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2074912 
Journal Article 
Rucksack Paralysis with and without Rucksack Frames 
Bessen, RJ; Belcher, VW; Franklin, RJ 
1987 
1 
Military Medicine
ISSN: 0026-4075
EISSN: 1930-613X 
NIOSH/00171895 
152 
7 
372-375 
Various aspects of brachial plexus injuries resulting from a military type backpack were studied in 18 cases of motor or sensory neurological deficit. The All Purpose Lightweight Individual Carrying Equipment (ALICE) pack was worn by 12,850 soldiers in basic training. Of those, 15 individuals suffered brachial plexus injuries as a result of wearing the pack without its designated aluminum supporting frame on 2 to 15 mile marches. When the soldiers wore the pack with its frame (19,050 soldiers), only three individuals sustained the injuries. Thus, a 7.4 fold increased rate of injury occurred when the ALICE pack was worn without the frame. The initial symptoms were numbness, tingling, pins and needles, or the sensation of part of the arm falling asleep. Weakness was often observed which made it difficult to carry a rifle and perform pushups after the march. In patients where the upper brachial plexus was primarily involved (11 cases), the posterior deltoid muscle was the most severely affected. In four patients, three of whom were those wearing frames, long thoracic nerve injuries were seen. Thirteen of the fifteen patients had recovered within 4 to 21 weeks with a mean recovery time of 10.6 weeks, but only six soldiers were retained on active duty. The length of time carrying the pack appeared to be important, with most injuries occurring on longer marches. The authors conclude that such injuries should be viewed as preventable, and they recommend the use of pack frames. They point out that other work has shown that the extent of injury also depends on the weight of the load carried.