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Gait Posture. Author manuscript; available in PMC 2022 August 29.
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Published in final edited form as:

Gait Posture. 2020 July ; 80: 117–123. doi:10.1016/j.gaitpost.2020.05.013.

Baby Carrying Method Impacts Caregiver Posture and Loading

During Gait and Item Retrieval
Kathryn L. Havensa, Anna C. Severinb, David Bumpassb, Erin M. Mannen*,b,c
aDivisionof Biokinesiology and Physical Therapy, University of Southern California, 1540
East Alcazar Street, CHP-155, Los Angeles, California, United States of America 90033,
323-442-2940
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bDepartmentof Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West
Markham Street, Slot 531, Little Rock, Arkansas, United States of America 72205
cCenter for Orthopaedic Biomechanics, Department of Mechanical and Materials Engineering,
University of Denver, 2115 East Wesley Avenue, Denver, Colorado, United States of America
80208

Abstract
Background: Human babies are carried by their caregivers during infancy, and the use of
ergonomic aids to wear the baby on the body has recently grown in popularity. However, the
effects of wearing or holding a baby in-arms on an individual’s mechanics during gait and a
common object retrieval task are not fully understood.
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Research question: What are the differences in: 1) spatiotemporal, lower extremity kinematics,
and ground reaction force variables during gait, and 2) technique, center of mass motion, and
kinematics during an object retrieval task between holding and wearing an infant mannequin?

Methods: In this prospective biomechanics study, 10 healthy females performed over-ground

walking and an object retrieval task in three conditions, holding: (1) nothing (unloaded), (2)
an infant mannequin in-arms, and (3) an infant mannequin in a baby carrier. Mechanics were
compared using repeated measures ANOVA.

Results: During gait, greater vertical ground reaction force and impulse and braking force was
found during the in-arms and carrier conditions compared to unloaded. Significant but small
(<5°) differences were found between conditions in lower extremity kinematics. Increased back
extension was found during carrier and in-arms compared to unloaded. Step length was the
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only spatiotemporal parameter that differed between conditions. During object retrieval, most
participants used a squatting technique to retrieve the object from the floor. They maintained a
more upright posture, with less trunk flexion and anteroposterior movement of their center of
mass, and also did not try to fold forward over their hips during the two loaded conditions. Lower

*
Corresponding Author: Erin M. Mannen, Ph.D., Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences,
4301 West Markham Street, Slot 531, Little Rock, Arkansas, United States of America 72205, (501) 686-5416, emannen@uams.edu.
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 Havens et al. Page 2

extremity kinematics did not differ between unloaded and carrier, suggesting that babywearing
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may promote more similar lower extremity mechanics to not carrying anything.

Significance: Holding or wearing an infant provides a mechanical constraint that impacts the
forces and kinematics, which has implications for caregivers’ pain and dysfunction.

Keywords
load carriage; babywearing; carrying; attachment parenting; low back pain

1. INTRODUCTION
At the beginning of life, human infants are helpless. Unlike many infant mammals, they are
unable to transport themselves, creating a significant obligation for a caregiver. The use of
ergonomic aids to attach an infant to the caregiver’s body for transportation (babywearing) is
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not a new practice but has recently grown in popularity. Caregivers benefit from holding the
baby close while keeping their hands free to attend to other tasks. Other proposed benefits
of infant wearing include increased mother-infant attachment [1], increased breastfeeding
duration [2], and reduced agitation [3].

Researchers have begun to explore the effects of infant carrying on caregivers’ mechanics
during walking. Juanqueira et al., [4] and Schmid et al. [5] demonstrated increased lumbar
lordosis and thoracic kyphosis [4, 5], backward inclination of the trunk [4], and paraspinal
muscle activity [5], indicating that individuals modulate their trunk mechanics while holding
or front carrying infant mannequins compared to unloaded gait. Babywearing is ultimately a
load carriage task, and differences in forces and loading have been recently reported. Brown
et al. [6] showed an increase in normalized impact peak vertical ground reaction force (GRF)
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and anteroposterior GRF impulse while walking using baby carriers compared to unloaded.
Lower extremity joint moments also differ, and a recent research concluded that knee and
hip frontal plane loading moments were more similar between unloaded and babywearing
conditions compared to in-arms carrying [7]. This line of research has begun to demonstrate
that infant carrying affects caregivers’ biomechanics. However, no study has investigated
lower extremity gait kinematics during these conditions.

Aside from gait, few other tasks have been studied with respect to baby carrying. Another
common task for caregivers is picking up an object from the floor without putting the infant
down. This task may be performed dozens of times a day, particularly when caring for other
young children who drop objects and play on the floor. Object retrieval is an unconstrained
task that can be achieved in many different ways [8], and requires individuals to both lower
their center of mass and reach their arm out to lift the object. Both of these subtasks have
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been shown to require postural adjustments to prevent falling [9, 10]. Holding an infant may
alter the technique and mechanics used, and a better understanding of this may reduce falls.

The purpose of this study was to characterize the biomechanical differences between
holding and carrying an infant during gait and a retrieval task. We hypothesize that (1)
spatiotemporal, GRF and sagittal plane lower extremity and trunk gait mechanics will differ
between carrying an infant in arms, holding an infant in a carrier, and an unloaded control

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condition, and (2) that individuals will choose different techniques and exhibit differences in
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timing, center of mass displacement and sagittal plane kinematics when retrieving an item
from the ground between the three conditions. Understanding the biomechanical impact of
different carrying methods may ultimately inform caregivers on best practice to avoid injury
or pain.

2. METHODS
2.1. Participants
The Institutional Review Board at the University of Denver approved this study.
Ten nulliparous healthy females (27.4±4.1 years; 62.6±12.2 kg; 1.7±0.1 m) with no
previous babywearing experience provided informed consent. No participants had any
musculoskeletal or neurological disorders.
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2.2. Instrumentation
Marker-based motion capture (100 Hz; Vicon Motion Systems, Oxford, UK) monitored
movement (detailed in Figure 1). Two force platforms embedded into the floor recorded
GRF (1000 Hz; Bertec Corporation, Columbus, OH).

2.3. Procedures
Testing was conducted at the Human Dynamics Laboratory in the Center for Orthopaedic
Biomechanics at the University of Denver. Age, height, and weight were recorded for each
individual.

Participants performed gait and an item retrieval task for each of three conditions: (1)
holding nothing (unloaded), (2), holding an infant mannequin (5000 g, Dietz, Freiburg,
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Germany) in her arms (in-arms), and (3) holding an infant mannequin in a soft-structured
baby carrier (carrier) (Ergobaby, Inc., Los Angeles, CA; Figure 1). For in-arms, individuals
were instructed to carry the mannequin close to their own bodies as if it was a living infant
with good head control, and participants self-selected their carrying strategy with the infant
in contact with their own bodies. For carrier, individuals watched an instructional video from
a certified babywearing consultant explaining the correct way to fit the All-Position 360™
baby carrier before self-fitting the carrier and the mannequin inward-facing on their own
bodies [11].

For gait, individuals were instructed to walk overground at a self-selected, comfortable pace
(20 meters, with force platforms near 10 meters). For the retrieval task, a hand towel was
placed beyond the force platform’s edge. Individuals were instructed to walk to the towel,
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pick it up, and return to standing. Participants completed several trials of each task until
three trials with clean force plate strikes were completed for each condition (in-arms, carrier,
unloaded), in a randomized order.

2.4. Data Analysis

Marker and GRF data were low pass filtered using 6 Hz fourth-order Butterworth filter, in
accordance with previous studies [12–14]. Reconstructed marker coordinate data were used

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to compute segmental kinematics (Visual3D v.6.01.35, C-Motion, Germantown, MD). Joint

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kinematics were calculated using the joint coordinate approach following Cardan sequence
of rotations [15].

2.4.1 Gait—Spatiotemporal gait parameters were calculated and expressed as

dimensionless values by using leg length as the anthropometric factor [5, 16]. Variables
of interest included step length, step time, stance time, gait speed, and step width.

GRF impulse was calculated for posterior (braking), anterior (propulsive), mediolateral,
and vertical direction during stance [17]. Time of posterior and anterior GRF (braking and
propulsive time) were calculated. Peak GRFs were also identified. Vertical peak GRF was
identified during midstance (∼25% stance) [18]. Force data were normalized to body weight
of participant [6].
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Sagittal plane kinematics of the ankle, knee, hip, pelvis, and trunk were identified at key
gait events [18]: peak ankle plantarflexion during loading response, peak ankle dorsiflexion
at terminal stance (∼75% stance); peak knee flexion during midstance (∼25% stance) and
pre-swing (toe-off); peak hip and trunk flexion and extension; peak maximum and minimum
pelvic posterior tilt.

2.4.2 Retrieval—Techniques used during the retrieval task were qualitatively assessed
and grouped into three categories: squat, lateral bend, and stoop [8]. Squat was defined
as a deep knee bend with little lateral bend or forward flexion. Lateral bend was defined
as an asymmetric bend at the waist. Stoop was defined as an anterior bend at the waist
with little knee flexion. The lowest point of the squat (squat depth) was identified as the
minimum vertical position of the center of mass (COM). Times from standing upright
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to squat depth (downward phase) and from squat depth back to standing (upward phase)
were also calculated. The COM displacement during the downward phase was calculated in
the anteroposterior, mediolateral, and vertical directions and normalized to subjects’ body
height. Bilateral kinematics were identified at squat depth, including sagittal plane ankle and
knee, and tri-planar angles of the hip and trunk.

2.5 Statistics
Shapiro-Wilk tests of normality indicated that parametric tests were appropriate. To
determine differences in mechanics between conditions, repeated measures ANOVA was
used (α≤0.05). Effect sizes were determined using partial eta-square and interpreted as
small (0.01), medium (0.09) and large (0.25) [6]. Paired t-tests were used for pairwise
comparisons, when appropriate. Bonferroni adjustments were used for multiple comparisons
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(α=0.017). Statistical analyses were performed using SPSS (Version 18, Chicago, IL).

3. RESULTS
3.1 Gait
All gait values are presented in Table 1. Few differences were found between conditions
in spatiotemporal gait parameters. Only step length was significantly different between
conditions, with 2.2% greater step length for unloaded compared to in-arms.

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Compared to unloaded, total vertical impulse was 10.1% greater during carrier and 11.3%
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greater in-arms, and vertical GRF during midstance was 10.0% greater during carrier and
8.6% greater in-arms. Braking impulse was 16.0% greater during carrier and 14.8% greater
in-arms, and braking GRF was 11.9% greater during carrier and 11.3% greater in-arms
compared to unloaded.

At the ankle, peak ankle dorsiflexion was significantly different between conditions, with
about 2° more dorsiflexion in carrier and arms compared to unloaded. Knee flexion angle
at toe-off was significantly different between conditions, with 3° greater flexion during both
carrier and in-arms compared to unloaded. The ANOVA revealed a significant difference
in knee flexion angle during mid-stance and in peak hip flexion during loading response,
but pairwise comparisons did not reach significance. Both peak trunk flexion and extension
differed between conditions. Individuals exhibited more trunk extension during the in-arms
(4°) and carrier (7°) conditions compared to unloaded. Compared to in-arms, participants
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exhibited 2–3° more minimum pelvis posterior tilt in the unloaded and carrier conditions.

3.2 Retrieval
Participants used different techniques to retrieve the object from the floor (Figure 2). Most
individuals performed the squat technique to retrieve the object: 70% (21/30) of trials for
unloaded and carrier and 77% (23/30) for in-arms. Some individuals used the lateral bending
technique: 10% (3/30) for unloaded, 30% (9/30) for carrier, and 23% (7/30) for in-arms. The
stoop technique was only used during unloaded in 20% (6/30) of the trials. Most individuals
utilized the same technique for all trials of a particular condition. Because the majority of
trials from all participants were performed using the squat technique, only these trials were
used for the subsequent analyses.
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There were no timing differences between the downward and upward phases of the squat
between the conditions (Table 2). However, the anterior-posterior translation of the COM
was different between the conditions during the downward phase, with 19% more motion
during unloaded compared to carrier.

Individuals performed the squat asymmetrically to retrieve the object. There were significant
differences in lower limb kinematics at the squat depth between right and left legs when
all conditions were considered; therefore, kinematics of right and left side were analyzed
separately.

Knee flexion angles were significantly different between conditions for both right and left
limbs, where 23–30° greater flexion was found in-arms compared to unloaded for both legs,
and 7° greater in-arms compared to carrier for the right leg. Although the right hip frontal
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plane angle was significantly different between conditions, pairwise comparisons did not
reach significance and the left frontal plane hip angle was not different between conditions.
Trunk flexion angle was significantly different between conditions, with 22° less flexion for
in-arms, and 33° less flexion for carrier compared to unloaded. Trunk frontal plane angle
was also significantly different between conditions, but the pairwise comparisons did not
reach significance. Figure 3 highlights the greater flexion of the knee and less flexion at the
trunk for in-arms and carrier compared to unloaded.

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4. DISCUSSION
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The purpose of this study was to identify differences in gait and retrieval mechanics
between carrying an infant mannequin in-arms, in a structured carrier, and an unloaded
control condition. The data supported our hypotheses as (1) biomechanical differences
existed between the conditions for both the gait and retrieval tasks, and (2) participants
demonstrated different techniques when retrieving an object from the ground.

4.1 Gait
Our results are consistent with previous studies showing a shorter step during infant carrying
compared to a control condition [5, 19]. However, step length was the only spatiotemporal
gait parameter that differed between conditions in our study. While Juanqueira et al [4]
demonstrated that individuals carrying an infant mannequin in arms walked slower than
when not carrying anything, other researchers have not shown a difference when an infant
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mannequin was carried in a structured carrier [5, 6]. Our data are consistent with these
studies, as we found that individuals did not walk with different speeds, or step or stance
times between conditions. Similar to Schmid et al. [5], we expressed spatiotemporal gait
parameters as dimensionless numbers by scaling to body size, which may account for the
difference between our findings and Juanqueira et al. [4].

Vertical GRF and impulse were both greater during the carrying conditions compared to
unloaded. The mannequin added a 5–10% body weight load. The increased vertical GRF
was approximately proportionate to the increase in load, which is consistent with other
research on infant carrying [6] and backpack loading [20, 21]. As stance time was not
affected by the loading conditions, the increase in vertical impulse was likely driven by
the increased force rather than time of force application. No difference was found between
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the carrier and in-arms conditions, suggesting that the added load of the carrier itself
did not significantly contribute to the interaction force at the ground. Braking force and
impulse were also larger during the two loaded conditions. Time spent braking was not
different between conditions. Similar to vertical, this finding indicates that braking impulse
differences were also driven by the magnitude of force. Differences were also not found in
gait speed, suggesting that the increased braking force did not slow the individuals during
gait.

Sagittal plane kinematics differed between the carrying conditions, particularly for trunk.
When compared to the unloaded condition, individuals exhibited more trunk extension
during both loaded carrying conditions. In fact, during the carrier condition, individuals
never flexed their trunks during stance but remained extended throughout. This is similar to
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previous research demonstrating more backward trunk inclination during front pack carrying
[22] and infant carrying [4], which may be a compensation to keep the body-plus-infant
COM over the base of support. Slightly more peak ankle dorsiflexion was found during arms
and carrier compared to unloaded, as seen in front pack carrying [22]. This ankle position at
terminal stance may facilitate forward progression of the anteriorly shifted COM beyond the
base of support in the carrying conditions. At the hip, individuals exhibit peak hip flexion
at or near initial contact. This facilitates weight bearing stability while the knee and ankle
go through an initial arc of motion [18]. We found a trend towards increased hip flexion in

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the carrier condition, which is similar to previous research on military backpack carrying.
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Majumdar et al [23] demonstrated a trend towards increased hip flexion with increased load
magnitude.

Previous research has suggested that knee flexion during early stance is important to
attenuate forces during increased loading [20, 21, 24]. This makes sense; peak flexion occurs
during the transition between loading response and midstance and contributes to controlled
shock absorption [18]. Williams et al. found increased knee extension moment during infant
carrying and wearing [7], similar to the results found during front-pack carrying [22].
Similarly, our study identified differences in knee flexion at ∼25% of stance and toe-off,
which may indicate a pattern of more flexed lower extremity posture to attenuate the larger
vertical forces and accommodate the added load.

Together our findings suggest that individuals alter their mechanics in order to accommodate
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an infant mannequin. They do this similarly whether holding in arms or in a baby carrier
during gait, but alter their kinematics compared to holding nothing. However, our results
and those of others studying load carriage [22, 23] demonstrate small differences in joint
angle (<5°), making clinical relevance unclear [7, 25], as these kinematic differences may
not result in significant changes to joint moments. We did not analyze joint moments during
this task; however, Williams et al [7] reported no differences in hip or ankle sagittal plane
joint moments during baby wearing or holding. However, it is important to note that even
small changes in joint moments over many cycles may cause pain or discomfort in some
individuals, so further study is required to truly understand the impact of small changes in
kinematics.

4.2 Retrieval
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During the retrieval task, individuals approached an object on the floor and picked it up
using any self-selected technique. The techniques varied between conditions, supporting
our hypothesis. For most trials, participants performed a squat-like technique by flexing
their knees while maintaining an upright torso. Only during the unloaded condition did
participants use the stoop technique. This makes sense, given the added load was meant to
simulate carrying a living baby. While an individual could bend at the waist while holding
or wearing baby, they likely prefer not to invert the baby’s body in the process. The stoop
lifting strategy is performed by using a large amount of trunk flexion, which results in
a large external moment arm for the low back [26]. This strategy may increase spinal
loads compared to other lifting techniques that rely on increased knee and hip flexion and
decreased trunk flexion [27, 28].
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Foot placement was not constrained during the retrieval task and individuals achieved the
task goal through a variety of joint positions and strategies, which resulted in asymmetrical
lower extremity positions. This differs from other retrieval research that required participants
to pick up an object in a prescribed way [8]. Because literature suggests that a free style
lifting strategy allows for more self-perceived natural and safer functional strategies [29],
we purposefully chose to leave the task unconstrained to allow for self-selected strategies.
Generally, participants used a large amount of knee flexion in conjunction with hip flexion,
abduction and some external rotation. This appears consistent with the pattern used during

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late pregnancy for a stand to sit task [30]. For both pregnancy and baby carrying, individuals
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must manage a large and delicate mass in front of them while maintaining their balance as
they go from standing to a seated or squatting posture.

Participants reached the same vertical depth when using the squat technique during all
conditions. This indicates that all participants lowered their COM to the same degree, but
they used a variety of joint kinematics to accomplish this. Participants relied on trunk
flexion to accomplish the retrieval task while unloaded, and they flexed at their knee during
in-arms. In the carrier condition, individuals used a combination of sagittal and frontal plane
movements to reach the retrieval goal. Interestingly, no differences existed in the lower body
kinematics between the carrier and unloaded conditions, which suggests that the use of a
baby carrier may promote lower extremity mechanics more similar to unloaded retrieval
compared to carrying an infant in arms. This is likely beneficial when considering joint
moment differences during lifting. Similar joint positions between unloaded and carrier
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suggest that lower extremity external moment arms were not increased. Joint torque would
thus be affected only by the relatively small increased load of the infant mannequin but not
increased moment arms.

4.3 Limitations and Future Work

While other studies have examined gait during infant holding and carrying [4–7, 31],
this study also uniquely examined lower extremity mechanics during these conditions.
Limitations of this study include the tasks chosen, and subject population and size. The
results of this study did not identify large effects of infant transportation method during short
duration overground gait. Other studies have used longer duration walking (10–20 minutes
on treadmill) [7, 31, 32], which may impact the mechanics used. This is the first study to our
knowledge to analyze a retrieval task during baby carrying. The unconstrained retrieval task
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allowed participants to use any single method, which reduced the number of trials available
for comparative analysis. Also, we used nulliparous females and infant mannequins, and
future studies could consider analysis of postpartum mothers or other caregivers with their
own infants.

4.4 Conclusions
This study characterized the biomechanical differences between holding and carrying an
infant mannequin during gait and a retrieval task. While GRF variables differed during
gait, spatiotemporal and lower extremity kinematics showed small differences, and clinical
significance is unclear. During an item retrieval task, participants selected more upright
postures and strategies while holding or carrying the infant mannequin. Lower extremity
joint positions were similar during the unloaded and carrier conditions. Taken together,
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the results of this study suggest that infant transportation affects caregiver mechanics,
particularly during object retrieval. As few differences were found between lower extremity
kinematics during both tasks between the baby carrier and unloaded conditions, this research
agrees with Williams et al. [7], suggesting that the use of a baby carrier may promote
mechanics that more closely resemble unloaded mechanics.

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CONFLICT OF INTEREST
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This study was supported by Ergobaby, Inc., and the National Institute of General Medical Sciences of the National
Institutes of Health under Award Number P20GM125503. The content is solely the responsibility of the authors and
does not necessarily represent the official views of Ergobaby, Inc. or the National Institutes of Health. The funding
sources had no influence in study design, experimentation, analysis, or manuscript preparation.

REFERENCES
[1]. Anisfeld E, Casper V, Nozyce M, Cunningham N, Does Infant Carrying Promote Attachment?
An Experimental Study of the Effects of Increased Physical Contact on the Development of
Attachment, Child Development 61(5) (1990) 1617–1627. 10.1111/j.1467-8624.1990.tb02888.x.
[PubMed: 2245751]
[2]. Little E, Legare C, Carver L, Mother–Infant Physical Contact Predicts Responsive Feeding among
US Breastfeeding Mothers, Nutrients 10(9) (2018) 1251.
[3]. Hunziker UA, Barr RG, Increased Carrying Reduces Infant Crying: A Randomized
Controlled Trial, Pediatrics 77(5) (1986) 641–648. http://pediatrics.aappublications.org/content/
Author Manuscript

pediatrics/77/5/641.full.pdf. [PubMed: 3517799]

[4]. Junqueira LD, Amaral LQ, Iutaka AS, Duarte M, Effects of transporting an infant on the
posture of women during walking and standing still, Gait & Posture 41(3) (2015) 841–846.
http://www.sciencedirect.com/science/article/pii/S0966636215000624. [PubMed: 25800000]
[5]. Schmid S, Stauffer M, Jäger J, List R, Lorenzetti S, Sling-based infant carrying affects lumbar and
thoracic spine neuromechanics during standing and walking, Gait & posture 67 (2019) 172–180.
[PubMed: 30343249]
[6]. Brown MB, Digby-Bowl CJ, Todd SD, Assessing Infant Carriage Systems: Ground Reaction
Force Implications for Gait of the Caregiver, Human Factors 60(2) (2017) 160–171.
10.1177/0018720817744661. [PubMed: 29244534]
[7]. Williams L, Standifird T, Madsen M, Effects of infant transportation on lower extremity joint
moments: Baby carrier versus carrying in-arms, Gait & Posture 70 (2019) 168–174. http://
www.sciencedirect.com/science/article/pii/S0966636218314218. [PubMed: 30877855]
[8]. Shariff R, Panchani S, Moorehead JD, Scott SJ, Kinematic assessment of hip
Author Manuscript

movement when retrieving an object from the floor, Journal of orthopaedic surgery
and research 6 (2011) 11–11. https://www.ncbi.nlm.nih.gov/pubmed/21338520 https://
www.ncbi.nlm.nih.gov/pmc/PMC3050770/. [PubMed: 21338520]
[9]. Kollmitzer J, Oddsson L, Ebenbichler G, Giphart J, DeLuca C, Postural control during lifting,
Journal of Biomechanics 35(5) (2002) 585–594. [PubMed: 11955498]
[10]. Toussaint HM, Commissaris D, Hoozemans MJ, Ober MJ, Beek PJ, Anticipatory postural
adjustments before load pickup in a bi-manual whole body lifting task, Medicine and science in
sports and exercise 29(9) (1997) 1208–1215. [PubMed: 9309633]
[11]. Ergobaby, Ergobaby Instructional Video. https://www.youtube.com/watch?v=Q6a5fQVgQak,
2014 (accessed November 25 2015).
[12]. Huang S-C, Lu T-W, Chen H-L, Wang T-M, Chou L-S, Age and height effects on the center of
mass and center of pressure inclination angles during obstacle-crossing, Medical engineering &
physics 30(8) (2008) 968–975. [PubMed: 18243037]
[13]. Kaufman KR, Hughes C, Morrey BF, Morrey M, An K-N, Gait characteristics of patients with
knee osteoarthritis, Journal of biomechanics 34(7) (2001) 907–915. [PubMed: 11410174]
Author Manuscript

[14]. Lee H-J, Chou L-S, Detection of gait instability using the center of mass and center of pressure
inclination angles, Archives of physical medicine and rehabilitation 87(4) (2006) 569–575.
[PubMed: 16571399]
[15]. Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, et al. , ISB recommendation
on definitions of joint coordinate system of various joints for the reporting of human joint
motion—part I: ankle, hip, and spine, Journal of Biomechanics 35(4) (2002) 543–548. [PubMed:
11934426]

Gait Posture. Author manuscript; available in PMC 2022 August 29.

 Havens et al. Page 10

[16]. Hof AL, Scaling gait data to body size, Gait & Posture 4(3) (1996) 222–223. http://
www.sciencedirect.com/science/article/pii/0966636295010572.
Author Manuscript

[17]. Zeni JA Jr., Richards JG, Higginson JS, Two simple methods for determining gait events during
treadmill and overground walking using kinematic data, Gait Posture 27(4) (2008) 710–4. https://
www.ncbi.nlm.nih.gov/pubmed/17723303. [PubMed: 17723303]
[18]. Perry J, Gait analysis : normal and pathological function, 2nd ed. ed., SLACK, Thorofare, NJ,
2010.
[19]. Wall-Scheffler CM, Geiger K, Steudel-Numbers KL, Infant carrying: The role of increased
locomotory costs in early tool development, American Journal of Physical Anthropology 133(2)
(2007) 841–846. 10.1002/ajpa.20603. [PubMed: 17427923]
[20]. Birrell SA, Hooper RH, Haslam RA, The effect of military load carriage on ground reaction
forces, Gait & Posture 26(4) (2007) 611–614. http://www.sciencedirect.com/science/article/pii/
S0966636207000057. [PubMed: 17337189]
[21]. Dames KD, Smith JD, Effects of load carriage and footwear on lower extremity kinetics
and kinematics during overground walking, Gait & Posture 50 (2016) 207–211. http://
www.sciencedirect.com/science/article/pii/S0966636216305471. [PubMed: 27649512]
Author Manuscript

[22]. Yali H, Yiyu L, Haitao G, Qing ZS, The biomechanics effects of back and front pack load
carriage for human locomotion, 2012 IEEE International Conference on Mechatronics and
Automation, IEEE, 2012, pp. 1621–1626.
[23]. Majumdar D, Pal MS, Majumdar D, Effects of military load carriage on kinematics of gait,
Ergonomics 53(6) (2010) 782–791. [PubMed: 20496244]
[24]. Quesada PM, Mengelkoch LJ, Hale RC, Simon SR, Biomechanical and metabolic effects of
varying backpack loading on simulated marching, Ergonomics 43(3) (2000) 293–309. [PubMed:
10755654]
[25]. Wilken JM, Rodriguez KM, Brawner M, Darter BJ, Reliability and minimal detectible change
values for gait kinematics and kinetics in healthy adults, Gait & Posture 35(2) (2012) 301–307.
http://www.sciencedirect.com/science/article/pii/S0966636211004024. [PubMed: 22041096]
[26]. Neumann DA, Kinesiology of the musculoskeletal system-e-book: foundations for rehabilitation,
Elsevier Health Sciences 2013.
[27]. Schoenfeld BJ, Squatting kinematics and kinetics and their application to exercise performance,
Author Manuscript

J. Strength Cond. Res. 24(12) (2010) 3497–3506. https://www.ncbi.nlm.nih.gov/pubmed/

20182386. [PubMed: 20182386]
[28]. Bazrgari B, Shirazi-Adl A, Arjmand N, Analysis of squat and stoop dynamic liftings: muscle
forces and internal spinal loads, European spine journal : official publication of the European
Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical
Spine Research Society 16(5) (2007) 687–99. https://www.ncbi.nlm.nih.gov/pubmed/17103232.
[29]. Stevenson J, Bryant T, Greenhorn D, Smith T, Deakin J, Surgenor B, The effect of lifting
protocol on comparisons with isoinertial lifting performance, Ergonomics 33(12) (1990) 1455–
1469. 10.1080/00140139008925346. [PubMed: 2286194]
[30]. Catena RD, Bailey JP, Campbell N, Music HE, Stand-to-sit kinematic changes during pregnancy
correspond with reduced sagittal plane hip motion, Clinical Biomechanics (2019).
[31]. Wu C-Y, Huang H-R, Wang M-J, Baby carriers: a comparison of traditional
sling and front-worn, rear-facing harness carriers, Ergonomics 60(1) (2017) 111–117.
10.1080/00140139.2016.1168871. [PubMed: 27054475]
[32]. Watson JC, Payne RC, Chamberlain AT, Jones RK, Sellers WI, The energetic costs of load-
Author Manuscript

carrying and the evolution of bipedalism, Journal of Human Evolution 54(5) (2008) 675–683.
http://www.sciencedirect.com/science/article/pii/S0047248407002072. [PubMed: 18023469]

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HIGHLIGHTS
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• Mechanics of babywearing, in-arms holding, and unloaded conditions were

investigated

• Greater forces and back extension found in-arms and baby carrier vs unloaded
in gait

• Small (<5°) differences found in lower extremity kinematics during gait

• During retrieval, a more upright posture was used in-arms and carrier vs
unloaded
• Babywearing may promote more similar lower extremity postures to unloaded
conditions
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Figure 1.
Experimental setup of one participant in each testing condition: (A) unloaded, (B) in-arms,
and (C) carrier. 9 mm reflective markers were placed on anatomical landmarks: C7, T10,
manubrium, xiphoid process, and bilaterally on the anterior superior iliac spine, posterior
superior iliac spine, greater trochanter, lateral and medial femoral epicondyles, tibial
tuberosity, medial and lateral malleolus, calcaneus, 1st and 5th metatarsal heads and the
base of the 2nd toe. Marker clusters were also placed on the lateral surface of the thighs and
shanks half-way between the proximal and distal joint centers.
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Figure 2.
Examples of one participant performing the item retrieval task using the (A) stoop and (B)
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squat technique.
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Figure 3:
The relative sagittal plane joint angle contribution to the vertical movement of the body
when subjects squatted to retrieve the object from the floor
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Table 1:

Gait spatiotemoral, ground reaction force, and kinematic data by condition (unloaded, arms, and carrier) with corresponding statistical results.

Variables Unloaded Arms Carrier F-statistics p η2

Havens et al.

Spatiotemporal parameters

Step length* 0.90 ± 0.07 a 0.87 ± 0.08 (2, 0.004) = 3.877 0.040 0.301
0.88 ± 0.06

Step time* 2.03 ± 0.16 2.04 ± 0.21 2.00 ± 0.14 0.586

Stance time* 2.26 ± 0.18 2.33 ± 0.25 2.28 ± 0.20 0.173

Speed* 0.45 ± 0.06 0.44 ± 0.05 0.45 ± 0.05 0.327

Step width* 0.16 ± 0.05 0.16 ± 0.04 0.16 ± 0.04 0.939

Impulse
Braking (BWs) 0.033 ± 0.006 a a (2, 0.0001) = 11.822 0.001 0.568
0.038 ± 0.006 0.038 ± 0.006
Propulsive (BWs) 0.030 ± 0.006 0.032 ± 0.004 0.032 ± 0.005 0.227
Braking time (s) 0.387 ± 0.024 0.393 ± 0.033 0.392 ± 0.031 0.678
Propulsive time (s) 0.314 ± 0.026 0.327 ± 0.033 0.312 ± 0.026 0.158
Mediolateral (BWs) 0.020 ± 0.011 0.021 ± 0.010 0.022 ± 0.010 0.694
Vertical (BWs) 0.553 ± 0.033 a a (2, 0.012) = 23.487 <0.001 0.723
0.615 ± 0.050 0.608 ± 0.042
Ground reaction force
Braking (BW) −0.19 ± 0.04 a a (2, 0.002) = 8.13 0.003 0.475
−0.22 ± 0.04 −0.22 ± 0.04
Propulsive (BW) 0.20 ± 0.04 0.21 ± 0.04 0.21 ± 0.04 0.192
Medial (BW) 0.07 ± 0.02 0.07 ± 0.02 0.07 ± 0.02 0.578

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Vertical (bW) 1.14 ± 0.10 a a (2, 0.065) = 47.071 <0.001 0.839
1.24 ± 0.11 1.26 ± 0.12
Peak Kinematics
Ankle plantarflexion (°) 4.6 ± 2.2 4.0 ± 2.9 4.3 ± 2.8 0.728
Ankle dorsiflexion (°) 13.8 ± 2.8 a a (2, 8.748) = 8.221 0.003 0.477
15.2 ± 2.2 15.6 ± 2.1
Knee flexion midstance (°) 12.0 ± 7.6 12.8 ± 8.0 14.4 ± 7.2 (2, 15.339) = 5.374 0.015 0.374
Knee flexion toe off (°) 46.4 ± 3.4 a a (2, 31.997) = 7.034 0.006 0.439
49.5 ± 3.8 49.5 ± 5.0
Hip flexion (°) 29.2 ± 6.6 28.7 ± 6.4 32.3 ± 6.3 (2, 37.222) = 3.968 0.037 0.306
Hip extension (°) 8.6 ± 6.1 9.3 ± 7.6 6.6 ± 6.6 0.143
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Variables Unloaded Arms Carrier F-statistics p η2

Pelvis max posterior tilt (°) 11.6 ± 4.6 10.3 ± 5.1 12.9 ± 4.6 0.077
Pelvis min posterior tilt (°) 8.3 ± 4.5 a b (2, 27.637) = 6.61 0.007 0.423
6.1 ± 4.9 9.4 ± 4.1
Havens et al.

Trunk flexion (°) 4.27 ± 4.3 a a (2, 107.059) = 15.656 <0.001 0.635
0.30 ± 5.1 −2.22 ± 3.7
Trunk extension (°) 0.7 ± 4.7 a a (2, 132.126) = 14.766 <0.001 0.621
4.1 ± 5.9 8.0 ± 4.4

*
Expressed as dimensionless number according to Hof [16];
a
significantly different to the unloaded condition (p<0.017),
b
significantly different to the in-arms condition (p<0.017)

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Table 2.

Retrieval timing, center-of-mass (COM), and kinematic data; COM variables all reported as dimensionless values (normalized to body height).

Variables Unloaded Arms Carrier F-statistics p η2

Havens et al.

Timina
Time down (s) 0.70 ± 0.08 0.87 ± 0.21 0.87 ± 0.13 0.152
Time up (s) 0.97 ± 0.11 1.02 ± 0.11 1.07 ± 0.08 0.234
COM translation
ML 0.032 ± 0.012 0.039 ± 0.022 0.031 ± 1.01 , 0.326
AP 0.241 ± 0.043 0.166 ± 0.068 a (2, 0.011) = 8.237 0.011 0.673
0.202 ± 0.090
Vertical 0.206 ± 0.047 0.243 ± 0.046 0.229 ± 0.062 0.174
Kinematics
Left ankle dorsiflexion (°) −4.5 ± 6.8 4.1 ± 6.9 2.8 ± 4.0 0.073
Right ankle dorsiflexion (°) 3.2 ± 7.2 9.3 ± 5.2 8.5 ± 5.1 0.080
Left knee flexion (°) 95.2 ± 28.4 a 116.6 ± 27.8 (2, 544.373) = 10.236 0.006 0.719
125.7 ± 24.5
Right knee flexion (°) 95.8 ± 30.4 a b (2, 369.444) = 10.481 0.006 0.724
118.5 ± 23.1 111.9 ± 24.1
Left hip flexion (°) 83.3 ± 10.7 90.1 ± 12.8 93.6 ± 9.6 0.102
Right hip flexion (°) 74.8 ± 9.8 79.1 ± 16.0 86.7 ± 12.5 0.123
Left hip abduction (°) 1.9 ± 5.7 7.7 ± 12.9 19.5 ± 7.3 0.086
Right hip abduction (°) 10.3 ± 8.1 19.4 ± 13.2 24.2 ± 10.7 (2, 435.813) = 7.813 0.013 0.661
Left hip internal rotation (°) −4.7 ± 6.6 4.3 ± 14.6 −3.3 ± 14.1 0.898
Right hip internal rotation (°) −18.8 ± 14.0 −16.3 ± 9.7 −16.6 ± 10.6 0.580

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Trunk flexion (°) 70.9 ± 13.8 a a (2, 1037.833) = 19.109 <0.001 0.827
49.0 ± 10.5 37.8 ± 16.5
Trunk frontal (°) −3.0 ± 3.2 −0.9 ± 4.2 3.5 ± 8.4 (2,128.743) = 9.053 0.009 0.694
T runk rotation (°) 19.2 ± 9.2 15.3 ± 17.5 16.5 ± 14.0 0.539

a
significantly different to the unloaded condition (p<0.017),
b
significantly different to the in-arms condition (p<0.017)
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