IndependentevaluationandreviewofARCHANGELARM

1、 IFLBA Evaluation-Dr. Richard Kuhns 01-07-2010 1 Independent evaluation and review of ARCHANGEL ARMOR IFLBA Dr. Richard M. Kuhns, III Executive Summary: Current IOTV and MBAV cause postural changes and spinal compression that lead to accelerated fatigue and injury of the spine and its supporting str

2、uctures when compared with a non-load bearing system such as the IFLBA. I. General Education A. In General, the scenario that results in making a human physically tired throughout a normal day is the result of expending energy via all bodily systems to perform a given task or set of tasks within and

3、/or during a certain period of time. The details of this as they relate to fatigue are somewhat individual in nature as they correlate to the current conditioning level of the person doing the work and how efficient their body is at performing said tasks. Certain factors affect this and create some

4、variability such as nutritional status, past injury status, how well rested is the person, etc. However, spinal loading will eventually affect everyone in a detrimental manner regardless of the individual conditioning level. B. The body systems that are impacted during a normal day that contribute t

5、o a person being physically tired are basically every system in the body. The musculoskeletal system (bones, ligaments, muscles, tendons, intervertebral discs, etc.) is tasked with keeping a person physically moving and supported in a healthy capable posture and set of movement patterns. The circula

6、tory and respiratory system must provide the entire body with blood, oxygen and vital nutrients to all cells of the body. The endocrine system works with the central nervous system to balance the bodys delicate balance of chemicals, hormones, enzymes, etc. The brain must keep the person focused IFLB

7、A Evaluation-Dr. Richard Kuhns 01-07-2010 2 and alert to perform tasks and minimize mistakes that prolong the tasks and increase chances of injury and unneeded repetition. C. The average soldier has an increased need, compared to most civilians, to be fit and injury free to perform all the necessary

8、 requirements of their job especially as they relate to the safety and protection of themselves, their fellow soldiers and our country. The daily duties of physical training, to include the increased emotional and physical stress their bodies must endure, are more traumatic on a daily basis than the

9、 average civilian encounters. The occurrence of most injuries, (acute, sub acute, and chronic) are increased significantly. A major source of such injuries is increased physical load bearing on the spine and its supporting structures, along with the associated structural compensations that are the r

10、esult of functional changes in body mechanics. The long-term effect of these being the chronic disability of the soldier. D. In terms of the acute affects on the body of increased spinal loading, especially using the current IOTV and MBAV, the most common injuries are those affecting the spinal tiss

11、ues. These injuries are mostly due to excessive strains on biologic tissues in the spine that require less than 5% deformation to cause microfailure. Microfailure of tissues that generally begins as fatigue then progresses to injury. (See Attached Fig. 2.4 and 2.5).1 If there is repeated or prolonge

12、d loading, which can sometimes be just a few minutes, tissue damage in the form of rearrangement of collagen fibers, proteoglycans (vital components of cartilage tissue), and water in the ligaments and joint capsule can occur. Following these changes the tissues have difficulty returning to their or

13、iginal length. This then leads to hysteresis, which is the energy lost after repeated or prolonged loading. Usually the person is now aware of acute pain and dysfunction. IFLBA Evaluation-Dr. Richard Kuhns 01-07-2010 3 Pain and dysfunction are noticed usually first in the muscles. Myofascial trigger

14、 points have direct and referred pain patterns that are commonly seen in soldiers carrying the current IOTV and MBAV. The common affected muscles are upper trapezius, levator scapulae, scalenes, sternocleidomastoids, quadratus lumborum. The most common joint injuries and their referral patterns are

15、cervical spine joints and lumbar spine joints. (See attached Fig. 10A.6, 10A.7, 10A.9, 10A.10, 10A.14, 10A.15).2 Even mild strains can cause microdamage which if repeated will frequently result in tissue deformation. Various studies have concluded that fatigue causes failure. According to Bogduk and

16、 Twomey, hysteresis makes fatigued tissues more vulnerable to injury.3 According to Andersson, repetitive loading of various tissues causes fatigue which leads to failure.4 E. The long term or chronic affects on the body are basically the result of the acute injuries not being treated (due to missio

17、n status and availability of proper treatment modalities), and continued actions that initiated the injury to begin with. The above mentioned acute injury scenario is magnified and becomes chronic with each successive attempt to continue performing the same job with the same equipment. The more impa

18、ired the soft tissue site is, the less stress required to attain the soft tissue fatigue/failure point. The articular surfaces, joint capsules and ligaments contain the most nociceptors in the body and are likely the most common pain generators. Activation of these sites and any other pain generator

19、s will cause a compensatory reaction in the entire motor system that will cause adaptive patterns to remain for extended periods of time after the injury has occurred. This is the foundation of chronic injury. F. The easiest way to mitigate and interfere with acute and chronic injury patterns, as th

20、ey relate to the soldiers and the use of the current IOTV and MBAV, is to remove as much spinal load bearing as possible and add spinal support. IFLBA Evaluation-Dr. Richard Kuhns 01-07-2010 4 For instance, the current use IOTV and MBAV causes the soldier to lean forward to balance the pack on the s

21、pine. This body position creates a forward head carriage that mimics adding weight to the head. For every inch the head moves forward of its normal posture (See attached: normal posture references viewed in Fig. 7.1 and 7.2),5 the weight of the compressive forces on the lower neck increases by the a

22、dditional weight of the entire head. (See attached Fig. 10a.19).6 I see these injuries on a daily basis for treatment and they always involve the recruitment of other spinal muscles, joints and supporting structures due to compensation factors that the body performs instinctively in response to fati

23、gue and trauma. Changing the load bearing dynamics of the current IOTV and MBAV to something that has little or no negative effects on the spine and its supporting structures is an ideal way to decrease fatigue and injury, and will thereby increase performance, endurance and tactical readiness. The

24、ARCHANGEL IFLBA does this easily. By utilizing the ARCHANGEL IFLBA, the load bearing focus is re-directed to the sacrum and iliac crests. These are much stronger bodily structures, ideally suited for carrying heavy loads with less fatigue and less potential for injury to a majority of spinal structu

25、res. In my opinion the ARCHANGELL IFLBA completely satisfies the two goals of a) completely removing gear related spinal loading and b) providing improved support to the spine. These factors, individually and cumulatively, increase endurance while reducing fatigue and injury. II. Device Evaluation *

26、Evaluation was performed in both clinical and non-specific outdoor settings. Evaluation included fitting and general body movement IFLBA Evaluation-Dr. Richard Kuhns 01-07-2010 5 observations, with myself, and numerous volunteer soldiers as test subjects. The soldiers involved where veterans and act

27、ive duty personnel who are very familiar with currently used IOTV and MBAV systems. The evaluation was with IFLBA loaded with armor. A. The ARCHANGEL IFLBAs purpose of decreasing spinal loading and re-directing the load to a more stable structure of the body is successful. The current IOTV and MBAV

28、places all of its loading on the spine and the supporting structures in such a way as to not only cause increased occurrence of injury but also increased fatigue, limited range of motion and alterations of body mechanics to account for the load being supported, and to balance that shifting load. The

29、 ARCHANGEL IFLBA re-directs the load bearing to a stronger, more secure area of the body, which will reduce injuries to the spine and its supporting structures. It allows greater range of motion in the head/neck/shoulder area regardless of loads carried. The nominal changes in total measured weight

30、are negligible especially in light of the idea that the ARCHANGEL IFLBA creates less fatigue which will equate to greater levels of job performance and decreased injury occurrence. The ARCHANGEL IFLBA also provides ergonomic support for the spine. The added benefit of this will be evident with prolo

31、nged periods of standing, sitting, walking, running, laying prone and laying supine. B. Since 2001 I have treated over a thousand soldiers for various injuries. In order to understand how to rehabilitate an injury, we must also understand how and why the injury occurred. In roughly three quarters of

32、 these cases, the injuries could be reduced with changes that reduce strain. Strain that occurs because of spinal load bearing packs is a major problem. The current use IOTV and MBAV requires the soldier to alter body mechanics to endure many hours carrying equipment, supplies, etc. IFLBA Evaluation

33、-Dr. Richard Kuhns 01-07-2010 6 If a soldier is required to change body mechanics while carrying a large amount of weight, then to reduce fatigue and injury the soldier must either reduce weight significantly or re-direct the way the weight is being loaded on the body. The lumbosacral, gluteal, and

34、leg musculoskeletal structures are much stronger than the neck, shoulder region and can carry significantly more weight with less fatigue. The overall result here is greater support for the spine, less fatigue for the body structures and the entire body, greater endurance on mission tasks, enhanced

35、mobility, decreased rate of fatigue and injury. C. Simply stated, less fatigue has enormous implications on overall body function. Less fatigue means the body organs and systems have to work less and expend less energy to maintain homeostasis. Overall body strength is preserved for longer consecutiv

36、e periods of time. Fewer calories are burned which means nutritional intake is reduced. Circulatory and respiratory systems are less taxed which means less need for rest to regain energy. Hydration needs are minimized due to less caloric expenditure and a reduced rate of energy usage. D. The ARCHANG

37、EL IFLBA also has the unique quality of providing support for the body due to a specific lumbar support that enables proper engagement of lumbosacral musculature throughout most movements. This acts as a guard to again prevent injury in the event of an unexpected incident or accident that may usuall

38、y compromise the integrity of the spine. This is accomplished by the kyphotic thoracic support piece that stabilizes the upper spine and again by the lumbar support pad and cumber bun that stabilizes and protects the lumbosacral spine. IFLBA Evaluation-Dr. Richard Kuhns 01-07-2010 7 It is also my pr

39、ofessional opinion that the marked reduction in spinal load bearing, and the increase in spinal support provided by the ILFBA will have noticeable secondary effects of increased endurance, tactical readiness, protection, and freedom of movement. E. Whether sitting or standing, the effect of the ARCH

40、ANGEL IFLBAs posture support system on the soldier is evident. While sitting, the load is removed from the shoulders and neck which enables greater freedom to use the arms more effectively to handle a weapon or to maneuver a vehicle. All of this while the rest of the spine is naturally supported in

41、a proper position to reduce fatigue and injury. While standing, the same effects are noted with the use of the arms having notably more freedom to carry out required actions. While lying in the prone position, the soldier also has the same freedoms of motion and is better able to arise quickly due t

42、o the positioning of the IFLBA on the hips. This is an easier fulcrum point than the shoulders and neck, which carry most of the weight in the current use IOTV and MBAV. Most of the time when arising from a prone position, the hips arise first to establish footing to raise the upper body. If the wei

43、ght is raised first with hips (as it is with the ILFBA), the upper body arises with less effort, enabling this particular task to be performed multiple times with much less effort, especially when compared with the IOTV and MBAV systems that tend to ride up higher onto the soldiers neck area further

44、 increasing spinal strain and fatigue. It is also my opinion that that the advantages of the IFLBA are going to be more pronounced in areas of high altitude or high temperature. These are the conditions observed in the current theatre of operations of the U.S. The reason for this is the combination

45、of high temperatures and hydration needs, as well as the rugged terrain, high altitudes and decreased oxygen experienced by our soldiers, acts to accelerate fatigue. It is therefore imperative to minimize that fatigue by using the ILFBA, rather than continuing to compound the fatigue levels as I obs

46、erve fro the current IOTV and MBAV. IFLBA Evaluation-Dr. Richard Kuhns 01-07-2010 8 It is also important to realize that the load lifting and spinal supporting behavior of the ILFBA further reduces fatigue by reducing escalation of body temperature by allowing some air circulation to reach the dorsa

47、l surface of the soldier to diminish perspiration. In doing this, blood flow is improved along with hydration needs being reduced. The higher temperature, and altitude are both factors that must be factored in to the equation that requires our soldiers to perform at their best. The IFLBA enables the soldier to utilize all of the skills, training and conditioning to a much higher level than currently experienced. This is an advantage to our soldiers that should be in place in all branches for the