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      The Impact of Backpack Loads on School Children: A Critical Narrative Review

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          Abstract

          Background: Backpack loads of school students during school days have been suggested to range from 10% to as high as 25% of their body weight and may have a negative impact on their body. The aim of this review was to identify and review studies that have examined impacts of contemporary backpack loads on school children. Methods: A systematic search was conducted of the literature using key search terms. After relevant studies published in recent years were selected using strict inclusion and exclusion criteria, the studies were critically appraised and relevant data were extracted and tabulated prior to conducting a critical narrative synthesis of findings. Results: Twenty-one studies were included, ranging in methodological quality from poor to good (critical appraisal scores 22% to 77%). Students carried on average over 15% of their own body weight, which caused biomechanical and physiological adaptations that could increase musculoskeletal injury risk, fatigue, redness, swelling and discomfort. Conclusion: Considering the limited methodological quality and variations in foci across studies, further research is needed to elucidate: (1) the loads students carry around on a school day in their school backpacks and; (2) the biomechanical, physiological and physical effects of load carriage on students.

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          Soldier load carriage: historical, physiological, biomechanical, and medical aspects.

          This study reviews historical and biomedical aspects of soldier load carriage. Before the 18th century, foot soldiers seldom carried more than 15 kg while on the march, but loads have progressively risen since then. This load increase is presumably due to the weight of weapons and equipment that incorporate new technologies to increase protection, firepower, communications, and mobility. Research shows that locating the load center of mass as close as possible to the body center of mass results in the lowest energy cost and tends to keep the body in an upright position similar to unloaded walking. Loads carried on other parts of the body result in higher energy expenditures: each kilogram added to the foot increases energy expenditure 7% to 10%; each kilogram added to the thigh increases energy expenditure 4%. Hip belts on rucksacks should be used whenever possible as they reduce pressure on the shoulders and increase comfort. Low or mid-back load placement might be preferable on uneven terrain but high load placement may be best for even terrain. In some tactical situations, combat load carts can be used, and these can considerably reduce energy expenditure and improve performance. Physical training that includes aerobic exercise, resistance training targeted at specific muscle groups, and regular road marching can considerably improve road marching speed and efficiency. The energy cost of walking with backpack loads increases progressively with increases in weight carried, body mass, walking speed, or grade; type of terrain also influences energy cost. Predictive equations have been developed, but these may not be accurate for prolonged load carriage. Common injuries associated with prolonged load carriage include foot blisters, stress fractures, back strains, metatarsalgia, rucksack palsy, and knee pain. Load carriage can be facilitated by lightening loads, improving load distribution, optimizing load-carriage equipment, and taking preventive action to reduce the incidence of injury.
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            Spinal Cord Injury Rehabilitation Evidence: Methods of the SCIRE Systematic Review.

            The Spinal Cord Injury Rehabilitation Evidence (SCIRE) is a synthesis of the research evidence underlying rehabilitation interventions to improve the health of people living with SCI. SCIRE covers a comprehensive set of topics and in this issue we present six papers relevant to SCI rehabilitation clinicians (SCI inpatient rehabilitation practices, gait strategies, upper extremity reconstructive surgery, spasticity treatments, cardiovascular health and bone health). The SCIRE used a systematic and well-defined protocol to assess and synthesize the evidence. Each article was scored for its methodological quality using either the Physiotherapy Evidence Database (PEDro) Score for randomized controlled trials or the Downs and Black Tool for other types of studies. Following the individual study assessment, conclusions were drawn about the accumulated studies for each topic of interest based on the levels of evidence, quality of studies and concurring evidence. The SCIRE project was designed for health professionals to inform them of best practices.
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              Adolescent standing postural response to backpack loads: a randomised controlled experimental study

              Background Backpack loads produce changes in standing posture when compared with unloaded posture. Although 'poor' unloaded standing posture has been related to spinal pain, there is little evidence of whether, and how much, exposure to posterior load produces injurious effects on spinal tissue. The objective of this study was to describe the effect on adolescent sagittal plane standing posture of different loads and positions of a common design of school backpack. The underlying study aim was to test the appropriateness of two adult 'rules-of-thumb'-that for postural efficiency, backpacks should be worn high on the spine, and loads should be limited to 10% of body weight. Method A randomised controlled experimental study was conducted on 250 adolescents (12–18 years), randomly selected from five South Australian metropolitan high schools. Sagittal view anatomical points were marked on head, neck, shoulder, hip, thigh, knee and ankle. There were nine experimental conditions: combinations of backpack loads (3, 5 or 10% of body weight) and positions (backpack centred at T7, T12 or L3). Sagittal plane photographs were taken of unloaded standing posture (baseline), and standing posture under the experimental conditions. Posture was quantified from the x (horizontal) coordinate of each anatomical point under each experimental condition. Differences in postural response were described, and differences between conditions were determined using Analysis of Variance models. Results Neither age nor gender was a significant factor when comparing postural response to backpack loads or conditions. Backpacks positioned at T7 produced the largest forward (horizontal) displacement at all the anatomical points. The horizontal position of all anatomical points increased linearly with load. Conclusion There is evidence refuting the 'rule-of-thumb' to carry the backpack high on the back. Typical school backpacks should be positioned with the centre at waist or hip level. There is no evidence for the 10% body weight limit.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                12 November 2018
                November 2018
                : 15
                : 11
                : 2529
                Affiliations
                [1 ]Bond Institute of Health and Sport, Bond University, Gold Coast, QLD 4229, Australia; rorr@ 123456bond.edu.au (R.O.); whing@ 123456bond.edu.au (W.H.); nmilne@ 123456bond.edu.au (N.M.)
                [2 ]School of Community Health, Charles Sturt University, Albury-Wodonga, NSW 2640, Australia; rpope@ 123456csu.edu.au
                Author notes
                [* ]Correspondence: michelle.perrone@ 123456student.bond.edu.au ; Tel.: +61-433-379-190
                Author information
                https://orcid.org/0000-0001-8297-8288
                https://orcid.org/0000-0002-5507-9778
                https://orcid.org/0000-0002-5121-9825
                https://orcid.org/0000-0002-1320-5801
                Article
                ijerph-15-02529
                10.3390/ijerph15112529
                6267109
                30424517
                fac4df81-0b45-49de-b73b-b02ea4a952b7
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 06 August 2018
                : 06 November 2018
                Categories
                Review

                Public health
                load carriage,children,school backpacks,configuration,impact
                Public health
                load carriage, children, school backpacks, configuration, impact

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