Peri-flight Neuromusculoskeletal Injuries in Astronauts

The space sector is growing remarkably fast. Its value is expected to increase from $447 billion in 2022 to $2.7 trillion by 2040. The demand for astronauts and astro-civilians is growing, and there will be an increased need for experts who understand the effects of spaceflight on the neuromusculoskeletal (NMSK) system. Orthopedic specialists in space medicine are sparsely reported in the literature, and standards of care for astro-civilians are not well established. This review discusses the current prevalence of peri-flight NMSK injuries in astronauts, the role of orthopedic specialists, and considerations for standards of care for astro-civilians.

A systematic review using PubMed, MEDLINE, and NASA Technical Report Server was performed to identify original research containing NMSK injuries in astronauts.

There were 29 studies included in the review. In 2388 documented injuries, the prevalence of injuries during preflight is 46.5%, in flight is 37.0%, and postflight is 16.5%. In 2081 documented injury locations, the prevalence of injuries in the upper extremity is 32.4%, in the shoulder is 31.4%, in the back is 26.4%, in the lower extremity is 5.5%, and in the neck is 2.3%.

Common peri-flight injuries involve the shoulder, back, and hand, such as shoulder tendonitis, space adaptation back pain, and herniated nucleus pulposus. It is critical to consider NMSK injuries for the growing space sector. As public interest grows, costs related to space are expected to decrease. Decreased costs increase accessibility to space and, consequently, the risk of NMSK injuries, increasing the demand for medical standards and experts in orthopedics and space medicine. Ward GH, Anderson DN, Scheuring RA. Peri-flight neuromusculoskeletal injuries in astronauts. Aerosp Med Hum Perform. 2025; 96(2):155-167.