideddataonancientmilitaryunits.Untilaboutthe18thcentury,
troopscarriedloadsthatseldomexceeded15kgastheymarched.
Extraequipmentwasoftenmovedbyauxiliarytransport,including
assistants,horses,carts,andcampfollowers.Theextraequipment
oftenconsistedofweaponsandprotectionusedbytroopswhenthey
wentintobattle(eg,swordsandshields).Afterthe18thcentury,
auxiliarytransportwasdeemphasized,andmoredisciplinedarmies
requiredtroopstocarrytheirownloads.Thelatterdayservice
memberoftencarriedmoreequipmentduringthemarchandless
whenincontactwithhostileforces.2Itshouldbenotedthatmostof
theloadsprovidedinFigure1arefromestimatesandliterarysources.
TheonlyactuallymeasuredvaluesarethosefromtheJoint
ReadinessTrainingCenter(inFortChaffe,Ark)andOperation
EnduringFreedom(Afghanistan).19thand20thCenturyEffortsto
StudyLoadCarriageEuropeanEffortsAftertheCrimeanWar,a
BritishCommitteeAppointedtoInquireintotheEffectsofthePresent
SystemofCarryingAccouterments,AmmunitionandKitofthe
InfantrySoldierrecommendedthatsoldier
13.Figure1.Loadscarriedonthemarchbyvariousinfantryunitsthroughouthistory.Inf:infantryJRTC:JointReadinessTrainin
OperationEnduringFreedomUS:UnitedStatesWWI:WorldWarIWWII:WorldWarII.
Datasources:DeanCE.TheModernWarriorsCombatLoad.DismountedOperationsinAfghanistanApril
May2003.FtLeavenworth,Kan:ArmyCenter
forLessonsLearned2004.DownsF.TheKillingZone:MyLifeintheVietnamWar.NewYork,NY:BerkleyPublishingGroup197
TheBehaviorofMeninBattle.NewYork,NY:MacMillanandCo,1985.JointReadinessTrainingCenter.Unpublisheddatacolle
inexercisesattheJointReadinessTrainingCenter,1988.LothianNV.Theloadcarriedbythesoldier.JRArmyMedCorps.1922
24.PorterSC.Thesoldiersload.Infantry.1992MayJune:1922.6|
LoadCarriageinMilitaryOperations50403020100
EstimatedLoadMass(kg)GreekHoplitesRomanLegionsByzantine
InfantryAngloSaxonFreemenEnglishPikemenNapoleonicWarsUS
CivilWarBritishCrimeanWarJRTCUSVietnamBritishonSomme
WWIUSMarinesKoreaUSInfDesertShieldWingate'sChinditsWWII
Estimatedloadmassescarriedonthemarch
EstimatedtotalmassofallequipmentsoldierstookOEF
14.loadsbereducedto21kgthroughtheeliminationof
necessaries,especiallyunderclothing.2,4StudiesattheFrederick
WilhelmInstitutein1895showedthat,iftheweatherwascool,
soldierscouldtoleratemarching24kmwithaloadmassof22kg.In
warmweather,thistestcausedminordisturbances,fromwhichthe
menrecoveredin1day.2In1908,aCommitteeonthePhysiological
EffectsofFood,Training,andClothingoftheSoldierdevelopeda
muchimprovedloadcarriagesystemthatwasusedinWorldWarI.In
1920,theHygieneAdvisoryBoardoftheBritishArmyrecommended
thatthesoldiersloadshouldnotexceed18to20kgoronethirdofhis
bodyweightwhilemarching.Withthedevelopmentofindirect
calorimetry,Cathcartandcolleagues12wereabletostudytheenergy
costoftwomenmarchingatavarietyofpacesandwithavarietyof
loadmasses.Theyfoundthatenergycostpermasscarriedwas
lowestwhensubjectscarriedamassequalto40%oftheirbodymass.
AmericanEffortsThereislittleinformationaboutAmericaneffortsto
studyloadcarriageformallybeforeWorldWarII,iftheseeffortseven
existed.UnderthedirectionoftheQuartermasterGeneral,CaptainH.
W.Taylordevelopedasoldierpayloadplan.Thiswasanattemptto
unburdenthesoldierbyprovidinghimwithonlytheitemsneededfor
combat.Therewerealsoattemptstodevelopsegmentedpacks:ifthe
tacticalsituationpermitted,aportionofthepackcontaining
nonessentialequipmentcouldbeleftbehind.13WorldWarIIledto
manysituationsinwhichsoldiershadtocarryloadsforlong
distances.Figure2showsAmericansoldiersmarchingtorelieve
troopsintheArdennesForestduringtheBattleoftheBulge.Figure3
showsatrainingexerciseinwhichamodernairmanisbeing
transportedusingatwomancarry,notanuncommonsituationin
WorldWarII.Figure4showsaninfantrymantransportingloadsby
mulesinBurma.Presumablydrawingonmanyoftheexperiences
fromWorldWarII,USArmyFieldBoardNo.3(FortBenning,Ga)
performedanumberofstudiesfrom1948to1950.Boardmembers
notedthatpreviousworkhadignoredtheindividualsoldiersmission
withinthemilitaryunit.Instudyingindividualpositions,theyfoundthat
loadsrangedfrom25kgfortheriflemanto50kgfortheammunition
carrier.IncooperationwiththeOfficeofTheSurgeonGeneral,the
Boardestimatedhowloadmassesshouldbereducedtomakethe
soldiermorecombateffective.Metabolicdataandstressplacedon
soldiersincombatwereconsidHistoricalPerspective|7
15.ered.Basedonaliteraturereview,theBoarddeterminedthatthe
energyavailableformarching(withthebasalmetabolicrate
subtracted)couldnotexceed3,680kcal/day.Theyrecommendedthat
ariflemancarry18kgintheworstconditions25kgwas
recommendedasthemaximummarchload.14Aboutadecadelater,
theUSArmyInfantryCombatDevelopmentsAgency15,16reinforced
theweightrecommendationsofUSArmyFieldBoardNo.3.The
agencyrecommendedaloadof18kg(or30%bodyweight)fora
conditionedfightingsoldierand25kg(or45%bodyweight)fora
marchingsoldier.Theydevelopedtheideaofloadecheloningand
definedafightingloadandanexistenceload.In1987,theUSArmy
DevelopmentandEmploymentAgency(ADEAFortLewis,Wa)
furtherdevelopedtheconceptofloadecheloning.17Theycalledthe
loadcarriedbyasoldierthecombatload,definedasthemission
essentialequipmentrequiredbysoldierstofight,survive,Figure2.
Americansoldiersmarchingtorelievetroopsencircledinthe
ArdennesForestduringtheBattleoftheBulge.Photograph:Courtesy
ofOliveDrab.com.Fromhttp://www.olivedrab.com/od_history_
ww2_ops_battles_1944bulge.php.8|LoadCarriageinMilitary
Operations
16.Figure3.Anairmanbeingtransportedusingatwomancarryina
trainingexercise.Photograph:CourtesyoftheUSAirForce.From
http://www.af.mil/shared/media/photodb/photos/070515F4127S
706.jpg.Figure4.MarsTaskForcemuleskinners(2ndBattalion,
475thInfantryRegiment)leadmulesthroughtheswiftriverthat
impededtheirprogresstoBhamo,Burma,November17,1944.
Photograph:CourtesyofOliveDrab.com.Fromhttp://www.olive
drab.com/od_armyhorsesmules_ww2.php.HistoricalPerspective|9
17.andcompletetheircombatmission.Thecombatloadwasfurther
dividedintoafightingloadandanapproachmarchload.Thefighting
loadwascarriedwhenenemycontactwasexpectedorstealthwas
necessary.Itconsistedofthesoldiersclothing,loadbearing
equipment,helmet,weapon,rations,bayonet,andammunition.The
approachmarchloadwascarriedinmoreprolongedoperations.It
includedthecombatloadplusapack,sleepingroll,extraclothing,
extrarations,andextraammunition.CurrentUSArmydoctrine
recommends22kg(or30%bodyweight)forthefightingloadand33
kg(or45%bodyweight)fortheapproachmarchload.18ADEA
studiedninelightinfantryjobsthatsoldiersmighthavetoperformina
worstcasesituation.Theloadscarriedbysoldiersinthesepositions
areshowninTable1.ADEA17proposedfiveapproachesfor
lighteningsoldierloads:(1)developmentoflighterweightcomponents
however,technicaldevelopmentswereexpectedtoreduceloads
byonly6%overall(seeTable1)19(2)useofthesoldierload
planningmodelacomputerprogramthataidedthecommanderin
tailoringloadsthroughariskanalysisbasedonthemission,enemy,
terrain,troops,andtime(3)developmentofspecialized,loadcarrying
equipment(includingitemssuchashandcartsandallterrain
vehicles)(4)reevaluationofcurrentdoctrinethatmightaffectload
carriage(eg,anincreasedemphasisonmarksmanshiptoreduce
ammunitionloads)and(5)developmentofspecialphysicaltraining
programstoconditionsoldierstodevelopmorephysicalcapabilityfor
loadcarriage.Table1.WorstCaseLoadsandProjectedWeights
BecauseofNewTechnologies(IncludingClothingandPersonal
Equipment)forNineUSArmyLightInfantryPositionsUSArmy
DevelopmentandEmploymentExpectedWeightsBecauseofPosition
AgencyWorstCaseLoads(kg)NewTechnologies(kg)19Assistant
DragonGunner7674AssistantMachineGunner6959Radio
TelephoneOperator6864DragonGunner6461Rifleman6264
SquadAutomaticWeapon5957GunnerPlatoonLeader5854
MachineGunner5853Grenadier565310|LoadCarriageinMilitary
Operations
18.Thefirststudyofloadsactuallycarriedincombatwasperformed
withalightinfantrybrigade(the82ndAirborneDivision)engagedina
lowintensityconflictinthedesertsandmountainsofAfghanistan
duringspring2003.Ateamofinfantrymenwasdedicatedtothedata
collectioneffortandalsoservedtoaugmentthecombatforces.Loads
wereinventoriedandweighedwithdigitalscaleson15separate
occasionsinvolvingsevencombatmissionsfromApril4,2003toMay
5,2003.Theloadscarriedbysoldiersineachofthe29dutypositions
areshowninTable2.Table2.AverageLoadsCarriedbyLight
InfantrySoldiersDuringDismountedOperationsinAfghanistanin
AprilandMay20035FightingApproachMarchEmergencyApproach
DutyPositionLoad(kg)Load(kg)MarchLoad(kg)Rifleman294358
M203Grenadier324862AutomaticRifleman365064Antitank
Specialist314559RifleTeamLeader294359RifleSquadLeader
284358ForwardObserver264158ForwardObserver
Radio/TelephoneOperator273954WeaponsSquadLeader284560
M240MachineGunner375160M240BAssistantGunner325567
M240BAmmunitionBearer315365RiflePlatoonSergeant284154
RiflePlatoonLeader284253PlatoonMedic254254
Radio/TelephoneOperator2945NodataMortarSectionLeader26
5068MortarSquadLeader28586560mmMortarGunner294961
60mmMortarAssistantGunner2555Nodata60mmMortar
AmmunitionBearer2446NodataRifleCompanyCommunication
Chief3150NodataFireSupportOfficer2542NodataFireSupport
NoncommissionedOfficer244165SapperEngineer274360
CompanyExecutiveOfficer2742NodataCompanyFirstSergeant29
4157CompanyRadio/TelephoneOperator294459RifleCompany
Commander304450Average294660HistoricalPerspective|11
19.Theemergencyapproachmarchloadwasdefinedastheloadthat
wascarriedinfootoperationswhentheterrainwasimpassableto
vehiclesorwhereground/airtransportationresourcesarenot
available.Itwasnotedthatrecentimprovementsinballisticprotection
(interceptorbodyarmor,advancedcombathelmet)hadincreased
soldiersurvivability,buthaddecreasedmobilityandendurance.Body
armorandtheprotectivehelmetaccountedforroughly31%ofthe
fightingload.5LoadCarriageThroughoutHistoryManyofthe
approachesproposedmorerecentlyforreducingsoldierloads5,17are
notnew.Forexample,commandersandindividualsoldiershave
practicedloadtailoringthroughouthistory.IphicratesofAncient
Greecearmedhisinfantrywithonlyawoodenshield,lance,and
sword.TheydefeatedaSpartanforceofheavilyequippedHoplites,
presumablybecauseoftheirgreateragility.TheHoplitescarrieda
loadofabout37kgintobattle.Inthe17thcentury,GustavusAdolphus
ofSwedenlightenedhissoldiersloadsbyremovingarmorand
shorteningweapons.IntheBoerWars,theBritishArmycarriedonly
arms,ammunition,water,andahaversackatotalweightof11kg.2
Soldiersinbattlehaveoftenreducedloadsontheirowninitiative.
DuringthehighlysuccessfulShenandoahcampaign,theConfederate
troopsunderStonewallJacksondiscardedextraclothing,overcoats,
andknapsacks.Theycarriedonlyrifles,ammunition,food,ablanket
(orrubbersheet),andtheclothingtheywore.2,3American
paratroopersenteringNormandyin1944exitedtheaircraftwithaload
ofabout36kg.However,onceontheground,theyquicklydiscarded
equipmenttheyconsideredunnecessary.3Awidevarietyofload
carryingsystemshavealsobeenusedthroughouthistory.TheGreek
Hoplitesusedhelots(serfsinancientSparta)tocarrytheirequipment
onthemarch.CartsandpackswereusedbyRomanlegions.Oliver
Cromwellsarmiesusedpackboys.Napoleonusedcartswhenever
possibletorelievehissoldiersoftheirmarchloads.Campfollowers
alsocarriedmuchofthesoldiersloadduringvariouswars.1,2
Physicaltraininghasbeenusedtoimprovemarchingwithloads.Ro
manlegionnairesareestimatedtohaveperformedroadmarching
threetimespermonthatarateofabout5km/hcarryinga20kgpack
overa32kmdistance.InCromwellsarmy(circa1640),paywas
contingentonmarching24kmonaregularbasis.DuringWorldWarI,
theFrench12|LoadCarriageinMilitaryOperations
20.Chasseurs(infantry),carryingalightkit,marchedmorethan13
to18kmtwotimesperweek.RecruittraininginGermanyduring
WorldWarIincludedtakinganinitial10kmmarch,with1kmadded
weeklyuntilrecruitsweremarching20kmwithafullkit.2
McMichael20givesabriefdescriptionofthetrainingofWingates
Chindits(fromtheBurmeseTable3.PhysicalCharacteristicsof
SoldiersandRecruitsBodyMassFatFreeBodySampleHeight(cm)
Weight(kg)Index(kg/m2)Mass(kg)Fat(%)FrenchSamplesFrench
(CrimeanWar)21635621.1NANAFrench(PostWWI)2163NANA
NANABritishSamplesBritish(PostWWI)21685920.9NANA
Britishrecruits(1978)(1)1757022.9NANABritishinfantry(1976)(1)
1757323.8NANAUSSamplesUSmalesoldiers(1864)(2)17164
21.953*16.9*USmalesoldiers(1919)(2)1726622.355*15.7*US
malesoldiers(1946)(2)1747023.160*14.4*USmalesoldiers
(1976)(3)1757323.85919.5USmalesoldiers(1984)(2)17476
25.16317.3USmalesoldiers(1986)211777624.2NANAUS
malesoldiers(1988)1301767624.563*15.9*USmalesoldiers
(1989)231787724.46415.9USmalesoldiers(2004)17781
25.7NANAUSmalesoldiers(2005)(4)1788326.46817.7*
Estimatedfromcircumferencemeasures.(5)Estimatedfrom
skinfolds.(6)Estimatedfromdensiometry.(7)Previously
unpublisheddata,FortCampbell,Kentucky.EstimatedfromdualX
rayabsorptiometry.(8)NA:notavailableWWI:WorldWarIData
sources:(1)VogelJA,CrowdyJP.Aerobicfitnessandbodyfatof
youngBritishmalesenteringtheArmy.EurJApplPhysiol.
197840:7383.(2)FriedlKE.Bodycompositionandmilitary
performance:originsoftheArmystandards.In:MarriottBM,
GrumstrupScottJ,eds.BodyCompositionandMilitaryPerformance.
Washington,DC:NationalAcademyPress1992.(3)VogelJA,Patton
JF,MelloRP,DanielsWL.Ananalysisofaerobiccapacityinalarge
UnitedStatespopulation.JApplPhysiol.198660:494500.(4)Sharp
M,KnapikJJ,WalkerLM,etal.Changesinphysicalfitnessandbody
compositionfollowing9monthsdeploymenttoAfghanistan.MedSci
SportsExerc.200840:16871692.(5)VogelJA,KirkpatrickJW,
FitzgeraldPI,HodgdonJA,HarmanEA.DerivationofAnthropometry
BasedBodyFatEquationsfortheArmysWeightControlProgram.
Natick,Mass:USArmyResearchInstituteofEnvironmentalMedicine
1988.TechnicalReport1788.(6)DurninJV,WomersleyJ.Bodyfat
assessedfromtotalbodydensityanditsestimatefromskinfold
thickness:measurementson481menandwomenaged16to72
years.BrJNutr.197432:7797.(7)FitzgeraldPI,VogelJA,MilettiJ,
FosterJM.AnImprovedPortableHydrostaticWeighingSystemfor
BodyComposition.Natick,Mass:USArmyResearchInstituteof
EnvironmentalMedicine1988.TechnicalReportT4/88.(8)Lohman
TG.DualenergyXrayabsorptiometry.In:RocheAF,HeymsfieldSB,
LohmanTG,eds.HumanBodyComposition.Champaign,Ill:Human
Kinetics1996.HistoricalPerspective|13
21.wordchinthe[orlions]alsoknownasWingatesRaiders),who
foughtaslightinfantryduringtheCentralBurmacampaigninWorld
WarII.Theywereloadedwithhuge34kgpacksandmarched
unmercifullythroughmankillingterrain.20Thesesoldiersperformed
a225kmroadmarchjustbeforetheirdeploymenttoBurma.Units
withintheUSArmys10thMountainDivisionroutinelyroadmarched
withtheirfightingloadsaboutthreetimespermonth.Training
guidanceprescribedaquarterlyroadmarchof40km(7min/km[or11
min/mile]pace)andayearlyroadmarchof161kmin5days.21Body
StatureandBodyMassasFactorsinLoadCarriageAservice
membersheightandweightmightbeimportantfactorsinload
carriage.2,22Largerservicemembersmightbeabletocarryheavier
loadsbyvirtueoftheirgreaterboneandmusclemass.2325Ithas
beenestimatedthathumanshaveincreasedtheirheightabout10cm
sincetheIndustrialRevolution,possiblybecauseofbetternutrition.26
Table3providesasummaryoftheheightsandweightsofvarious
groupsderivedfromavarietyofsources.BeforetheBritishCrimean
War,onlyminimumstandardswereavailable.USsamplesshowa
progressiveincreaseinheight,weight,andbodymassindexsincethe
AmericanCivilWar.Theincreaseinweightisapparentlyattributable
toanincreaseinfatfreemass,withtemporalchangesinbodyfatless
consistent.DataonthegeneralUSpopulationsuggestthatbody
weightandbodymassindexhavebeenprogressivelyincreasing
since1980.27,28DataonArmyrecruitssuggestthattheincreasein
weightisaccountedforbyaboutequalincreasesinfatfreemassand
bodyfat.2914|LoadCarriageinMilitaryOperations
22.PhysiologicalandBiomechanicalAspectsofLoadCarriage
Althoughhistoricalstudiesareusefultoshowthattheproblemsof
loadcarriagehavebeenwiththemilitaryforaconsiderabletime,itis
physiologicalandbiomechanicalresearchconductedduringthelast
70yearsthathavedevelopedsomepracticalmethodstoreduceload
stressonservicemembers.Manygeneralprinciplesandtechniques
haveemerged,butstudiesdonotrevealasinglewayofcarrying
loadsthatappliestoallsituations.Commandersmustconsiderthe
mission,environment,time,andterraintoadjusttheservicemembers
burdens.LoadDistributionTherearemanywaystocarryloads,and
thetechniqueuseddependsonthecharacteristicsoftheload(size,
shape,mass,etc),howfartheloadmaybecarried,previous
experience,andtheequipmentavailabletotheservicemember.30
Figure5illustratestechniquesofcarryingloadsthathavebeen
directlyinvestigatedforindividualsoldiers.3037Teamlifting
techniquescanassistinmovinglargerloads,asshowninFigures6
and7.TwoloadcarryingsystemscurrentlyavailabletoindividualUS
soldiersinclude(1)theAllPurposeLightweightIndividualCarrying
Equipment(ALICE)packand(2)theModularLightweightLoad
Carrying
23.Figure5.Methodsofloadcarriageinvestigatedinvariousstudies.
Photograph:CourtesyofSURVIAC(Survivability/Vulnerabiity
InformationAnalysisCenterWrightPattersonAirForceBase,
Ohio)/ARL(USArmyResearchLaboratoryAdelphi,Md)/BoozAllen
(McLean,Va).16|LoadCarriageinMilitaryOperations
24.Figure6.AnArmyreliefteamcarriesanArmytentinaboxtoa
waitingtruckfollowingamajorearthquakeonNovember23,1980.
Themenarefromthe1stBattalion,509thInfantryRegiment,Vicenza,
Italy.Photograph:CourtesyofDefenseImagery.mil.From
http://www.defenseimagery.mil/imagery.
html#a=search&s=4%20man%20carry&chk=6cfe0&guid=beed46698d7727f882c43439bd
8bcef71d23261e.Equipment(MOLLE)pack.TheALICEpackismore
than35yearsold,havingbeenintroducedwithinthe1973to1974
timeframe.TheALICEpackisdurable,stablewithheavyloads,and
providesventilationtothebackbecausetheexternalframeholdsthe
rucksackawayfromthebodyhowever,adjustmentislimited.Studies
completedin199538showedtheneedforamodularsystem,with
betterequipmentcompatibilityandfeaturesforfittingspecial
equipment.Studies39resultedinthedevelopmentandimprovement
oftheMOLLEpack,whichwasadoptedbytheMarineCorpsin1999
andbytheArmyin2001.40TheMOLLEpack(Figure8)isanentire
systemthatconsistsofamainpackwithanexternalframe,buttpack,
andloadbearingvest.Themainpackhaspouchesandasleeping
bagcompartmentattachedtotheexternalframe.Theexternalframe
isalightweightplasticpolymerthatisanatomicallycontoured.Apatrol
packcanbedetachedandusedseparately.Thevesthasremovable
pocketstoaccommodatedifferentobjects.Paddedshoulderstraps,
waistbelt,andstrapadjustmentsallowforbetterloaddistribution,and
PhysiologicalandBiomechanicalAspectsofLoadCarriage|17
25.Figure7.Marinescarryastretcherbearingasnipervictimon
GuadalcanalinWorldWarII.Photograph:CourtesyoftheNational
ArchivesandRecordsAdministration,ArchivalResearchCatalog.
From:http://www.pbs.org/thewar/at_war_timeline_1942.htm.the
soldiercanshifttheloadtodifferentanatomicallocations.Aninter
mediatesystembetweentheALICEpackandtheMOLLEpackwas
theIntegratedIndividualFightingSystemthatwasintroducedin1988.
TheIntegratedIndividualFightingSystemhadalargeinternalframe
packandatacticalloadvest,withpocketsthatallowedmoreflexibility
thantheALICEsystemhowever,theinternalframepackwas
unstablewithheavyloads(morethan36kg)andwasproneto
breakage.40,4118|LoadCarriageinMilitaryOperations
26.Figure8.SoldierwearingtheModularLightweightLoadCarrying
Equipment(MOLLE)pack.TheMOLLEpackisanentiremodular
systemthatincludesamainpackwithanexternalframe,buttpack,
andloadbearingvest.Apatrolpackcanbedetachedandused
separately.Thevesthasremovablepocketstoaccommodatedifferent
objects.Paddedshoulderstraps,waistbelt,andstrapadjustments
allowforbetterloaddistribution,andthesoldiercanshifttheloadto
differentanatomicallocations.Photograph:CourtesyofWikipedia.org.
Fromhttps://peosoldier.army.mil/factsheets/SEQ_CIE_MOLLE.pdf.
27.BackpacksandDoublePacksWheretheloadiscarriedonthe
bodywillaffectbothenergycostandgaitmechanics.Loadscanbe
transportedwiththelowestenergycost(ie,mostefficiently)whenthey
arecarriedonthehead.35,42However,thismethodisimpracticalfor
militaryoperationsbecauseitrequiresalongtrainingtimetolearn
howtouseeffectively,isusefulonlyonunobstructedhorizontal
terrain,andproducesahighprofile(greaterbodysignature).Amore
practicalchoiceistocarryaloadascloseaspossibletothecenterof
massofthebody.4345Inthisregard,thebackpackanddoublepack
methods(Figure9)havebeenshowntohavealowerenergycost
thanmostotherformsofloadcarriage.36,37,46,47Nonetheless,a
backpackplacesmostoftheloadonthebackandproducesaforward
inclinationofthetrunkandheadthatbecomesgreaterastheload
increases.4851Theforwardinclinationkeepstheloadplusbody
centerofmassoverthefeet(thebaseofsupport),butthisleadsto
repetitivecontractions(andstress)oflowbackmuscles.52,53Just
standingwithabackpackincreasesposturalsway(anteriorposterior,
mediallateralcenterofpressureexcursions)inalinearmanneras
theloadincreases.54Ontheotherhand,Figure9.AMarinewitha
doublepackataforwardoperatingbase.Themarineisfromthe26th
MarineExpeditionaryUnitandisboardingforaflightbackto
Kandahar,Afghanistan,insupportofOperationEnduringFreedom.
Photograph:CourtesyofDefenseImagery.mil.From
http://www.defenseimagery.mil.VIRIN:020212M7370C126.
Photographer:CWO2WilliamD.Crow,USMC.20|LoadCarriagein
MilitaryOperations
28.thedoublepackproducesfewerdeviationsfromnormalwalking
thandoesabackpack,includinglessforwardleanofthetrunk.49,55
Withthedoublepack,increasingloadproducesareductioninstride
lengthandanincreaseinstridefrequencythatismoredesirable
becauseitcanreducestressonthebonesofthefoot.Incontrast,
stridelengthbecomeslongerasbackpackloadsincreasewhich,by
thesamelineofreasoning,couldbepotentiallyharmful.30Double
packscanbeusefulinsomemilitarysituations(eg,medicscarrying
theiraidbagsonthefrontoftheirbodies),butbackpacksappearto
providegreaterversatilityinmilitarysituations.Doublepackscan
inhibitmovementandlimitthefieldofvisioninfrontofthebody,
makingitdifficulttoseeobstructionsandtraps.Theycanbeburden
sometodonanddoffdoffingcanbeveryimportantwhensuddenor
unexpectedenemycontactoccurs.Thedoublepackcanalsoinduce
ventilatoryimpairments30andgreaterheatstresssymptoms,56
comparedwiththebackpack.Thedoublepackcanrestricttasks,such
asfiringweaponsanddonningprotectivemasks.Servicemembers
cantakeadvantageofwhathasbeenlearnedfromthedoublepack
bydistributingtheloadmoreevenlyoverthetorso.Althoughitis
difficulttomaketheloadequalonthefrontandbackofthebody,both
theALICEandMOLLEsystemsallowapartoftheloadtobemoved
forwardontotheloadcarryingvest.Doingthismightbeexpectedto
reduceenergycost,improvebodyposture,andreduceinjuries.Pack
FramesandHipBeltsPackframesandhipbeltsreduceshoulder
stress.Theshoulderstrapsofapackexertpressureontheskin,
whichcanbemeasuredwithtransducersunderthestraps.57
Shoulderpressureisconsiderablylowerwithapackframe
incorporatingawidehipbelt,comparedwithapackframewithouta
hipbelt.Inonestudy,10kgcarriedinaframelesspackresultedina
peakpressureof203mmHgthesamemasscarriedinapackwitha
frameandwidehipbeltresultedinapeakpressureofonly15mmHg.
Thepackwiththeframeandhipbeltproducedlesselectro
myographicactivityinthetrapeziusmuscle,alsosuggestingless
stressintheshoulderarea.57Whenapackframeandhipbeltare
usedforaloadbetween14to41kg,theproportionoftheload
supportedonthehipsandlowerbackis30%andtheloadonthe
shouldersis70%,regardlessoftheloadmass.Thereisaconsistent
anteriorforceexertedonthelowerbackthatmightincreasestressin
thisarea.58ThereissomesuggestionthatexperiencedPhysiological
andBiomechanicalAspectsofLoadCarriage|21
29.individualsadjusttheirwalkingposturetoreduceforcesandforce
fluctuationsintheshoulderstraps.59Rigidrodsattachedtoboth
sidesofthepackandextendingintothehipbelttransferabout14%of
theverticalloadfromtheuppertorsotothepelvis.60Internalframe
packshavesupportingstructures(metalandplastic)insidethefabric
ofthepackandkeepthepackclosertothecenterofmassofthe
body.Externalframepackshavethesupportingstructureonthe
outsideofthepack,andthepackisusuallyfartherawayfromthe
centerofmassofthebody.Thereisconflictinginformationregarding
whethertheinternalframepackhasalowerenergycostthanthe
externalframepack.61,62Thereisnodifferenceinperceivedexertion
betweenexternalandinternalframepackswhenwalkingonlevel,
eventerrain.61However,perceivedexertionoverroughterrainis
lowerwiththeinternalframepack.63Subjectivereportsofdiscomfort
vary,dependingonthedesignofthepacksystem.Forbackpackswith
andwithoutframes,themajorityofdiscomfortappearstobeinthe
neckandshoulderregion,althoughfootdiscomfortcanalsobe
substantial,presumablybecauseofthedevelopmentofhotspots
andblisters.64,65Forabackpackwithahipbelt,discomfortis
localizedtothemidtrunkandupperlegs.66Overall,whenaportionof
theloadiscarriedonthewaistthroughuseofahipbelt,thereisless
subjectivediscomfortthanthereiswithshoulderloadcarriage.67
Whenwalkinguphill,individualsgivehigherratingsforbalanceand
easeofgaitforpackswithhipbeltsthatpivotinthesagittalplane.68
PlacementofLoadintheBackpackThelocationofloadinthe
backpackcanaffectenergycost,subjectivecomfort,andbody
mechanics.Usingbothinternalandexternalframepacks,higher
energycostswereassociatedwithaloadthatwaslowerinthepack
andfartherawayfromthebodylowerenergycostswereassociated
withloadsplacedhigherinthepackandclosertothebody(Figure
10).69,70However,anotherstudyusinganexternalframepackand
similarmethodologyfoundnodifferenceinenergycostwithload
placements.71Amoreevendistributionofloadsusingaracksystem
withinthepackresultedinconsiderablylowerratingsofdiscomfortin
theneck,shoulders,andlowerback.63Althoughbothhighandlow
loadplacementsbringaboutforwardbodylean(knees,hips,
shoulders,andheadarefartherforward),thiseffectisgreaterforlow
placements.Thisisbecausethelowerloadisclosertotheankles,
whichrequiresmoreforwardbodyrotationtobringthe22|Load
CarriageinMilitaryOperations
30.packcenterofmassoverthefeet.72Theadditionalforwardbody
rotationtendstobringthebodyscenterofmassoverthefronthalfof
thefoot,whichcouldincreasethelikelihoodoffootstrainandinjury.
Nonetheless,placementoftheloadhighinthepacktendstodestabi
lizeposturetoagreaterextentthanlowerplacements,especially
amongtallmen,asmeasuredbytheamountofbodyswaywhile
standingwiththeload.73Dynamicmomentsareabout40%greater
withhighbackplacement,anaffectattributedtothegreater
rotationalinertiaofthehighload.74Alowormidbackloadplacement
mightbepreferableforstabilityPackLowerEnergyCostHigher
EnergyCost=CenterofLoadMassPackFrameFigure10.Effectsof
loaddistributionwithinthepackonenergycost.Ahighandmore
anteriorloadresultsinalowerenergycostthanalowandmore
posteriorload.Datasource:ObusekJP,HarmanEA,FrykmanPN,
PalmerCJ,BillsRK.Therelationshipofbackpackcenterofmassto
themetaboliccostofloadcarriage.MedSciSportsExerc.
199729:S205.PhysiologicalandBiomechanicalAspectsofLoad
Carriage|23
31.onuneventerrain,particularlyduringunexpectedstumbles,when
highloadplacementcannecessitaterelativelyhighmuscleforcesto
maintainposturalstability.Thehighloadplacementmightbebestfor
eventerrainbecauseitkeepsbodyposturewithaloadmostsimilarto
thatwithoutaload.72StrapAdjustmentsAlthoughnottested
experimentally,itisreasonabletoassumethatshiftingloadsfromone
partofthebodytoanotherduringamarchcanimprovesoldier
comfortandallowloadstobecarriedforlongerperiodsoftime.Load
shiftingisaccomplishedwithsomepacksystemsusingvariousstrap
adjustments.Strapadjustmentscanredistributetheloadtoother
musclesorotherportionsofpreviouslyloadedmuscles.Portionsof
thebodysubjectedtohighloadpressuresforlongperiodsoftimecan
sufferdiscomfort,circulatoryocclusion,andparesthesis.30,67,75
Somerucksackshavesternumstrapsthatareattachedhorizontally
acrossbothshoulderstrapsatmidchestlevel.Whenthesternum
strapistightened,itpullstheshoulderstrapstowardthemidlineofthe
bodysothatpressureisshiftedmoremedially.Whenthesternum
strapisloosened,theshoulderstrapsmovelaterally,andtheloadis
alsoshiftedlaterally.Mostpacksystemswithhipbeltsandshoulder
strapshaveadjustmentsthatpresumablyallowmoreoftheloadto
beplacedonthehipsorshoulders.Whentheshoulderstraptension
isreduced(strapsloosened),moreoftheloadisplacedonthehips.
Withtheshoulderstrapstighter,moreoftheloadisplacedonthe
shoulders.Somepacksystemshaveloadlifterstrapsthatattachthe
topoftheshoulderstrapstothepackframe.Whenthestrapis
tightened,thetopoftheloadispulledmoreanteriorlyoverthebaseof
supporthowever,whenthestrapisloosened,thetopoftheloadfalls
moreposteriorly.Otherstrapadjustmentsthatshiftloadpressures,
centerthepack,andimprovelumbarsupportcanfurtherimprove
soldiermobilityandcomfort.68LoadCarriageontheFeet,Thighs,
andintheHandsLoadscanbecarriedinplacesotherthanthetorso,
althoughotherbodypositionsresultinhigherenergyexpenditure.
Loadscarriedonthefeetresultinanenergycostfivetoseventimes
higherthananequivalentloadcarriedontheupperbody.44,76,77
Theincreaseinenergyexpenditureis7%to10%foreachkilogram
addedtothefoot.44,7679Thisfinding24|LoadCarriageinMilitary
Operations
32.suggeststhatfootwearshouldbeaslightaspossible,compatible
withdurabilityrequirements.Loadscarriedonthethighresultin
energycoststhatarelowerthanfootcarriage,butgreaterthantorso
carriage.Foreachkilogramaddedtothethighs(ataboutmidthigh
level),theincreaseinenergycostisabout4%.80,81Whenload
massesarecarriedonthethighs(comparedwiththefeet),less
mechanicalworkisperformedbecauseofreducedinertiaofthebody
segmentstherefore,changesingaitwithincreasingthighloadare
minimal.80Carriageofloadsinthehandsalsoresultsinahigher
energycostthanwithtorsocarriage36,46,76andproducesgreater
cardiovascularstrain.82Handcarriageismoreefficientthanfoot
carriagebecausetheenergycostofcarryingloadsontheankles
exceedsthatofcarryingloadsinthehandsbyfivetosixtimesifthe
handloadiscarriedclosetothebody.44Thisislikelyrelatedtothe
factthatlegswingisanessentialpartofwalking,whereasarmswing
isasecondaryaspectofgaitthatcanbegreatlyreducedwithout
affectingwalkingspeed.Forhandcarriagetasks(eg,transportinga
stretcher),theuseofsimpleshoulderstrapsormorecomplexharness
systemsconsiderablyreducecardiovascularstressandresultinmore
subjectivecomfort.83,84RifleCarriageAriflewillalmostalwaysbe
carriedindismountedmilitarytrainingandoperations.Riflecarriage
restrictsarmswing,addsweight,andmovesthecenterofmassmore
anteriorly.Duringrapidwalking(5.4km/h),a4.4kgrifle(aloaded
M16A2weighs4.0kg)hasminimal,butsignificant,effectsonhuman
gait.Thereareincreasesinforcesproducedatheelstrike(ground
impactforces,about5%),forcestodeceleratethebody(maximum
breakingforces,about1%),andsidetosideforces(mediolateral
impulse,about12%).Manyofthesechangesarelessbecauseofthe
massoftherifleandaremoreassociatedwiththerestrictionofarm
movement,whichincreasesthemovementofthebodycenterof
mass.85,86BodyArmorIndividualbodyarmoriscommonlywornby
soldierstoprotectagainstsmallarmsfireandexplosivedevices.The
systemcurrentlyusedistheInterceptorMultipurposeBodyArmor
System,consistingoftwomajorPhysiologicalandBiomechanical
AspectsofLoadCarriage|25
33.components:(1)anoutertacticalvest(OTV)and(2)smallarms
protectiveinserts.TheOTViscomposedofaKevlarweaveand
providesprotectionfrom9mmbulletsandfragmentation.TheOTV
hasaremovablecollar,throatprotector,andgroinprotector.Thesmall
armsprotectiveinsertsaresiliconcarbide/boroncarbideplatesworn
inthefrontandbackoftheOTV,andprovideprotectionfromrifleand
machinegunfire.Studies87,88indicatedthatadditionalprotection
wasneededandsubsequentlydevelopedenhancementsincluded
deltoidandaxillaryprotectorsprovidingfragmentationandprojectile
protectionoverandunderthearms(Figure11).Amediumsizedvest
withoutdeltoidandaxillaryprotectorsandothervestattachments
weighsabout13kg.89,90Asmightbeexpected,thewearingofbody
armor(comparedwithnobodyarmor)increasesperceivedexertion,
theenergycostofwalking,verticalgroundreactionforces,and
loadingrate(changeinforceovertimefromheelstriketopeakimpact
force)91,92menandwomenrespondinasimilarmanner.93As
walkingvelocityincreases,theincreaseinenergycostandrelative
exerciseintensity(%VO2max)isnotlinear,butrathertheincrease
isexponential.92Avestincreasesheatstress(coretemperature,
bodyheatstorage)duringprolonged(24hours)walking,
independentoftheincreaseinenergycost,andaspacergarment(to
presumablyprovidepassivecooling)doesnotmitigatethisheat
Figure11.(Left)InterceptorMultipurposeBodyArmorSystemwith
removablecollar,throatprotector,andgroinprotector.(Center)Deltoid
and(right)axillaryprotectors,respectively.Photographs:Courtesyof
GlobalSecurity.org.Fromhttp://www.globalsecurity.org/military/
systems/ground/interceptor.htm.26|LoadCarriageinMilitary
Operations
34.stress.94Soldiersreturningfromdeploymentreportdeployment
relatedincreasesinmusculoskeletalpain,with24%,29%,and27%of
soldiersattributingneck,back,andupperextremitypain,respectively,
tothewearingofindividualbodyarmor.89LoadCarriageUsingCarts
andMotorizedVehiclesMilitarypersonnelseldomconsiderusing
wheeledcartstotransportloads,but,forsomemissions,thiscanbe
anoption.Inafieldtrialofthreemanuallyoperatedloadcarts,both
positiveandnegativeaspectsemerged.Onthepositiveside,the
testedcartsweregenerallydurableabletocarryorexceedtheirrated
loads(91181kg)andwereeffectivelyusedonflatterrain,inbarrier
construction,andinresupply.Onthenegativeside,thecartscreated
problemsonruggedterrain:theywerenoisyinbrushorrockyareas,
thusreducingtacticalsurpriseandequipmentcouldgetcaughtinthe
wheelsofsomecarts.95Acombatloadcartappropriateformilitary
operationsshouldhavealowcenterofgravity,awidewheelbase,
andalargewheelsize.96,97Comparedwithbodycarriage,energy
costwasreducedby88%whena50kgloadwaspushedinacarton
asmoothsurface.97Pulledcarts(ratherthanpushed)seemtobe
easiertocontrolonuneventerrainandalsoresultinconsiderable
energycostsavings.96Overmixedterrain(pavedroad,dirtroad,
field,androughtrail),acartpulledbyahipbeltresultedin54%faster
marchtimes(comparedwitharucksack)overa3.2kmdistance.98
Thislattercart,specificallydevelopedformilitaryoperations,is
available.Besidescarts,removingmuchoftheloadburdenfromthe
soldiercanbeachievedthroughtheuseofawidevarietyofmotorized
vehicles.Systemsthathavecarriedsoldierequipmentinrugged
areasinAfghanistanhaveincludedtheMilitaryGator(orMGator
JohnDeereCompany,Moline,Ill)andthePolarisSportsmanMilitary
Vehicle(PolarisIndustries,Inc,Medina,Minn).TheMilitaryGatoris
atwoseat,sixwheelsquadvehiclethatcancarryuptoa550kgload
andrunsonJP8fuel(Figures12and13).ThePolarisSportsman
MilitaryVehicleisafourwheel,allterrainvehiclethatcancarryone
personandaloadupto204.1kg(Figure14).99,100Ofcourse,there
willstillbeterrainthatwillnotbesuitableforcartsormotorized
vehiclesofanytype,andsoldierswillbepersonallyrequiredtobear
theload.5PhysiologicalandBiomechanicalAspectsofLoadCarriage
|27
35.PhysiologicalFactorsAssociatedWithLoadCarriageSeveral
studieshaveexaminedassociationsbetweenloadcarriageand
variousphysiologicalfactorsusingverysimilarmethods.Subjects
wereadministeredaseriesofphysiologicalteststomeasurephysical
characteristics,bodycomposition,muscularstrength,anaerobic
capacity,andaerobiccapacity.Subjectswereaskedtocompletea
givendistanceasrapidlyaspossiblewhilecarryingvariousload
masses.Tripcompletiontimeswerecorrelatedwiththese
physiologicalmeasures.
Usingunivariatecorrelations,earlystudiesdemonstratedlow(r=0.20.6),
butstatisticallysignificant,relationshipsbetweentripcompletiontimes
andaerobiccapacity,backandlowerbodystrength,andfatfree
mass.23,101,102Morerecentstudiesusingmultivariatetechniques
generallyconfirmthataerobicfitness,fat
freemass,andleg/backstrengthareimportantphysiologicalfactors
associatedwithloadcarriageperformanceandchangesinloadcar
riageperformance.24,25Thesestudiesprovidecluesastothe
componentsofphysicalfitnessthatshouldbetrainedtoimproveload
carriageperformance.Figure12.TheMilitaryGator.Thisisatwo
seat,sixwheelsquadvehiclethatcancarryuptoa550kgloadand
runsonJP8fuel.Photograph:CourtesyofOliveDrab.com.From
http://www.olivedrab.com/idphoto/id_photos_mgator.php.28|Load
36.Figure13.USArmysoldiersassignedtothe86thCombatSupport
HospitalusingaMilitaryGatortotransportalitterpatientatan
undisclosedlocationinIraq,insupportofOperationIraqiFreedom.
Photograph:CourtesyofDefenseImagery.mil.From
http://www.defenseimagery.mil.ID:DFSD0401753.Photographer:
SSGTQuintonT.Burris,USAirForce.PhysicalTrainingandLoad
CarriageAppropriatelydesignedphysicaltrainingcanimproveservice
membersloadcarriagecapabilities.Walkingwithbackpackloads
overseveralweeksresultsinadecreaseintheenergycostof
carryingtheload.103Australianmilitaryrecruitswithhighinitial
aerobiccapacity(predictedVO2max=51mLkg1min1)
furtherimprovedtheiraerobicfitnessbyengaginginregularbackpack
loadcarriage.Loadswereprogressivelyincreasedduringthe11week
basictrainingprogram,andimprovementsinaerobiccapacitywere
similartothoseofacontrolgroupperformingthetraditionalrecruit
trainingprograminvolvingrunning.104Twelveweekphysicaltraining
programsinvolvingacombinationofaerobictraining(running)and
resistancetrainingimprovedthespeedatwhichmencompleteda3.2
kmdistancecarrying46kg,105andwomencompleteda5km
distancecarrying19kg,106evenwhentheseloadcarriagetasks
werenotincludedinthetrainingprogram.Itisinterestingthat
37.neitherrunningnorresistancetrainingaloneimprovedmarch
speed,105suggestingthatbothaerobiccapacityandmusclestrength
mustbetrainedtoimproveroadmarchingcapability.Whenregular
roadmarchingwithloads(atleasttwiceamonth)wasincludedina
trainingprogramthatalsoinvolvedrunningandresistancetraining,
servicemembersmarchedfasterthanifmarchtrainingwasnot
included.107Substantialimprovementsinloadcarryingperformance
werefoundwhencivilianwomenweretrainedwithacombinationof
resistancetraining,running,andloadcarrying.108Figure14.Polaris
Sportsmanmilitaryvehicle.Itisafourwheel,allterrainvehiclethat
cancarryonepersonandaloadupto204kg.Photograph:Courtesy
ofJustinBurke,MarketingManager,PolarisDefense,Medina,Minn.
Fromhttp://www.polarisindustries.com.30|LoadCarriageinMilitary
Operations
38.GenderDifferencesComparedwithmen,womenwalkwithshorter
stridelengthandgreaterstridefrequency.Asloadsincrease,womens
stridelengthdecreases,whereasmensstridelengthdoesnotshow
significantchange.Withincreasingload,womenalsoshowamore
pronouncedlinearincreaseinthetimethatbothfeetareonthe
ground(doublesupporttime)thandomen.Tobringthecenterofthe
loadmassoverthefeet(baseofsupport),womentendto
hyperextendtheirnecksandbringtheirshouldersfartherforwardthan
domen,possiblytocompensateforlessupperbodystrength.Manyof
thesedifferencesbetweenmenandwomenpersistevenwhen
differencesinbodysizeandcompositionaretakenintoaccount.40,50
Whenmenandwomenwereaskedtocompletea10kmroadmarch
asquicklyaspossiblecarryingloadsof18kg,27kg,and36kg(us
ingALICEpacks),menwereabout21%faster,regardlessofload.On
systematicallyadministeredquestionnaires,womencommentedmore
oftenthanmenthatthepackstrapswereuncomfortable,thatthe
pistolbeltsfitpoorly,andthattherucksacks(ALICEpacks)were
unstable.Anindependentpredictorofmarchtime(whengenderwas
includedintheequation)wasacromialbreadth(shoulderbreadth).
Becausepacksystemshavebeendesignedprimarilybasedonthe
anthropometryofmen,thesedatasuggestthatpacksystems
designedconsideringtheanthropometryofwomencanlessenthe
timegapbetweenmenandwomen.109StudieswiththeMOLLEpack
suggestthatthewellpaddedhipbeltallowsabettertransferofthe
loadtothehipssothatwomencanusethestrongermusclesofthe
legstocarrytheload.40,58Thismightassistinimprovingfemaleload
carriageperformance.PredictingtheEnergyCostofCarryingMilitary
LoadsStudiesconductedontreadmillsforshortperiodsoftimeshow
thatenergycostincreasesinasystematicmanner,withincreasesin
bodymass,loadmass,velocity,grade,oracombinationofthese
items.110116Typeofterrainalsoinfluencesenergycost,asshown
inFigure15.96,117,118Pandolfandcolleagues119expandedonthe
workofGivoniandGoldman120todevelopanequation(1)to
predicttheenergycostofloadcarriage:Physiologicaland
BiomechanicalAspectsofLoadCarriage|31
39.Mw=1.5W+2.0(W+L)(L/W)2+(1)T(W+L)(1.5V2
+0.35VG),whereMw=metaboliccostofwalking(Watts),W=
bodymass(kg),L=loadmass(kg),T=terrainfactor(1.0=blacktop
road,1.1=dirtroad,1.2=lightbrush,1.5=heavybrush,1.8=
swampybog,2.1=loosesand,snow[dependentondepthof
depression{T=1.30+0.082D,whereD=depressiondepthin
centimeters}]),117V=velocityorwalkrate(m/sec),andG=slopeor
grade(%).ThePandolfequationhasbeenindependentlyvalidated
usingarangeofloadsandbodymasses.121However,theequation
hasseverallimitations.First,itdoesnotpredictaccuratelythe
energycostofdownhillwalking.122,123Downhillwalkingenergycost
approximatesaUshapewhenplottedagainstgrade:itinitially
decreases,thenbeginsFigure15.Effectsofterrainonenergycost.
Energycostincreasesabout8%onadirtroadandabout24%for
movingthroughlightbrush.Muchheavierbrushrequiringtheuseof
armsandmoreliftingofthelegstomoveoverdownedtreesand
brushcanincreaseenergycostby60%.Goingthroughswampyland
orwalkingonsandalmostdoublesenergycost.Walkinginsnow
withouttheuseofsnowshoescanconsiderablyincreaseenergycost
3or4times,dependingonthedepthandqualityofthesnow.This
increaseinenergycostwithdeepersnowispresumablybecauseof
theextraenergyneededtoraisethelegs.Numbersafterthesnow
estimatesarethedepthofdepressiontheshoemakesinthesnow.
Datasources:HaismanMF,GoldmanRF.Effectofterrainonthe
energycostofwalkingwithbackloadsandhandcartloads.JAppl
Physiol.197436:545548.PandolfKB,HaismanMF,GoldmanRF.
Metabolicenergyexpenditureandterraincoefficientsforwalkingon
snow.Ergonomics.197619:683690.SouleRG,GoldmanRF.Terrain
coefficientsforenergycostprediction.JApplPhysiol.197232:706
708.32|LoadCarriageinMilitaryOperations403020100VO2
(ml/kg/min)TreadmillPavedRoadDirtRoadLightBrushHeavyBrush
SwampSandSnow(10cm)Snow(20cm)
40.toincrease.124126Thelowestenergycostoccursbetween5%
to15%,dependingonindividualgaitcharacteristics.124,126Santee
andcolleagues126developedanempiricalmodeltopredictthe
energycostofdownhillwalking.Themodelassumesthattheinitial
reductionindownhillwalkingenergycostisfromthenegativeworkof
gravity,butthatthisisreducedbytheeccentricactionofthemuscles
todeceleratethebodyandenergyabsorbedbythemusclesand
joints.Equation(2)isasfollows:(2)Wtd=Wl+(2.4(mtghs1)
0.3(/7.65)),whereWtd=totalmetaboliccost(Watts),Wl=
metaboliccostoflevelwalking(Watts),mt=totalloadmass(kg),g=
accelerationcausedbygravity(9.8m/s2),and=gradeorslopefor
negativework.AsecondlimitationofthePandolfequationmightbe
thatitdoesnotaccountforincreasesinenergycostovertime.In
studiesusedtodeveloptheequation,energycostwasexaminedfor
shortperiods,usuallylessthan30minutes.Moststudies127129
haveshownthattheenergycostofprolonged(2h)loadcarriageata
constantspeedincreasedovertimeathigherloads,orspeedsor
both.Energycostalsoincreasesovertimeduringdownhillwalking
withloads.129Whetherornotenergyexpenditureincreasesovertime
isimportant,becausetheindividualcarryingtheloadmightbecome
moreeasilyfatiguedifenergycostdoesincrease.Physiologicaland
BiomechanicalAspectsofLoadCarriage|33
41.MedicalProblemsAssociatedWithLoadCarriageInjuries
associatedwithloadcarriage,althoughgenerallyminor,canadversely
affectanindividualsmobilityandthusreducetheeffectivenessofan
entireunit.Tables4and5showtheresultsoftwostudiesthat
recordedacuteinjuriesduringmilitaryroadmarching
operations.130,131Footblisters,backproblems,andmetatarsalgia
werethemostcommonmarchrelatedinjuries.Theseinjuriesare
similartothoseselfreportedbyrecreationalhikerswhogenerally
carrylighterloads,buttherelativefrequencyissomewhat
different.132134Table6summarizescommonloadcarriagerelated
injuries,aswellaspreventionandtreatmentstrategies.FootBlisters
Footblistersarethemostcommonloadcarriagerelated
injury65,131,135137(Figure16).Theyresultfromfrictionbetween
thesocksandskin,138140aproductofpointpressuresexertedby
thebootandthefoot.Blisterscancauseextremediscomfort,prevent
servicemembersfromcompletingmarches,andcanleadtomany
daysoflimitedactivity.131,141,142Iftheyarenotproperlymanaged,
especiallyinfieldconditions,theycanprogresstomoreserious
problems,suchascellulitisorsepsis.141,143
42.Heavyloadsincreaseblisterincidence,109,137,144possiblyby
increasingpressureontheskinandcausingmoremovementofthe
footinsidethebootthroughhigherpropulsiveandbreaking
forces.49,145Riflecarriagealonehasminoreffectsonmaximal
breakingandpropulsiveforces.85Otherblisterriskfactorsinclude
tobaccouse,lowaerobicfitness,andethnicityotherthan
black.130,146Whenloadsareveryheavy(>61kg),thedoublepack
hasbeenshowntodemonstratealowerblisterincidencethanthe
backpack,147suggestingTable5.InjuriesAmong218Infantry
SoldiersDuringa5Day,161kmRoadMarch130DuringMarch*
TotalsSoldierContinuedSoldierDidNot115DaysInjuryMarch(n)
ContinueMarch(n)Postmarch(n)N%Footblisters43334948
Metatarsalgia8291919Backpain/strain41166Sprains23055
Kneepain31377Ingrowntoenail03033Stressfracture01011
Other8311212Total681717102100*Fromphysicians
assistantsatfixedmedicalsitesalongthemarch.Frommedical
recordsafterthemarch.36|LoadCarriageinMilitaryOperations
Table4.InjuriesAmong355InfantrySoldiersDuringa20
kmMaximalEffortRoadMarch131DuringMarch*TotalsSoldier
ContinuedSoldierDidNot112DaysInjuryMarch(n)Continue
March(n)Postmarch(n)N%Footblisters160193538Back
pain/strain5792123Metatarsalgia1191112Legstrain/pain007
78Sprains11467Kneepain00444Footcontusion01122
Other12255Total24125591100*Frommedicsandphysician
duringthemarch.Frommedicalrecordsafterthemarch.
43.Table6.SummaryofCommonLoadCarriageRelatedInjuries
WithPreventionandTreatmentStrategies*140,177SignsInjuryand
SymptomsPreventionTreatmentFootblistersElevatedarea,lighterin
colorthansurroundingskin,andfilledwithfluidpain,burning,
warmth,anderythema1.Useacrylic,nylon,orpolyesterinnersock
usethick,snug,denseweaveoutersockwithinnersock2.Use
Spencoinsoles3.Utilizeantiperspirants4.Makesurethatload
distributionismoreevenlyaroundthebodycenterofmass5.Reduce
loadmass6.Preconditionfeetthroughphysicaltrainingandroad
marchpractice7.Improveaerobicfitness8.
Ceasesmoking/tobaccouse9.Coverskinwhenhotspotsappear
Intactblister:drain,leavetopinplace,anduselightpressuredressing
Tornblister:removetop,useantibioticointment,andputonsurgical
bandageUsehydrogelorhydrocolloiddressingsalsopolyurethane
filmsMetatarsalgiaPain,swellingonsoleoffoot1.Preconditionfeet
throughphysicaltrainingandroadmarchpractice2.Reduceload
massRICEAntiinflammatorymedicationStressfractures
Persistent,bonypainwellcircumscribedpalpableareaofbony
tenderness1.Ceasesmoking/tobaccouse2.Preconditionfeetand
legsthroughphysicaltrainingandroadmarchpracticeRICE
AntiinflammatorymedicationKneepainPain,swelling,crepitus,and
instability1.Performlowerextremitystrengtheningandstretching
RICEAntiinflammatorymedicationLowbackpainPain,muscle
spasm,andneurologicalsymptoms1.Besurethatloaddistribution
ismoreevenlyaroundthebodycenterofmass2.Reduceloadmass
3.PerformtrunkandabdominalstrengtheningRICE
AntiinflammatorymedicationRucksackpalsyUpperextremity
numbness,paralysis,andcrampingscapularwinging1.Useframed
rucksack2.Utilizehipbeltonrucksack3.Employloadshiftingvia
strapadjustmentsRICEAntiinflammatorymedicationMeralgia
parestheticaPain,paresthesia,andweaknessintheanterolateral
thigh1.Useproperlyfittedbodyarmor2.Avoidcompressingthighs
withloweredgeofbodyarmorReducebodyarmorwear
Antiinflammatorymedication*Seetextforfulldescriptionsand
applications.SpencoMedicalCorporation,Inc,Waco,Tex.RICE:
Rest,Ice,Compression,ElevationAntiinflammatorymedication
referstoaspirinoranonsteroidalantiinflammatorydrug.Medical
ProblemsAssociatedWithLoadCarriage|37
44.thatbetterloaddistributioncanreduceblisters.Spencoshoe
insoles(SpencoMedicalCorporation,Inc,Waco,Tex)havealsobeen
showntoreducefootblisterincidence,possiblybecausetheyabsorb
frictionalforcesinanteroposteriorandmediolateraldirections.148
150Regularphysicaltrainingwithloadcarriageinducesskin
adaptationsthatreducetheprobabilityofblisters.140Thus,blisters
canbelessofaprobleminunitsthatmarchregularlyhowever,
suddenincreasesinmarchintensityordistancewillprobablymake
blistersmorelikely,regardlessoftrainingregularity.Moistskin
increasesfrictionalforcesandprobablyincreasesblister
incidence.140,141,151Acrylicsocksdecreasethenumberandsizeof
blisters,152possiblybyconductingsweatawayfromthefoot.153A
nylonsockworninsideawoolsockreducestheincidenceofblisters
onsoldierswhoareroadmarching.154,155Polyestersocksalone,or
athinpolyestersockworninsidethickersocks(thatareeitherwool
polypropyleneorothersuchmoisturewickingwoolblendmaterials),
reducefootblisterincidenceduringmilitarytraining.156,157Figure
16.Frictionblistersonthefoot.Photograph:CourtesyofWikimedia
Commons.Fromhttp://commons.wikimedia.org/wiki/
File:Friction_Blisters_On_Human_Foot.jpg.38|LoadCarriagein
MilitaryOperations
45.Antiperspirantsalsoreducefootsweating,158,159andsome
anecdotalreportsandcasestudiessuggesttheymightbeeffectivein
reducingblisters.160162A20%solutionofaluminumchloride
hexahydrateinananhydrousethylalcoholbase(eg,Drysol,Person&
Covey,Inc,Glendale,Calif)waseffectiveinreducingthelikelihoodof
marchrelatedblisterswhenthepreparationwasappliedtotheentire
footforatleastthreenightsbeforeamarch.163Oncethe
antiperspiranteffecthasbeenachieved,itcanbemaintainedwith
applicationsonceperweek.164However,manyindividualsreport
irritantdermatitisusingthispreparation,163whichcanrequirethe
applicationofatopicalsteroid.Otheroptionsinthiscaseincludeusing
alowerconcentrationpreparation(eg,Xerex,Person&Covey,Inc,
Glendale,Calif),changingthetreatmentschedule(usingthesame
numberofapplications,butoveralongerperiodoftime),or
discontinuinguse.Antiperspirantsinemollientbasesarenoteffective
inreducingblisters,presumablybecauseemollientsinterferewiththe
antiperspiranteffect.165Soldierstypicallyexperienceareasoffriction
knownashotspots,thesubjectiveexperienceofwhichisalocalized
warmorburningsensation.Thispresumablypreblisterstageis
characterizedasalocalred(erythema)andtenderarea(Figure17).
Whenhotspotsaredetected,blistersmaybeavoidedbyshieldingthe
affectedareawithalowfrictionskincovering.Variousskincoverings
havebeenexaminedfortheircoefficientsoffriction(),andlower
valuesmaybemoreeffectiveinreducingblisterincidence.Tested
skincoverings(withvaluesinbrackets)includethefollowing:
Bursatec(Bursatec,MexicoCity,Mexico)[0.57],Dr.Scholls
MoleskinPlus(ScheringPloughHealthCareProducts,Inc,Memphis,
Tenn)[0.69],Moleskin[0.94],BandAidBrandAdhesiveBandages
(Johnson&JohnsonConsumerCompanies,Inc,NewBrunswick,NJ)
[1.01],BandAidPlasticBandages[1.03],Spenco2ndSkinBlister
Pad[1.04],NewSkin(PrestigeBrands,Inc,Irvington,NY)[1.05],
NexcareComfortBandage(3MCompany,StPaul,Minn)[1.08],Dr.
SchollsBlisterTreatment[1.20],BandAidBlisterBlock[1.37],and
Tegaderm(3MCompany,StPaul,Minn)[1.54].166MedicalProblems
AssociatedWithLoadCarriage|39
46.Anotheroptionisadoughnutpadorcovering(eg,DuoDERM,
ConvaTec,Inc,Skillman,NJ),whichshouldbeappliedtoreduce
frictionandpossibleblisterdevelopment.167Therearefewstudies
ofblistertreatment,andcareisbasedonclinicalexperienceand
commonsense.Smallblisters(<5mm)areusuallyselflimitingand
shouldnotbedrainedunlesstheyarepainful,becauseoftheriskof
infection.168Asmall,doughnutshapedmoleskinpadcanbeplaced
overtheblistertopreventrupture.Iftheblisterislargerthan5mm
andonaweightbearingarea,itshouldbedrained.Topromoteblister
topadhesionandhealing,blisterdrainageshouldoccurattheproper
time.Forblisterslessthan24hoursold,severalpuncturesshouldbe
madewithasterileneedleorano.11surgicalblade(Figure18).For
olderblisters,Figure17.Ahotspotonthemedialaspectofa
soldiersfootduringaroadmarch.40|LoadCarriageinMilitary
Operations
47.asinglepunctureisrecommended.169Topsshouldbekeptin
placetoserveasfunctionaldressings.170Apressuredressing(eg,
gauzepadandadhesivetape)canbeappliedtoensurethatthe
blisterroofadherestotheunderlyingtissue.Ifthetopoftheblisteris
almostcompletelytornoff,itshouldberemoved171andthesite
treatedasanopenwound.Inadditiontoantiseptictreatments(eg,
antibioticointment),asurgicalbandageshouldbeapplied.169For
smallerblisters,adoughnutshapedmoleskinpadaffixedwitha
porousadhesiveknitcover(eg,Coverlet,BSNJobst,Charlotte,NC)
willprotecttheblisterasshowninFigure19forlargerblisters,a
largerdressingwillbeneeded.162,164Hydrogeldressings(Figure
20)(eg,Spenco2ndSkin)orpolyurethanefilms(eg,Tegaderm)can
beaffixedtotheblisterandcoveredwithapadandtape.169,172
Hydrocolloiddressings,suchasDuoDERM(ConvaTec,Inc),can
alsobehelpfulinallowingmobility173andpromoting
healing.172,174,175MedicalProblemsAssociatedWithLoad
Carriage|41Figure18.Frictionblistersshowingsuggestedpuncture
sitestodraintheblister.Forblistersless
than24hoursold,severalpuncturesshouldbemadewithasterileneedleorano.11surgicalblade.
Illustration:CourtesyofHeidiMoncrief,Healthwise,Inc,Boise,Idaho.
Fromhttp://64.143.176.9/library/healthguide/en
us/images/media/medical/hw/hwkb17_072.jpg.
48.Figure19.Treatmentforsmallerblisters.Adoughnutshaped
moleskinpadaffixedwithaporousadhesivecover(eg,Coverlet,
BSNJobst,Charlotte,NC)willprotecttheblister.Illustration:Courtesy
oftheUSArmyResearchInstituteofEnvironmentalMedicine(Natick,
Mass).AntisepticointmentAdhesivecoverDoughnutmoleskinpad42
|LoadCarriageinMilitaryOperationsFigure20.Otherwaysof
protectingblisters.HydrogeldressingssuchasSpenco2ndSkin
(SpencoMedicalCorporation,Waco,Tex)orapolyurethanefilmsuch
asTegaderm(3MCompany,StPaul,Minn)canbeafixedtotheblister
andcoveredwithapadandtape.Illustration:CourtesyoftheUS
ArmyResearchInstituteofEnvironmentalMedicine(Natick,Mass).
AdhesivetapeGauzepadHydrogeldressing
49.MetatarsalgiaMetatarsalgiaisadescriptivetermfornonspecific,
painfuloveruseinjuryofthefoot.Theusualsymptomislocalized
tendernessonthesoleofthefootunderthesecondorthird
metatarsalhead(Figure21).Sutton176reporteda20%incidenceof
metatarsalgiaduringastrenuous7monthAirborneRangerphysical
trainingprogramthatincludedregularloadcarriage.Onestudy131
reporteda3.3%incidenceofmetatarsalgiaafterasingle,strenuous
20kmwalkwithsoldierscarrying45kg.Metatarsalgiaisusually
associatedwithfootstraincausedbyrapidchangesintheintensityof
weightbearingactivity.177Walkingwithheavyloadscanbea
predisposingfactorformetatarsalgia,becausethismightcausethe
foottorotateanteroposteriorlyaroundthedistalendsofthe
metatarsalbonesformoreprolongedperiodsoftime,thusresultingin
moremechanicalstressinthisarea.49Treatmentisconservativeand
includesrest,useoficepacks,elevationofthefoot,and
antiinflammatorymedications.Ametatarsalpadcanbeused.If
symptomspersist,despitetheseconservativemeasures,furthereval
uationformoreseriousproblems(eg,fractures,tumors)is
warranted.178StressFracturesLowerextremitystressfracturesare
commoninmilitaryrecruits179184andhavealsobeenreportedin
trainedsoldiers.184DuringtheCentralBurmacampaigninWorldWar
II,60stressfracturecaseswerereportedinoneinfantryunitduringa
483kmroadmarch.185Stressfracturesareattributabletorepetitive
overloadingofbonesduringactivities,suchasroadmarching.The
mostcommonareasofinvolvementarethelowerextremities,
especiallythetibia,tarsals,andmetatarsals.179,185190For
metatarsalstressfractures,tendernessisgenerallylocalizedonthe
dorsalsideofthemetatarsalshafts,whichdistinguishesthepainfrom
metatarsalgia(Figure22).Figure23showsxrayfilmsofametatarsal
stressfracturewhenthepatientfirstpresentedand3weekslater.
Generally,aperiodoftimeisnecessarybeforestressfracturesare
apparentonxrayfilms.Demonstratedriskfactorsforstressfractures
includethefollowing:MedicalProblemsAssociatedWithLoad
Carriage|43
50.femalegender,179,184,191194whiteethnicity,179,195197
olderage,179,196,197tallerbodystature,182highfoot
arches,198,199lowaerobicfitness,192,196priorphysical
inactivity,182,196,197olderrunningshoes,197genuvarus,200and
cigarettesmoking.195,201Otherfactorsthatmightincreaserisk
includeloadcarriagedistance184,202andwalkingstyle.182,203A
numberofinterventionshavebeentestedinanefforttoreducethe
incidenceofstressfractures.191,197,204210Allstudieswere
conductedinbasiccombattraining.Successfulinterventionsinclude
reducedrunningmileage,204neoprenebootinsoles,206and
calcium/vitaminDsupplementation.211,212Amultipleintervention
studyinAustralianbasictrainingdemonstratedthatreducingmarch
speed,allowingtraineestomarchattheirownsteplength(ratherthan
marchinginstep),runningandmarchinginmorewidelyspaced
formations,runningongrass,andFigure21.Sitesofmetatarsalgia.
Theusualsymptomislocalizedtendernessonthesoleofthefoot
underthesecondorthirdmetatarsalhead.Illustration:Courtesyofthe
USArmyResearchInstituteofEnvironmentalMedicine(Natick,
Mass).SitesoftendernessSoleoffoot44|LoadCarriageinMilitary
Operations
51.reducingrunningmileageweresuccessfulinreducingfemale
pelvicstressfractures.205Stressfracturetreatmentincludesalong
periodofrest,useoficepacks,andantiinflammatorymedications.If
thepatienthastobemobile,crutchesarenecessary.KneePainKnee
painisanotherconditionthathasbeenassociatedwithloadcar
riage.Dalenandcolleagues213reporteda15%incidenceofknee
pain(17casesof114subjects)duringtheirloadcarriagestudy.
Knapikandcolleagues131reportedonlya0.6%incidenceofknee
pain(2casesof335subjects)followingasinglestrenuouswalk,but
thetwocasesresultedinatotalof14daysofdisability.Kneepainis
difficulttodiagnose.Variousdisordersincludepatellofemoralpain
syndrome,patellartendonitis,bursitis,andligamentousFigure22.
Symptomofmetatarsalstressfracture.Tendernessisgenerally
localizedonthedorsalsideofthemetatarsalshafts,which
distinguishesthepainfrommetatarsalgia.MedicalProblems
AssociatedWithLoadCarriage|45
52.strain.Theseconditionscanarisefromanabruptincreaseinroad
marchingmileageorintensityorfromclimbinghillsifservice
membershavenotbeenconditionedforthisactivity.Treatment
includesrest,useoficepacks,andantiinflammatorymedications.
Quadricepsandhamstringstrengtheningandstretchingexercises,
alongwithheelcordstretching,maybeimportanttoprevent
recurrence.214LowBackInjuriesLowbackinjuriescanposea
significantproblemduringloadcarriage.Inonestudy,13150%ofthe
soldierswhowereunabletocompleteastrenuous20kmwalk
reportedproblemsassociatedwiththeirbacks.Dalenand
colleagues213reportedfrequentproblemswithbackstrainduringa
20to26kmwalk.Lowbackinjuriesaredifficulttodefinebecausethe
painmightresultfromtraumatoavarietyofstructures,including
Figure23.Xrayfilmsofametatarsalstressfracturewhenthepatient
firstpresentedtotheclinician(left)and3weekslater(right).
Photographs:CourtesyofKeithG.Hauret,MSPH,MPT.46|Load
53.spinaldiscs,theligamentsconnectingthevertebralbodies,nerve
roots,orsupportingmusculature.177Heavyloadscanbeariskfactor
forbackinjuries.137Thiscouldbebecauseheavierloadsleadto
changesintrunkangle,whichcanstressbackmuscles,52,53,215or
becauseheavierloadsdonotmoveinsynchronywiththe
trunk,53,216thuscausingcyclicstressofthebackmuscles,
ligaments,andspine.52,53Framedpacksexertaconsistentanterior
forceonthelowerback,andithasbeensuggestedthatthisforce
couldcontributetolowbackpainandsoreness.58Walkingwitha
framelesspackforarelativelyshortperiodoftime(18min)resultsina
greateranteriorcurvatureofthespine,whichcouldresultinmoments
ofgreaterposteriorcompressive/anteriortensileforceson
intervertebraldiscs.217Thedoublepackcanhelpreducethe
incidenceofbackproblemsbecauseitresultsinamorenormal
postureandeliminatesprolongedbendingoftheback.49,58Thus,
betterloaddistributioncouldreducebackinjuries.Also,ageneral
overallstrengtheningandwarmupprograminvolvingtheback,
abdomen,hamstrings,andhipmusclescanassistinprevention.177
RucksackPalsyRucksackpalsyisadisablinginjurythathasbeen
widelyreportedinassociationwithloadcarriage.75,176,218225The
incidenceofrucksackpalsywasreportedtobe,respectively,
1.2/1,000and0.2/1,000inUSArmybasictrainingwhenwearinga
rucksackaloneversusarucksackwithaframeandhipbelt218the
incidenceinFinnishbasictrainingwasreportedtobe0.5/1,000
recruits.226Itishypothesizedthattheshoulderstrapsofabackpack
orthetopportionofindividualbodyarmorwhenincertainpostures
cancauseatractioninjuryoftheC5andC6nerverootsoftheupper
brachialplexus.Inminorcases,compressionresultsinentrapmentof
thelongthoracicnerve.Symptomsincludenumbness,paralysis,and
cramping,andminorpainintheshouldergirdle,elbowflexors,and
wristextensors.Longthoracicnerveinjuriesusuallypresentwith
scapularwinging(Figure24)becauseofweaknessoftheserratus
anteriormuscle.Sensorimotordeficitsfromrucksackpalsyinjuriesare
usuallytemporary,but,insomecases,canresultinachronic
condition.Nerveconductionstudiesandelectromyographicstudies
mightbenecessarytodocumentthiscondition.218,221Useofa
backpackframeandhipbelthasbeendemonstratedtoreducethe
incidenceofrucksackpalsy,218presumablybyreducingpressure
MedicalProblemsAssociatedWithLoadCarriage|47
54.ontheshoulders.57,58Hypotheticalriskfactorsforrucksackpalsy
includeheavyloads,improperloaddistribution,andlongercarriage
distances.137,218Height,weight,bodymassindex,oraerobicfitness
werenotriskfactorsinFinnishbasictraining.226Meralgia
ParestheticaMeralgiaparestheticaisanabnormalcondition
characterizedbypainandparesthesiaintheouteranterolateralthigh.
Itiscausedbyacompressionofthelateralfemoralcutaneousnerve,
asensorynervebranchoftheL2/L3spinalarea.Arecentreportof
twocasesofthisdisordersuggeststhatwhensoldiersarewearing
bodyarmorandareseatedforlongperiods,theloweredgeofthe
bodyarmormaycompresstheinguinalregion,thusresultingina
compressionofthelateralfemoralcutaneousnerveandleadingto
painandparesthesia.Symptomsgenerallyresolvewithremovalofthe
chroniccompression.22748|LoadCarriageinMilitaryOperations
Figure24.Scapularwinging.Photograph:CourtesyofWikipedia.org.
Fromhttp://en.wikipedia.org/wiki/File:Wingingofscapula.jpg.
55.InfluenceofLoadCarriageonthePerformanceofOtherTasksA
significantconsiderationfromamilitaryperspectiveishowwellser
vicemembersareabletoperformmilitarytasksduringloadcarriage.
Loadmass,loadvolume,andloaddistributionseemtobeimportant
variables.Asthemassincreases,therearesystematicdecrementsin
theperformanceofspecifictasks(eg,shortsprints,agilityruns,ladder
climbs,andobstaclecourses).67,228Thedecrementinperformance
ofsuchtasksisestimatedatabout1%perkilogramload.67Loadsof
greatervolumewillinhibitmovementunderobstacles.Thedistribution
oftheloadwithinthebackpackcanalsoinfluenceperformanceof
specifictasks.67Wearingofindividualbodyarmor(10kg)resultsin
increasedperceivedexertionanddecrementsinpullupperformance,
flexedarmhangtime,andmaximalstairsteppingability,91whichmay
berelevanttosomesoldiertaskslikeclimbingoverobstaclesand
movementsinurbanbuildings.Insomeoperations,servicemembers
arerequiredtowalklongdistancesandperformcriticalmilitarytasks
atthecompletionofthemarch.Verystrenuousmarches(maximal
speedwithloadsof3461kgover10to20kmdistances)leadto
postmarchdecrementsinmarksmanshipandgrenadethrowing
distance.64,109,144Decrementsinmarksmanshiparepresumably
attributabletosmallmovementsoftherifle,resultingfromfatigueof
theupperbodymusclegroups,fatigueinducedtremors,
56.orelevatedheartrateorrespiration.64,144,229Thedecrementsin
grenadethrowingdistancemightbefromnerveentrapment
syndrome218,221orpainintheshoulderarea,bothresultingfrom
pressureoftherucksackstraps.Lowerbodymuscularpower(as
measuredbytheverticaljumpandWingatesAnaerobicTest[which
measuresanaerobiccapacityusingabicycleergometer])andmuscle
strengthdonotappeartobeadverselyaffectedbyprolongedpack
loadcarriage.64,109,144,23050|LoadCarriageinMilitary
Operations
57.SummaryThereareseveralwaystoimprovemilitaryload
carriage.Thetechniquesmostavailabletounitcommandersareload
reduction,loadredistribution,andphysicaltraining.Loadreduction
canbeaccomplishedbytailoringtheloadtothespecificobjective
andbyusingspecialloadhandlingdevices.Commandersmustmake
realisticriskanalysesandthentakeonlytheequipmentnecessaryfor
themission.Specialcombatloadcartsareavailablethatcouldbe
usefulinspecialsituations(eg,marchesonunobstructedterrainorin
closeresupplyoperations).Loadredistributioncanbeaccomplished
byplacingequipmentmoreevenlyaroundthetorso.Currentload
carriagesystemshaveattachmentpointsandpocketsthatcanbe
usefulformovingsomeitemsfromtherucksacktothefrontofthe
body.Itemscarriedonthefrontofthebodyshouldbethoselikelyto
beneededsuddenlyorneededoften.Themostadvantageous
distributionoftheloadinthepackmightdependonthetypeofterrain.
Onroadsorwellgradedpaths,placementofheavyitemshighinthe
packispreferableformaintainingamoreuprightbodypostureand
reducinglowbackproblems.Onuneventerrain,amoreeven
distributionoftheloadwithinthepackismorehelpfultomaintain
stability.Loadreductionandredistributioncanreduceenergycost,
decreaseinjuries,andimproveperformanceontasksfollowingload
carriage.Physicaltrainingthatincludesaerobicexercise,resistance
exercise,androadmarchingshouldbeperformedonaregularbasis.
Appropriateprogramscanbetailoredtounitneedsbasedon
previouslysuccessful
58.programs.Roadmarchingshouldbeconductedatleasttwice
eachmonth,withloadsthatservicememberswillbeexpectedtocarry
inunitoperations(thiscouldbeinplaceofregularphysicaltraining).
Loadanddistanceshouldbeincreasedgraduallyoversessionsuntila
maintenancelevelhasbeenachieved.Newunitmembersshouldbe
giventimetoadaptthroughthesamegradualprogram.Regular
physicaltraininghasbeenshowntoincreasemarchperformanceand
mightreduceinjuries.Tosomeextent,theselectionandproperuseof
equipmentcanassistinreducingloadcarryingstress.TheMOLLE
packhasaframewithawellpaddedhipbeltthatreducespressureon
theshoulders,resultsinlessperceivedstrain,andreducesthe
incidenceofsomeinjuries.Framesandhipbeltscanimproveservice
membersperformanceontasksrequiringuseoftheupperbody.
EquipmentsuchasthesternumstrapontheMOLLEpacksreduces
stressbyallowingpressuretobedistributedtootherpartsofthebody.
TheMOLLEpackalsoprovidessomeventilationacrosstheback
becauseofitsexternalframeconstruction.Newloadcarriage
technologiesthatarebeingtestedandwillbecomeavailablewilluse
manyoftheideasandprinciplesdiscussedinthismonograph.Itis
desirabletoreduceloadcarriagerelatedinjuriesthatimpair
performance,causediscomfortanddisability,andresultinalossof
manpower.Theuseofhipbeltscanreducetheincidenceof
rucksackpalsy.Keepingthefeetdryusinganacrylic,polypropylene,
ornyloninnersockscombinedwithwoolorwoolpolypropyleneouter
sockswillreducetheincidenceofblisters.Antiperspirants(appliedfor
atleastthreeconsecutivedaysbeforeamarch)andfrequentchanges
ofsockscanalsobehelpful.Blisterincidencecanbereducedby
usingSpencoinsoles(SpencoMedicalCorporation)andby
distributingtheloadmoreevenlyaroundthetorso(bothofwhichcan
reducefrictionalforcesaroundthefoot).Physicaltrainingdirectedat
improvingaerobicfitness,alongwithregularloadcarriagemarches,
canreducetheincidenceofstressfracturesandblisters.Inbasic
training,stressfracturescanalsobecontrolledbyusingneoprene
insoles,limitingrunningmileage,allowingtraineestomarchattheir
ownstridelength,andusingmorewidelyspacedformations.Making
loadslighter,improvingloaddistribution,usingappropriatephysical
training,selectingproperequipment,andchoosingspecifictechniques
directedatinjurypreventionwillallfacilitateloadcarriage.Suitable
changeswillallowservicememberstocontinuemissionsatlower
energycostsandwithfewerinjuries,andbebetterabletoperform
othertasks.52|LoadCarriageinMilitaryOperations
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