Abstract
Aviation and space medicine face many common musculoskeletal challenges that manifest in crew of rotary-wing aircraft (RWA), high-performance jet aircraft (HPJA), and spacecraft. Furthermore, many astronauts are former pilots of RWA or HPJA. Flight crew are exposed to recurrent musculoskeletal risk relating to the extreme environments in which they operate, including high-gravitational force equivalents (g-forces), altered gravitational vectors, vibratory loading, and interaction with equipment. Several countermeasures have been implemented or are currently under development to reduce the magnitude and frequency of these injuries. Cervical and lumbar spine, as well as extremity injuries, are common to aviators and astronauts, and occur in training and operational environments. Stress on the spinal column secondary to gravitational loading and unloading, ± vibration are implicated in the development of pain syndromes and intervertebral disk pathology. While necessary for operation in extreme environments, crew-support equipment can contribute to musculoskeletal strain or trauma. Crew-focused injury prevention measures such as stretching, exercise, and conditioning programs have demonstrated the potential to prevent pre-flight, in-flight, and post-flight injuries. Equipment countermeasures, especially those addressing helmet mass and center of gravity and spacesuit ergonomics, are also key in injury prevention. Furthermore, behavioral and training interventions are required to ensure that crew are prepared to safely operate when faced with these exposures. The common operational exposures and risk factors between RWA and HPJA pilots and astronauts lend themselves to collaborative studies to develop and improve countermeasures. Countermeasures require time and resources, and careful consideration is warranted to ensure that crew have access to equipment and expertise necessary to implement them. Further investigation is required to demonstrate long-term success of these interventions and inform flight surgeon decision-making about individualized treatment. Lessons learned from each population must be applied to the others to mitigate adverse effects on crew health and well-being and mission readiness.
Highlights
The crew of high-performance jet aircraft (HPJA), rotarywing aircraft (RWA), and spacecraft are subjected to extreme occupational conditions that elevate their risk of pre-flight, inflight, and post-flight musculoskeletal pathology and disability
The astronaut population is small and the relative abundance of HPJA and RWA crew may assist in understanding the musculoskeletal complaints seen in astronauts
The impending launch of commercial spacecraft could pave the way to increased access to space in which case a more diverse population of individuals will be subjected to the musculoskeletal risks of flight
Summary
The crew of high-performance jet aircraft (HPJA), rotarywing aircraft (RWA), and spacecraft are subjected to extreme occupational conditions that elevate their risk of pre-flight, inflight, and post-flight musculoskeletal pathology and disability. Much like the evidence in support of directed exercise interventions for non-specific neck pain in the general population, studies have demonstrated success in RWA and HPJA pilots using a prescribed resistive exercise regimen with elastic bands to improve strength and endurance of cervical spine musculature (Figure 5), mitigate neck pain, and reduce time removed from flying duties due to injury (Hamalainen et al, 1998; Hurwitz et al, 2008; Ang et al, 2009; Bronfort et al, 2010; Salmon et al, 2013). Possible interventions include reconfiguration of cockpit seat and flight control geometry (Phillips, 2011)
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