Al-Khabbaz2008 Backpack
Al-Khabbaz2008 Backpack
Al-Khabbaz2008 Backpack
com
Abstract
The purpose of the present study is to analyze trunk-lower extremity muscle activities and trunk postural changes during the carriage of
different backpacks. Nineteen male university students (21 3 years) participated in the experiment’s four standing modes: (1) unloaded
standing, (2) 10% body weight (BW) load (in the form of a backpack), (3) 15% BW load and (4) 20% BW load. Bilateral rectus abdominis,
erector spinae, vastus medialis and biceps femoris muscle activities were recorded using surface electromyography (SEMG), while trunk
inclination, side flexion and rotation were measured by using VICON 250 during all standing modes. The results showed that rectus abdominis
muscle activities increased progressively and disproportionably as the backpack load increased. As for the trunk posture, almost the same
backward inclination was adapted even with increasing backpack heaviness. Twenty percent BW backpack causes the most significant
muscular and postural changes so it should be avoided. However, it is recommended to study other backpack factors such as frequency of
usage, usage time, type of the backpack and age to come up with a complete usage recommendation.
# 2008 Elsevier B.V. All rights reserved.
0966-6362/$ – see front matter # 2008 Elsevier B.V. All rights reserved.
doi:10.1016/j.gaitpost.2008.01.002
298 Y.S.S.M. Al-Khabbaz et al. / Gait & Posture 28 (2008) 297–302
different between empty and loaded backpack stances. Goh 2.2. Experiment design
et al. [9] compared the change in lumbosacral trunk forces
under different backpack loads in 10 infantry soldiers. Each subject was asked to stand in four modes: (1)
Results showed significant increase in peak lumbosacral unloaded standing, (2) 10% BW load, (3) 15% BW load and
forces as backpack load increases (26.7% and 64% with 15% (4) 20% BW load. Unloaded standing served as a reference
and 30% BW backpack loading, respectively). to compare muscle activity and trunk postural changes
Although some researchers studied the effect of external between the three different load modes. The load was
load on the human body, it is a very wide field and requires applied in the form of a regular non-framed backpack. The
more explanations. Steele et al. [11] made a systematic same backpack was used during all loaded standing modes
literature review to emphasize the research evidence for all subjects. The backpack was filled with sand weights
regarding load carriage related postural changes in young to weigh 10%, 15% or 20% BW of each subject depending
people. They found that only seven papers met their on the loaded standing mode.
required level of evidence, concluding that no current During each standing mode, the subjects stood erect with
standardized approach is available to study the load- extended knees and head facing forward. To keep the
induced postural changes in young people. Moreover, fewer subjects focus on facing forward, the subjects were asked to
papers were found in adult subjects, and – for the keep looking at a piece of towel at eye level placed four
researchers’ knowledge – there are no previous studies to meters away. Each subject did all standing modes in one
examine changes in trunk and lower extremities during session (Fig. 1).
loaded standing posture. The present study is the first
research to study changes in trunk-lower extremity muscle 2.3. Data collection
activities and trunk posture during carrying different
backpack loads. The purpose of the present study is to Data collection took place over eight trials, two trials per
analyze trunk-lower extremity muscle activities and trunk standing mode. During each trial, trunk-lower extremity
postural changes during carrying backpacks. 10%, 15% and muscle activities were recorded by SEMG, while trunk
20% body weight (BW) load backpacks were used to postural changes were collected by VICON motion analysis
emphasize if muscular and postural measurements differed system. SEMG and VICON data was collected during 5 s
from the unloaded standing, and so to recommend suitable and 30 frames respectively, beginning after 10 s initial
backpack weight limitations. In this study, bilateral rectus standing mode. All trials were followed by a 1 min rest to
abdominis, erector spinae, vastus medialis, and biceps avoid accumulative fatigue.
femoris muscle activities were recorded by surface
electromyography (SMEG), while biomechanical analysis 2.3.1. Surface electromyography (SEMG)
was performed to measure trunk inclination, rotation, and SEMG was utilized to study changes in trunk and lower
side flexion using a VICON 250. Muscular and postural extremity muscle activities [12–16]. Bilateral SEMG
changes due to the carrying of a backpack were compared to activities of erector spinae (trunk extensor), rectus abdo-
those of the unloaded standing position. It was hypothesized
that changes in backpack heaviness would lead to different
muscular and postural reactions.
2. Methodology
2.1. Participants
minis (trunk flexor), vastus medialis (knee extensor) and normalized and expressed as an MVC percentage. On the
biceps femoris (knee flexor) were recorded during all other hand, to elucidate changes in trunk posture,
standing modes. unloaded standing data served as a reference of 08 (the
Rectus abdominis fiber orientation was approximated at difference between unloaded standing and it self).
the level of the anterior superior iliac spine, 2 cm lateral to Changes in trunk posture were expressed as the difference
the midline. Erector spinae muscle sites were determined at between 10%, 15% and 20% BW load modes and
the level of the L4–L5 interspace, 2 cm lateral to the midline unloaded standing.
[17]. Eighty percent on the line between the anterior superior Mean and standard deviation of the eight muscles
iliac spine and medial knee joint space in front of anterior recorded activities and trunk postural changes were
border of the medial ligament was the electrode site for the calculated for all standing modes. Repeated ANOVA
vastus medialis, while 50% on the line between the ischial procedure was used to compare MVC normalized muscle
tuberosity at the lateral condyle of the tibia was for the activities and trunk postural changes during all standing
biceps femoris [18]. modes. To identify the main significant effect, a Post-Hoc
Before attaching surface electrodes, electrode sites were Tukey Kramer test was utilized to get the specific
cleaned with alcohol and shaved with disposable shavers. mean differences. Results were considered significant at
After that, the skin was abraded by soft sand paper then P < 0.05.
again cleaned with alcohol to ensure decreasing skin
impedance to lower than 5 V. Ag/AgCl pre-amplified
disposable surface electrodes (Blue sensor M, Ambu, 4. Results
Denmark) were used to record EMG data. Blue sensor
EMG electrodes were self adhesive with conductive wet gel, 4.1. Surface electromyography
and had a 13.2 mm2 sensor area.
Data was sampled at 1000 Hz and amplified by an eight- Average electromyography muscles activities are illu-
channel digital EMG system (Noraxon, MyoSystemTM strated in Fig. 2. Bilateral erector spinae showed no
1400A, USA). Myoresearch XP Master EditionTM was used significant changes in muscle activity. Average right
to process EMG raw data (rectification, smoothing, ECG erector spinae muscle activities were 16.17%, 15.96%,
reduction and maximum voluntary contraction (MVC) 16.85% and 16.78%, while average left erector spinae
normalization). To normalize EMG data, MVC was muscle activity were 17.5%, 18.05%, 18.71% and 19%
performed for all examined muscles [19–21]. MVC records during unloaded standing, 10%, 15% and 20% BW load
were taken in two trials. Each trial lasted for 5 s and was modes respectively. On the other side, bilateral rectus
followed by 2 min rest to avoid muscle fatigue. All vocal abdominis showed significant changes between each mode
commands and encouragements were done by a tape (P < 0.05). Average right rectus abdominis muscle
recorder. activities were 3.1%, 3.98%, 5.37% and 6.84%, while
average left rectus abdominis muscle activities were
2.3.2. Trunk posture 2.96%, 3.41%, 4.58% and 5.42% during unloaded
Changes in trunk inclination, side flexion and rotation standing, 10%, 15% and 20% BW load modes, respectively
were studied using VICON 250 motion analysis system (P < 0.05). It was also revealed that the right rectus
(Oxford Metrics Group, Oxford, UK). VICON 250’s five abdominis showed more activity than the left rectus
camera system can localize reflective markers in three abdominis during all standing modes.
dimensional co-ordinal spaces. VICON Cameras have No significant changes were found during the different
300,000 pixel resolution and sample frames at 60 Hz [22– standing modes in vastus medialis and biceps femoris
24]. VICON reflective skin markers are 25 mm in diameter bilaterally.
and placed on certain bony markers externally. Reflective
markers placed on each subject’s sacrum, bilaterally on 4.2. Trunk posture
acromion process, elbow lateral epicondyle, radius styloid
process, one third on the line between the anterior superior Changes in trunk posture are demonstrated in Fig. 3.
iliac spine and the femur greater trochanter, knee joint lateral The positive degree means forward inclination, right side
aspect, calcaneus and forefoot. Diff Gait and Wave Eyes flexion and right rotation, while negative degree means
software programs were used to analyze VICON 250’s backward inclination, left side flexion and left rotation.
collected raw data. Results clarify that with a change in carriage only trunk
inclination showed significant changes (P < 0.05). Trunk
inclined backward 3.378, 3.028 and 3.908 during
3. Statistical analysis 10%, 15% and 20% BW load respectively (P < 0.05).
Trunk rotation and side flexion remained almost the
All muscle activities (bilateral erector spinae, rectus same during load modes and no significant changes were
abdominis, biceps femoris and vastus medialis) were found.
300 Y.S.S.M. Al-Khabbaz et al. / Gait & Posture 28 (2008) 297–302
Fig. 2. EMG activities of the trunk and lower extremity muscles during the different standing modes.
5. Discussion side and a 20% and 65% on the left side respectively.
Maximum increases were 157% on the right side and 110%
5.1. Trunk muscle EMG activities on left side during carrying 20% BW backpack. It is also
interesting to note that the increase in EMG activity on the
Rectus abdominis EMG activities increased significantly right side was always higher than left side during all load
with the increase of backpack heaviness. This increase can modes. Similar results were reported by Motmans et al. [17]
be explained bio-mechanically as Goh et al. [9] reported. who studied trunk EMG activity during carrying various
According to them, carrying a backpack shifts the centre of types of school bags. They reported 54% and 99% increase
gravity (COG) backward and causes extra extension on the left and right rectus abdominis respectively during
moment. As a result, both side’s rectus abdominis will carrying 15% BW backpack. However, there is no logical
contract more to counter balance this extra extension explanation for this unique phenomenon. It is assumed that
moment which was manifested as an increase in EMG both left and right rectus abdominis are not the trunk’s main
record during loaded standing modes. It was also noticed stabilizers and not adapted to the new posture. This may lead
that rectus abdominis EMG activity increase differs as the to rough imbalance muscle activation between the left and
heaviness of backpack changes. However, the EMG right side.
increases are not of the same proportion as in the increase Motmans et al. [17] also reported decrease in erector
of backpack heaviness. With 10% and 15% BW load, rectus spinae activities during the carriage of 15% BW backpack.
abdominis EMG had a 35% and 105% increase on the right However, in the current study, erector spinae remained the
same with no significant changes during all standing modes. 5.5. Limitations and recommendations
The steadiness of erector trunk activation was explained by
O’Sullivan et al. [25] who stated that erector spinae muscles The limitations of this study are the sample size and sex.
play a role in the trunk postural stabilizing during standing It is recommended to apply the same study on bigger
posture. The erector spinae were active to stabilize the trunk samples, both male and female.
from change due to external load effect. Even though trunk rotation and side flexion showed no
significant changes, different results may appear during
5.2. Lower extremity EMG activities walking. Therefore, it is recommended to study the effect of
carrying a backpack on human gait generally and trunk
Both vastus medialis and biceps femoris showed no specifically. Both trunk and lower extremity muscles need to
significant changes in EMG activities during load modes. be investigated too to have a better understanding of
This lack of change suggests that external load (backpack) muscular changes. In another point of view, the current study
has a neglectable effect on lower extremity muscles. It also was applied on normal subjects. The difference between a
explains why in the 77% of musculoskeletal symptoms normal subject and a musculoskeletal symptomatic patient’s
prevalence related to wearing schoolbag only 5.7% were in reactions to carrying a backpack should be studied.
the knees or lower leg as shown by Whittfield et al. [6]. Most
prevalent symptoms were in the neck (44%), shoulders
(57.9%), upper back (36.7%) and lower back (35%). 6. Conclusion
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