LITERATURE SURVEY

Research Works
In 2001, Scott Greenberger made a study on the topic Heavy Backpacks Harmful to Students, Simmons
Study Says. Students who use backpacks to carry heavy textbooks to and from school execute those
moves dozens of times a day. Though most are used to the burden, a new study suggests many are
doing themselves harm. Fifty-five percent of the Massachusetts children surveyed by researchers at
Simmons College typically carry loads heavier than 15 percent of their body weight - the limit
recommended by the American Academy of Orthopedic Surgeons.

Though the researchers couldn't definitively draw a connection, one-third of the 345 children in grades 5
through 8 surveyed reported back pain that forced them to see a doctor, miss school, or skip athletic
activities.

The students, who were recruited through Health net, a statewide Internet health education program,
weighed themselves and their backpacks under the supervision of teachers. "If your head is kind of like a
turtle in a forward position, that will cause pain and make you more vulnerable to injury," said Shelley
Goodgold, associate professor of physical therapy at Simmons. "We know that putting the backpack on
will make you more vulnerable."

Though a heavy backpack isn't healthy for anyone, children are particularly susceptible to injury because
their bodies are still developing, Goodgold said. Ninety-four percent of the students in the -study carried
standard two-strap backpacks, and most said they used both straps. But only 4 percent used the hip belt
recommended by health professionals. Packs designed to give better support, such as those with metal
frames, weren't popular among the middle school students.

The Simmons study comes amid growing concern about heavy packs. In Melrose, school officials sent a
letter to parents warning them about heavy backpack burdens. Northeastern University researchers
have tapped Beverly High School students for their study on backpack back pain. And the US Consumer
Product Safety Commission has reported that in 1999, more than 800 youngsters were treated in
emergency rooms for backpack-related injuries.

"They shouldn't make us take all this stuff around," said 11-year-old Sean White, who looked like he
might be swallowed up by his black backpack as he stood outside Richard J. Murphy School in
Dorchester. When I go to sleep sometimes, my back hurts." But a heavy backpack isn't all bad,
according to White. He said it comes in handy when he has to swing the pack at his 13-year-old sister.

In 2013, Hohee Son, PhD, PT , Department of Physical Therapy, College of Health Sciences, Catholic
University of Pusan: 57 Oryundae-ro, Geumjeong-gu, Busan 609-757, Republic of Korea, made a
research on The Effect of Backpack Load on Muscle Activities of the Trunk and Lower Extremities and
Plantar Foot Pressure in Flatfoot. The purpose of this study was to investigate the changes in muscle
activation of the trunk and lower extremities and plantar foot pressure due to backpack loads of 0, 10,
15, and 20% of body weight during level walking in individuals with flatfoot. [Methods] Fourteen young
flatfoot subjects and 12 normal foot subjects participated in this study. In each session, the subjects
were assigned to carry a backpack load, and there were four level walking modes: unloaded walking
(0%), 10% body weight (BW) load, 15% BW load, and 20% BW load. Trunk and lower extremity muscle
activities were recorded by surface EMG, and contact area and plantar foot pressure were determined
using a RS scan system. [Results] The erector spinae, vastus medialis, tibialis anterior and gastrocnemius
muscle activities, but not the rectus femoris and rectus abdominis muscle activities of flatfoot subjects
significantly and progressively increased as load increased in flatfoot subjects. Contact area and pressure
of the lateral and medial heel zones were significantly increased too. [Conclusion] Based on this data,
the weight of a backpack could influence muscle activation and plantar foot pressure in flatfoot.

In January 2012, Fafa Ben-Hatira, Kaouthar Saidane, Abdelfatah Mrabet made a research on A finite
element modeling of the human lumbar unit including the spinal cord. The purpose of this present work
is to provide a tool to better understand mechanically related pathologies of the lumbar unit and the
spinal structure by pro-viding spinal cord deformations in different loading cases. In fact, spinal cord
injury (SCI) resulting from a traumatic movement leads to a deformation of the neural and vascular
structure of the spinal cord. And since the magnitude of the spinal cord stress is correlated with the
pressure of the vertebral elements, stresses will be computed on all these components. Physical
properties of the vertebrae, various ligaments, the discs, and the spinal cord are described under simple
loading as compression, and combined loading, flexion and lateral bending to evaluate the pressure
undergone by different components of the lumbar unit. A nonlinear three-dimensional finite element
method is used as a numerical tool to perform all the computations. This study provides accurate results
for the localization and the magnitude of maximum equivalent stress and shear stress on the lumbar
unit and especially for the spinal cord. These results showed that stresses are more important when a
compression of 500 N is combined with a flexion and a lateral bending. In particular, shear stresses are
maximum for the spinal cord and the four inter vertebral discs for the case of a flexion of 3.8 Nm and a
lateral bending of 6.5 Nm.

Marta Kurutz, Budapest University of Technology and Economics, Hungary made a research on Finite
Element Modeling of the Human Lumbar Spine. In this research the FE modeling aspects of the most
frequented spinal part, the lumbar spine is presented. After giving a short overview of the anatomy of
the lumbar spine, biomechanical effects, loads, internal forces and movements are detailed. Then the
three steps of FE modeling procedure, the geometric, material and element/mesh type modeling is
discussed, followed by the validation of the complete FE model. Finally, an example for FE numerical
simulation closes the paper.

In November, 1999, Peter Alec Cripton, Department of Mechanical Engineering Queen's University
Kingston, Ontario, Canada published a thesis titled Load-Sharing In The Human Cervical Spine. By virtue
of the relative slenderness of the neck and the weight of the head, the cervical spine can be subjected to
considerable toads. Knowledge about the basic biomechanics and load-sharing of the cervical spine may
help to elucidate injury mechanisms or even suggest mechanisms leading to cervical joint degeneration.
The aim of this study was to characterize the load transmission paths through cervical functional spinal
units (FSUs). Compression and flexion, extension, lateral bending and torsional bending moments and
anterior, posterior and lateral shear forces were applied. Under compression loading, the influence of
superimposed flexion and extension postures was established. Under al1 other loading modes the
effect of a constant axial preload was evaluated. The preload represented an active neck musculature
and the weight of the head. An optoelectronic motion analysis system was used to measure specimen
kinematics. Load-sharing mechanisms were studied using a miniature pressure sensor to measure inter
vertebral disc pressure and tri-axial strain gauges mounted beneath each of the facet joints and on the
anterior surface of the vertebral body.

Our results suggest that flexion and compression-flexion loading modes result in compressive force in
the anterior column and tensile (or small compressive) forces in the posterior column. Extension
moments resulted in compressive force at the posterior column and tension in the anterior column.
Extension-compression caused compressive forces in both the anterior and posterior columns. Lateral
bending moments were associated with higher loads in the facet toward which the segment rotated.
Torsion moments caused equal loading at each of the facets. Under anterior shear the vertebra pivoted
about the compressed annulus interiorly and ramped up the facet joints exteriorly resulting in a net
distraction of the inter vertebral disc and decrease in disc pressure. Posterior shear resulted in a pure
posterior translation tension at the anterior annulus and distraction of the facet joints. Lateral shear
caused an impingement of the facet joint on the underlying lamina. These results identify which specific
anatomic structures may be highly loaded under each of the loads applied. Clinically, they can be used
to identify parts of the anatomy that should be examined for injury.

In 2002, Tobias Pitzen, Dieter Matthis, Wolf-Ingo Steudel made a research on Posterior Element Injury
and Cervical Spine Flexibility Following Anterior Cervical Fusion and Plating. The purpose of this study
was to quantify the stabilizing effect of anterior cervical fusion and plating (ACFP) on various grades of
simulated flexion/distraction injuries to the human cervical spine.

Material and Methods: A finite element approach was used. Digitized data from computed tomography of
a human cervical spine were taken to generate a three dimensional, anisotropic, linear finite element
model (FEM) C4C7. Based on this FEM of the intact segments (FEM 1), an additional model was
generated: FEM with simulation of ACFP of C5/6 using bi-cortical screws (FEM 2). Loading of each FEM
was simulated using pure moments of 2.5 Nm in flexion/extension, left/right axial rotation, and left/right
lateral bending. For validation of the models, their predictions of range of motion (ROM) C5/6 were
compared to the results of a previous, corresponding in vitro study, using human segments C4C7
surgically altered with the same implants.

Results: Results obtained by the FEM 1 and 2 for each loading case were within one standard deviation
of the results of the corresponding in vitro study. Thus, alterations of FEM 2 were used in the following to
predict the changes in flexibility C5/6 after stepwise transaction of the posterior ligaments. An increase in
ROM occurred in each loading case after trans-section of single components, which was pronounced in
rotation and bending following removal of the capsules.

Conclusions: ACFP may be sufficient for flexion-distraction injuries if the capsular ligaments and facets
are not injured.
In 2013, Philippe K Zysset, Enrico DallAra, Peter Varga and Dieter H Pahr made a study on topic Finite
element analysis for prediction of bone strength. This study aims to review the predictability of human
bone strength at the three major osteoporotic fracture sites quantified in recently completed in vitro
studies at our former institute. Specifically, the performance of FE analysis based on clinical computer
tomography (QCT) is compared with the ones of the current densitometric standards, bone mineral
content, bone mineral density (BMD) and areal BMD (aBMD). Clinical fractures were produced in
monotonic axial compression of the distal radii, vertebral sections and inside loading of the proximal
femora. QCT-based FE models of the three bones were developed to simulate as closely as possible the
boundary conditions of each experiment. For all sites, the FE methodology exhibited the lowest errors
and the highest correlations in predicting the experimental bone strength. Likely due to the improved CT
image resolution, the quality of the FE prediction in the peripheral skeleton using high-resolution
peripheral CT was superior to that in the axial skeleton with whole-body QCT. Because of its projective
and scalar nature, the performance of aBMD in predicting bone strength depended on loading mode
and was significantly inferior to FE in axial compression of radial or vertebral sections but not
significantly inferior to FE in side loading of the femur. Considering the cumulated evidence from the
published validation studies, it is concluded that FE models provide the most reliable surrogates of bone
strength at any of the three fracture sites.

In 2013, Hohee Son, PhD, PT , Department of Physical Therapy, College of Health Sciences, Catholic
University of Pusan: 57 Oryundae-ro, Geumjeong-gu, Busan 609-757, Republic of Korea, made a
research on The Effect of Backpack Load on Muscle Activities of the Trunk and Lower Extremities and
Plantar Foot Pressure in Flatfoot. The purpose of this study was to investigate the changes in muscle
activation of the trunk and lower extremities and plantar foot pressure due to backpack loads of 0, 10,
15, and 20% of body weight during level walking in individuals with flatfoot. [Methods] Fourteen young
flatfoot subjects and 12 normal foot subjects participated in this study. In each session, the subjects
were assigned to carry a backpack load, and there were four level walking modes: unloaded walking
(0%), 10% body weight (BW) load, 15% BW load, and 20% BW load. Trunk and lower extremity muscle
activities were recorded by surface EMG, and contact area and plantar foot pressure were determined
using a RS scan system. [Results] The erector spinae, vastus medialis, tibialis anterior and gastrocnemius
muscle activities, but not the rectus femoris and rectus abdominis muscle activities of flatfoot subjects
significantly and progressively increased as load increased in flatfoot subjects. Contact area and pressure
of the lateral and medial heel zones were significantly increased too. [Conclusion] Based on this data,
the weight of a backpack could influence muscle activation and plantar foot pressure in flatfoot.