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

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