Putting your best weighted foot forward: Reviewing lower extremity injuries by sex in weighted military marching.

Introduction: The Nijmegen Marches are an annual event in which military participants complete four consecutive days of 40-kilometre marches. Load carriage requirements differ among nations. The objective of this review is to apply a Gender-based Analysis Plus (GBA+) lens to injury prevention and consider the appropriateness of sex-based load carriage requirements. Methods: Two independent literature searches were undertaken using the MEDLINE database. A title and abstract screening review was conducted of articles reporting on gait biomechanics or injury risk related to load carriage that were published in English in the past 30 years. Thirteen articles were included in the review. Results: Four studies looked at sex-specific biomechanical adaptations to load carriage, with two reporting no significant differences and two reporting differences that may increase the risk of hip or knee injuries among women. Individuals who marched with a stride length longer than their natural or preferred length had more range of motion in their lower extremities and greater impact force; thus, they may be at a higher risk of injury. Weight carried was also identified as a risk factor, but the literature suggests that both sexes respond similarly to increased load as a proportion of body mass. Discussion: On the basis of the literature reviewed, no evidence-based recommendations can be made for sex-specific load carriage requirements in endurance marching. The published literature suggests that event standards for load carriage based on individual characteristics such as body weight or height may be more effective for injury prevention.