Mechanical Predictors of Discomfort during Load Carriage.

Discomfort during load carriage is a major issue for activities using backpacks (e.g. infantry maneuvers, children carrying school supplies, or outdoor sports). It is currently unclear which mechanical parameters are responsible for subjectively perceived discomfort. The aim of this study was to identify objectively measured mechanical predictors of discomfort during load carriage. We compared twelve different configurations of a typical load carriage system, a commercially available backpack with a hip belt. The pressure distribution under the hip belt and the shoulder strap, as well as the tensile force in the strap and the relative motion of the backpack were measured. Multiple linear regression analyses were conducted to investigate possible predictors of discomfort. The results demonstrate that static peak pressure, or alternatively, static strap force is a significant (p<0.001) predictor of discomfort during load carriage in the shoulder and hip region, accounting for 85% or more of the variation in discomfort. As an additional finding, we discovered that the regression coefficients of these predictors are significantly smaller for the hip than for the shoulder region. As static peak pressure is measured directly on the body, it is less dependent on the type of load carriage system than static strap force. Therefore, static peak pressure is well suited as a generally applicable, objective mechanical parameter for the optimization of load carriage system design. Alternatively, when limited to load carriage systems of the type backpack with hip belt, static strap force is the most valuable predictor of discomfort. The regionally differing regression coefficients of both predictors imply that the hip region is significantly more tolerant than the shoulder region. In order to minimize discomfort, users should be encouraged to shift load from the shoulders to the hip region wherever possible, at the same time likely decreasing the risk of low back pain or injury.