Musculoskeletal Injuries in Astronauts: Review of Pre-flight, In-flight, Post-flight, and Extravehicular Activity Injuries
- 37 Downloads
Purpose of the Review
To provide a comprehensive review of musculoskeletal injuries in astronauts during pre-flight, in-flight (including extravehicular activity), and post-flight periods. The discussion is inclusive of etiology and nature of the injury, preventative measures, and future considerations.
The most common injuries were to the hand, shoulder, and back/spine. Patterns and location of injury depend on the phase of flight during which they occurred. Current countermeasures are effective for some concerns, but do not ameliorate all musculoskeletal risks, thus new countermeasure and preventative approaches are warranted in some arenas.
During pre-flight preparations, the shoulder is a site with the most concerning injuries, and they occur during extravehicular activity training, usually secondary to interaction with the planar hard upper torso. Suit redesign is under consideration, for both the pre- and in-flight environments. Hand injuries are also common in both pre-flight training and in-flight extravehicular activity. Countermeasures include reducing moisture and protective bandaging of fingertips. Space-adaptation back pain and herniated nucleus pulposus occur in-flight and post-flight, respectively. In-flight exercise countermeasures may mitigate many in-flight and post-flight spinal pathologies. In-flight loss of bone mineral and trabecular architecture can be mediated via both pharmacologic and exercise countermeasures. The advanced resistive exercise device has shown ability to reduce not only bone loss, but also muscular atrophy. Standardized and anonymous injury reporting is essential to track the full range of injuries over time. Participation of physical medicine and orthopedic-trained physicians and therapists, working alongside the ASCR (Astronaut Strength, Conditions, and Rehabilitation) group during astronaut exercise, training, and rehab should be considered value added.
KeywordsAstronaut Extravehicular Training Injury Musculoskeletal Spaceflight
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
- 4.Charles JB, Lathers CM. Cardiovascular adaptation to spaceflight. J Clin Pharmacol. 1991;31:1010–23. https://doi.org/10.1002/j.1552-4604.1991.tb03665.x.CrossRefPubMedGoogle Scholar
- 10.Vandenburgh H, Chromiak J, Shansky J, Del Tatto M, Lemaire J. Space travel directly induces skeletal muscle atrophy. FASEB J Off Publ Fed Am Soc Exp Biol. 1999;13:1031–8.Google Scholar
- 11.Scheuring RA. Musculoskeletal changes, injuries and rehabilitation associated with spaceflight Anaheim, CA, United States 2010.Google Scholar
- 13.Clément G. Fundamentals of space medicine. 2nd ed. New York: Springer-Verlag; 2010.Google Scholar
- 16.Scheuring RA, Jones JA, Novak JD, Polk JD, Gillis DB, Schmid J, et al. The Apollo Medical Operations Project: recommendations to improve crew health and performance for future exploration missions and lunar surface operations. Acta Astronaut. 2008;63:980–7. https://doi.org/10.1016/j.actaastro.2007.12.065.CrossRefGoogle Scholar
- 17.Scheuring RA. Musculoskeletal injuries in US astronauts. 2017. Presentation from National Jewish Health Meeting Jun 20-23, 2017 Denver, CO, USA JSC-CN-39841 https://ntrs.nasa.gov/search.jsp?R=20170005908 2018-07-23T17:53:12+00:00Z. Accessed 23 July 2018.
- 18.Kim HJ. South Korea’s first astronaut hospitalized with back pain In: Space.com. https://www.space.com/5301-south-korea-astronaut-hospitalized-pain.html. 30 April 2008. Accessed 7 Mar 2018.
- 19.“Injury Rate of Shuttle Astronauts.” The Longitudinal Study of Astronaut Health Newsletter. 1999:8:2.14.pdf. Accessed 7 Mar 2018.Google Scholar
- 20.Johnson BJW. Results from an investigation into extra-vehicular activity (EVA) training related shoulder injuries. San Diego, CA, United States 2004.Google Scholar
- 22.“A brief history of space accidents.” Jane’s Civil Aerospace 03 February 2003. https://web.archive.org/web/20030204073904/http://www.janes.com/aerospace/civil/news/jsd/jsd030203_3_n.shtml. Accessed 7 Mar 2018.
- 23.Laughlin MS, Murray JD, Young M, Wear ML, Tarver WJ, Van Baalen M. Do astronauts have a higher rate of orthopedic shoulder conditions than a cohort of working professionals. NASA Human Research Program Investigators’ Workshop (HRP IWS 2016); 8–11 Feb. 2016; Galveston, TX; United States.Google Scholar
- 24.Essner, E. “U.S. military well-represented among NASA astronauts.” In: Veterans United Netw. 31 March 2016. https://www.veteransunited.com/network/to-the-battlefield-and-beyond-military-members-in-space/.
- 28.Fiscal Year 2017 Budget Estimates.Google Scholar
- 29.“Mercury Manned Flights Summary.” 30 November 2006. In: NASA. http://www.nasa.gov/mission_pages/mercury/missions/manned_flights.html.
- 30.Williams DR. The Gemini Program (1962–1966). 30 December 2004. https://nssdc.gsfc.nasa.gov/planetary/gemini.html.
- 31.Scheuring RA, McCulloch P, van Baalen M, Minard C, Watson R, Bowen S et al. Shoulder injuries in US astronauts related to EVA suit design. Aerospace Medical Association Annual Meeting, Dallas TX 2012.Google Scholar
- 32.Strauss S. Extravehicular mobility unit training suit symptom study report. 2004.Google Scholar
- 33.Laughlin MSM. Shoulder injury incidence rates in NASA astronauts. 2014.Google Scholar
- 34.Williams DR, Johnson BJ. EMU shoulder injury tiger team report. 2003.Google Scholar
- 35.Chappell SP, Norcross JR, Abercromby AFJ, Bekdash OS, Benson EA, Jarvis SL. Evidence report: risk of injury and compromised performance due to EVA operations. 2017.Google Scholar
- 37.Dewitt J., Jones J.A., Velasquez L., et al. Evaluation of the Hard Upper Torso Shoulder Harness NASA/JSC TP-2007-214751. NASA Johnson Space Center, Houston.Google Scholar
- 38.Gernhardt, M.L., Jones, J.A., Scheuring, R.A., et al. Chapter 14- Risk of Compromised EVA Performance and Crew Health Due to Inadequate EVA suit systems; In Human Health and Performance Risks of Space Exploration Missions eds. Human Research Program Requirements Document, HRP-47052, Rev. C, Jan 2009.Google Scholar
- 39.McFarland SMR. Spacesuit glove-induced hand trauma and analysis of potentially related risk variables. 12–16 Jul. 2015, United States.Google Scholar
- 40.Charvat CM, Norcross J, Reid CR, McFarland SM. Spacesuit glove-induced hand trauma and analysis of potentially related risk variables. 45th International Conference on Environmental Systems (ICES); 12–16 Jul. 2015; Bellevue, WA; United States.Google Scholar
- 42.Green DA, Scott JPR. Spinal health during unloading and reloading associated with spaceflight. Front Physiol. 2018;8 https://doi.org/10.3389/fphys.2017.01126.
- 43.Thomspon L, Kerstman R, Butler D (2008) Fingernail injuries and NASA’s integrated medical model. NASA Technical Reports Server. Accessed: March 22, 2018.Google Scholar
- 47.Personal communication with Richard A. Scheuring, 2018.Google Scholar
- 48.Personal communication with Jeffrey A. Jones, 2018.Google Scholar
- 49.JSC Technical Report Server. https://ston.jsc.nasa.gov/collections/trs/_2007-abs.html. Accessed 7 May 2018.
- 50.Ross A (2014) Z-2 Prototype Space Suit Development Tucson, AZ, United States.Google Scholar
- 51.Abercromby A (2017) Integrated Extravehicular Activity Human Research Plan: 2017.Google Scholar
- 52.Ansari RR, Jones JA, Pollonini L, et al (2009) A non-invasive miniaturized-wireless laser-Doppler fiber-optic sensor for understanding distal fingertip injuries in astronauts. SPIE.Google Scholar
- 53.Jones JAH (2007) Risk reduction and measures of injury for EVA associated upper extremity medical issues: extended vent tube study. Beijing, China.Google Scholar
- 56.Laughlin MSM (2016) post-flight back pain following international space station missions: evaluation of spaceflight risk factors. Galveston, TX, United States.Google Scholar
- 57.Smith SM, Heer MA, Shackelford LC, Sibonga JD, Ploutz-Snyder L, Zwart SR. Benefits for bone from resistance exercise and nutrition in long-duration spaceflight: evidence from biochemistry and densitometry. J Bone Miner Res. 2012;27:1896–906. https://doi.org/10.1002/jbmr.1647.CrossRefPubMedGoogle Scholar
- 64.Office IPS NASA Commercial Biomedical Testing Module-3: Assessment of sclerostin antibody as a novel bone forming agent for prevention of spaceflight-induced skeletal fragility in mice. https://www.nasa.gov/mission_pages/station/research/experiments/CBTM3Sclerostin_Antibody.html. Accessed 8 May 2018.
- 65.NASA Assessment of myostatin inhibition to prevent Skelet Muscle atrophy and weakness in mice exposed to long-duration Spaceflight https://www.nasa.gov/mission_pages/station/research/experiments/1722.html. Accessed 8 May 2018.
- 67.Nieschwitz B (2011) Post flight reconditioning for US astronauts returning from the International Space Station. Atlanta, GA, United States.Google Scholar
- 69.Sibonga JD, Feiveson AH. Astronaut bone medical standards derived from finite element (FE) models of OCT scans from population studies.Google Scholar