Soldier Load Carriage: A Risk Management Approach Lieutenant Robin Marc Orr ADFPTI, BFET, MPhty A thesis submitted for the degree of Doctor of Philosophy at The University of Queensland in March 2012 School of Health and Rehabilitation Sciences DECLARATION BY AUTHOR This thesis is composed of my original work, and contains no material previously published or written by another person except where due reference has been made in the text. I have clearly stated the contribution by others to jointly-authored works that I have included in my thesis. I have clearly stated the contribution of others to my thesis as a whole, including statistical assistance, survey design, data analysis, significant technical procedures, professional editorial advice, and any other original research work used or reported in my thesis. The content of my thesis is the result of work I have carried out since the commencement of my research higher degree candidature and does not include a substantial part of work that has been submitted to qualify for the award of any other degree or diploma in any university or other tertiary institution. I have clearly stated which parts of my thesis, if any, have been submitted to qualify for another award. I acknowledge that an electronic copy of my thesis must be lodged with the University Library and, subject to the General Award Rules of The University of Queensland, immediately made available for research and study in accordance with the Copyright Act 1968. I acknowledge that copyright of all material contained in my thesis resides with the copyright holder(s) of that material. Robin Marc Orr PhD Candidate ii STATEMENT OF CONTRIBUTIONS TO JOINTLY AUTHORED WORKS CONTAINED IN THE THESIS Orr, R., Pope, R., Johnston, V., & Coyle, J. (2010). Load carriage: Minimising soldier injuries through physical conditioning – a narrative review, Journal of Military and Veterans’ Health, 18(3), 31-38. Orr was responsible for the design of the study, data collection, data analysis, writing, editing, and submitting the article. Pope, Johnston, and Coyle supervised the design of the study, guided the data collection and analysis, reviewed progressive drafts of the paper, and provided detailed feedback. Orr, R., Pope, R., Johnston, V., & Coyle, J. (2011). Load carriage and its force impact, Australian Defence Journal, 185, 52-63. Orr was responsible for the design of the study, data collection, data analysis, writing, editing, and submitting the article. Pope, Johnston, and Coyle supervised the design of the study, guided the data collection and analysis, reviewed progressive drafts of the paper, and provided detailed feedback. NOTE: This paper is currently being republished, with permission, in the South African Army Journal. Orr, R., Johnston, V., Coyle, J., & Pope, R., (2011). Load carriage and the female soldier, Journal of Military and Veterans’ Health, 19(3), 25-34. Orr was responsible for the design of the study, data collection, data analysis, writing, editing, and submitting the article. Pope, Johnston, and Coyle supervised the design of the study, guided the data collection and analysis, reviewed progressive drafts of the paper, and provided detailed feedback. iii STATEMENT OF CONTRIBUTIONS BY OTHERS TO THE THESIS AS A WHOLE Dr Rodney Pope, Dr Venerina Johnston, and A/Prof Julia Coyle assisted in the development of the research objectives, formulation of the research methodology and interpretation of the data. These members also provided thesis guidance through dedicated review of the manuscript, editorial assistance, and detailed comments. Joan Rosenthal provided professional editorial services that included proofreading; review of grammar and syntax; sentence structure and voice; identification of ambiguity, jargon and repetition; and suggestions to improve brevity and clarity. Joan Rosenthal does not have academic expertise in the area of the thesis. The candidate developed the research objectives, wrote the ethics applications, recruited the participants, conducted the research studies, conducted and interpreted the statistical analysis, and wrote and edited the thesis following feedback. STATEMENT OF PARTS OF THE THESIS SUBMITTED TO QUALIFY FOR THE AWARD OF ANOTHER DEGREE None iv PUBLISHED WORKS BY THE AUTHOR INCORPORATED INTO THE THESIS Orr, R. (2010). The history of the soldier’s load, Australian Army Journal, vii(2), 67-88 – Incorporated in Chapter 3: A Historical Review of Soldier Load Carriage. Orr, R., Pope, R., Johnston, V., & Coyle, J. (2010). Load carriage: Minimising soldier injuries through physical conditioning – a narrative review, Journal of Military and Veterans’ Health, 18(3), 31-38 – Incorporated in Chapter 2: Soldier Load Carriage: A Review of the Literature, and Chapter 6: Study C: Soldier Load Carriage and Physical Training. Orr, R., Pope, R., Johnston, V., & Coyle, J. (2011). Load carriage and its force impact, Australian Defence Journal, 185, 52-63 – Incorporated in Chapter 2: Soldier Load Carriage: A Review of the Literature, Chapter 5: Study B: Load Carriage and its Associated Risks for the Soldier, and Chapter 9: Risk Treatments and Recommendations for Soldier Load Carriage. Orr, R., Johnston, V., Coyle, J., & Pope, R. (2011). Load carriage and the female soldier, Journal of Military and Veterans’ Health, 19(3), 25-34 – Incorporated in Chapter 2: Soldier Load Carriage: A Review of the Literature. Orr, R., Pope, R., Johnston, V., & Coyle, J. (2012). Load carriage and its force impact, reprinted South African Army Journal (in press) – Incorporated in Chapter 2: Soldier Load Carriage: A Review of the Literature, Chapter 5: Study B: Load Carriage and its Associated Risks for the Soldier, and Chapter 9: Risk Treatments and Recommendations for Soldier Load Carriage. Poster presentations Orr, R., Pope, R., Johnston, V., & Coyle, J. (2010). Load carriage: Minimising soldier injuries through physical conditioning – a narrative review, PREMUS 2010, the Seventh International Conference on Prevention of Work-Related Musculoskeletal Disorders in Angers, France (29 Aug 10 – 03 Sept 10). Podium presentations Orr, R., Pope, R., Johnston, V., & Coyle, J. (2011). Soldier Load Carriage: A Risk Management Approach, Force Generation Lessons Board in Sydney, Australia (10 Nov 11). v ADDITIONAL PUBLISHED WORKS BY THE AUTHOR RELEVANT TO THE THESIS BUT NOT FORMING PART OF IT Drain, J., Attwells, R., Billing, D., & Orr, R. A Commander’s guide to military load carriage, Defence Science and Technology Organisation: Department of Defence (under review). Drain, J., Orr, R., Billing, D., & Rudzki, S. (2010). Human Dimensions of Heavy Load Carriage. Paper presented at the Land Warfare Conference 2010 in Brisbane, Australia 15 – 19 November 2010. ACKNOWLEDGEMENTS My principal advisor, Dr. Rod Pope: For mentoring me through this journey and both my personal and professional journeys with unfailing support and encouragement. You have given so much of your personal time and incredible knowledge with a patience bordering on the supernatural: I can only hope to emulate your example. My principal advisor, Dr. Venerina Johnston: For trusting in my ability, encouraging me to expand my academic career, and reducing my stress immeasurably by taking the time and going the extra distance to help me through all the academic and administrative hurdles. Your wise counsel and the quiet chat we had in France opened my eyes to many possibilities. Thank you. My associate advisor, A/Prof Julia Coyle: For teaching a high school drop-out English and for broadening my research horizons beyond my comfort zone. Your constant encouragement and words of wisdom kept me grounded and reminded me that there is an end – even if I could not yet see it. Brigadier Simone Wilkie, FORCOMD: For undying support through my professional and academic pursuits over the last decade: You are a leader without measure, with a sense of humour to match. Brigadier Stephen Rudzki, Joint Health Command: For invaluable assistance in encouraging and promoting my work. Your diversity and depth of knowledge and passion for improving the health of fellow soldiers is an inspiration. Colonel Georgina Whelan, and Warrant Officer Class One Clayton Baker from FORCOMD and Warrant Officer Class One Andrew Cutts, 3 Brigade HQ: For tireless support in contacting (and re- contacting) units. Without you this work would never have been completed. vi Major Anthony Watson, Land Warfare Development Centre: For your time and valued assistance in obtaining clearances for the release of the relevant defence doctrines. Commanding Officers, Unit Coordinating Officers, officers and soldiers of the Australian Regular Army: For taking the time and making the effort to help me improve soldier load carriage. Your insights have expanded my knowledge and reminded me that there is still so much more to learn. The Australian Defence Human Research Ethics Committee (ADHREC) and the University of Queensland Behavioural and Social Sciences Ethical Review Committee (BSSERC): For educating me in the world of research ethics and approving and supporting the research. Dr. Asad Khan, University of Queensland and Dr. Michael Steele, Bond University: For your vital assistance in the general statistic appreciation. Ms. Joan Rosenthal: For your dazzling editorial and linguistic skills. You preserved my sanity in the final hours. My mother-in-law, Gaylynn and father-in-law, George: For your ongoing support and cheeky reminder to ‘get back into your study and do some work’ when distractions called to me. My mother,