Page 144 - Journal of Special Operations Medicine - Winter 2014

Prospective studies have identified greater movement of 7. Manusov EG. Evaluation and diagnosis of low back pain.
the patella as a risk factor for knee pain. 27,28 Other risk Prim Care. 2012;39:471–479.
factors for anterior knee pain include lower quadriceps 8. Dagenais S, Tricco AC, Haldeman S. Synthesis of recom-
flexibility; lower vertical jump performance (lower leg mendations for the assessment and management of low
power); greater hip adduction; lower isometric strength back pain from recent clinical practice guidelines. Spine J.
2010;10:514–529.
in hip adduction, knee extension, and knee flexion; and 9. Chou R, Loeser JD, Owens DK, et al. Interventional ther-
a smaller knee flexion angle (unloaded). 27,29 Because apies, surgery, and interdisciplinary rehabilitation for low
specific weaknesses of the hip adductors, knee flexors, back pain. Spine. 2009;34:1066–1077.
and knee extensors appear to be injury risk factors, 27,29 10. Orloff HA, Rapp CM. The effects of load carriage on spi-
specific strengthening exercises for these muscle groups nal curvature and posture. Spine. 2004;29:1325–1329.
may reduce knee pain during load carriage. Likewise, 11. Rodriguez-Soto AE, Jaworski J, Jensen A, et al. Effect of
increasing quadriceps flexibility and knee extension load carriage on lumbar spine kinematics. Spine. 2013;
power may assist in knee pain reduction. 27 38:E783–E791.
12. Goh, JH, Thambyah A, Bose K. Effects of varying back-
pack loads on peak forces in the lumboscral spine during
Additional Information walking. Clin Biomech (Bristol, Avon). 1998;13(Suppl 1):
S26–S31.
Additional information on foot marching, especially 13. Gallagher S, Marras WS. Tolerance of the lumbar spine
general guidance on care of the feet, can be found in FM to shear: a review and recommended exposure limits. Clin
21-19 (Foot Marches). Biomech. 2012;27:973–978.
14. Meakins JR, Smith FW, Gilbert FJ, et al. The effect of
axial load on the sagittal plane curvature of the upright
Summary
human spine in vivo. J Biomech. 2008;41:2850–2854.
In general, lighter loads (taking only what is needed 15. Pal P, Milosavljevic S, Gregory DE, et al. The influence of
for the mission), improving load distribution, using ap- skill and low back pain on trunk postures and low back
propriate physical training procedures, selecting proper loads of shearers. Ergonomics. 2010;53:65–73.
equipment, and choosing specific techniques directed at 16. Holt KG, Wagenaar RC, LaFiandra ME, et al. Increased
injury prevention will facilitate load carriage. An under- musculoskeletal stiffness during load carriage at increas-
ing walking speeds maintains constant vertical excursion
standing of injury mechanisms and implementation of of the body center of mass. J Biomech. 2003;36:465–471.
appropriate prevention strategies will provide Special 17. Reynolds KL, Kaszuba J, Mello RP, et al. Prolonged tread-
Operations Forces with a higher probability of mission mill load carriage: acute injuries and changes in foot an-
success. thropometry. Technical Report No. T1/91. Natick, MA:
US Army Research Institute of Environmental Medicine;
1990.
Disclosures
18. Roy TC, Lopez HP, Piva SR. Loads worn by soldiers pre-
The author has nothing to disclose. dict episodes of low back pain during deployments to Af-
ghanistan. Spine. 2013;38:1310–1317.
19. Johnson RF, Knapik JJ, Merullo DJ. Symptoms during
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