Post Space Mission Lumbo-Pelvic Neuromuscular Reconditioning: A European Perspective

Abstract

Long-duration exposure to the space environment causes physical adaptations that are deleterious to optimal functioning on Earth. Post-mission rehabilitation traditionally concentrates on regaining general muscle strength, neuromuscular control, and lumbo-pelvic stability. A particular problem is muscle imbalance caused by the hypertrophy of the flexor and atrophy of the extensor and local lumbo-pelvic muscles, increasing the risk of post-mission injury. A method currently used in European human spaceflight to aid post-mission recovery involves a motor control approach, focusing initially on teaching voluntary contraction of specific lumbo-pelvic muscles and optimizing spinal position, progressing to functional retraining in weight bearing positions. An alternative approach would be to use a Functional Readaptive Exercise Device to appropriately recruit this musculature, thus complementing current rehabilitation programs. Advances in post-mission recovery of this nature may both improve astronaut healthcare and aid terrestrial healthcare through more effective treatment of low back pain and accelerated post bed rest rehabilitation.

A novel approach to activate deep spinal muscles in space—Results of a biomechanical model

“…Exercise on the FRED also appears to promote an immediate phasic-to-tonic shift in lumbo-pelvic muscle activation as well as an increase in spinal extensor and reduction in spinal flexor muscle activation [7]. These findings suggest that the FRED could provide a useful tool in the rehabilitation of astronauts [12].…”

The immediate effects of exercise using the Functional Re-adaptive Exercise Device on lumbopelvic kinematics in people with and without low back pain

“…The capacity of FRED exercise to automatically promote increased lordosis, therefore, suggests it may be a useful intervention for both training LM and TrA as part of a rehabilitation programmes for LBP and for improving lubopelvic position, including recovery of lumbar lordosis. It could also be a relevant reconditioning tool for use in astronauts following exposure to microgravity, where the deep lumbopelvic muscles are known to be atrophied (Hides et al, 2015;Evetts et al, 2014;Hides et al, 2007).…”

“…Due to gravitational unloading of the spine in astronauts, and the reduced level of deep spinal muscle activity required to maintain upright posture, atrophy of the deep spinal muscles, similar to that seen in LBP, has been reported following as little as two weeks of exposure to microgravity (Evetts et al, 2014).…”

“…Specific motor control training is an evidence-based approach to the rehabilitation of LM and TrA function (Hodges et al, 2013;Hides et al, 2010;Hides, 2013;Hodges et al, 2013), and is currently used as part of astronaut reconditioning by the European Space Agency (Evetts et al, 2014;Lambrecht et al, 2016). It involves progressive training, beginning with isolating muscle recruitment, followed by recruitment during upright, functional positions while maintaining lumbar lordosis and thoracic kyphosis (Hides et al, 2008b;O'Sullivan, 2000).…”

Parallels between astronauts and terrestrial patients – Taking physiotherapy rehabilitation “To infinity and beyond”

“…The ESA approach to post space mission lumbo-pelvic reconditioning has been published (Evetts et al, 2014;Lambrecht et al 2017;Petersen et al 2017). Whilst the physiotherapy programme encompassed much more than rehabilitation of the lumbo-pelvic region, a recent case history documented changes in lumbo-pelvic muscles associated with spaceflight .…”