Sports Injury

Written By Elizabeth Gaffney

Hyperbaric Oxygen Therapy for Sports Injuries

Introduction

Hyperbaric Oxygen Therapy (HBOT) consists of breathing oxygen at a pressure higher than local atmospheric pressure for multiple sessions for the treatment or prevention of specific diseases. As per the European Code of Good Practice (Kot et al.), there is a general consensus that the term HBOT can only be applied when the partial pressure of oxygen in breathing mixture exceeds 1.5 absolute atmosphere (ATA) for a minimum period of 60 minutes (excluding compression and decompression).

Breathing oxygen under pressure increases the amount of oxygen dissolved in the blood and tissues, which enhances the body’s healing processes. Many professional sports teams, including hockey, basketball and soccer teams, use HBOT as an adjuvant therapy for sports-related injuries, ranging from minor sprains to severe ligament tears. There is strong evidence for the effectiveness of HBOT for sports-related injuries, and HBOT may hasten recovery and minimise the risk of re-injury.

Mechanism of Action of HBOT

HBOT may benefit patients with sports injuries through several mechanisms, primarily by enhancing oxygen delivery to tissues to enhance the healing process.

1. Enhanced oxygen delivery: Under hyperbaric conditions, oxygen dissolves more efficiently in the plasma, increasing overall tissue oxygenation and promoting tissue repair and regeneration (Cannellotto et al., 2024).

2. Reduced inflammation: Inflammation is common after injury. HBOT reduces inflammation and oedema, oxygenates injured muscle, and regenerates skeletal muscle via macrophage and satellite cell activation (Oyaizu et al., 2018; Fujita et al., 2014).

3. Angiogenesis: Healing is promoted by HBOT via increased angiogenesis and oxygen availability (Cannellotto et al., 2024), which are vital for collagen synthesis, fibroblast function, and tissue repair.

4. Satellite cells: Satellite cells play a vital role in the proliferative phase of muscle rehabilitation after injury. HBOT stimulates satellite cell proliferation, leading to improved muscle fibre regeneration and strength (Horie et al., 1985; Chaillou et al., 2016; Oyaizu et al., 2018).

5. Collagen synthesis: HBOT promotes collagen production, which is essential for repairing ligaments, tendons, and cartilage (Takeyama et al., 2007; Leite et al., 2023).

Benefits of HBOT for Sports Injuries

HBOT is generally well tolerated, and serious side effects are rare (Camporesi, 2014). Patients with sports injuries may experience a range of benefits from adjunctive HBOT that can significantly improve and hasten their healing (Babul & Rhodes, 2000; Barata et al., 2011).

1. Accelerated healing: Enhanced oxygen delivery to injured tissues promotes faster recovery (Best et al., 1998).

2. Reduced swelling and pain: The anti-inflammatory effects of HBOT (Oyaizu et al., 2018) help decrease swelling and pain.

3. Improved functional outcomes: Faster healing and reduced inflammation lead to a quicker return to normal activities and sports (Botha et al., 2015).

Clinical Evidence Supporting HBOT for Sports Injuries

Numerous studies in animals show the benefits of treating sports-related injuries, including ligament (Horn et al., 199) and muscle (Best et al., 1998) injuries, and case studies and clinical trials support the use of HBOT at 2 ATA or above in the treatment of sports injuries (Babul & Rhodes, 2000; Barata et al., 2011; Kanhai & Losito, 2003).

1. Muscle soreness: In a randomised controlled trial, HBOT (100% O2, 1.3 ATA, 40 mins) decreased the pain of delayed onset muscle soreness, increased the range of motion and promoted muscle recovery (Kim et al., 2019).

2. Muscle injuries: In a prospective, randomised, double-blind control study, HBOT (100% O2, 2.5 ATA, 60 mins, 10 sessions) facilitated the early recovery of exercise-related muscular injury (Chen et al., 2019). A case series of 42 hamstring muscle injuries showed significantly faster recovery with adjunct HBOT (100% O2, 2.4 ATA, 60 mins, up to 11 daily sessions) with platelet therapy (Botha et al., 2015).

3. Sprains: Several clinical studies indicate HBOT may be beneficial in the treatment of sprains. A pilot study by Yagishita et al. (2017) showed that HBOT (100% O2, 2.5 ATA, 60 mins, max. 5 sessions) may reduce oedema and pain in athletes with an ankle sprain. Yuan et al. (2016) showed that adjunct HBOT (100% O2, 2.5 ATA, 60 mins, 5 daily sessions) for ankle sprains more effectively reduced pain compared to physiotherapy alone.

4. Ligament and tendon injuries: In a double-blinded controlled study of patients with medial collateral ligament (MCL) injury, HBOT (100% O2, 2 ATA, 60 mins, 10 sessions) led to a more rapid reduction in oedema, less muscle wasting, a greater range of motion and increased mobility (Soolsma, 1996). A case study of a professional footballer with Achilles tendonitis suggested that healing was quicker following daily sessions of HBOT at 2 ATA (James et al., 1993).

Conclusion

HBOT represents a promising adjunctive therapy for sports injuries, offering benefits in terms of faster healing, reduced inflammation, and improved functional recovery. Medical professionals should consider integrating HBOT into treatment protocols for sports injuries to promote recovery.

References

  • Babul, S., & Rhodes, E. C. (2000). The role of hyperbaric oxygen therapy in sports medicine. Sports Medicine, 30, 395-403.

  • Barata, P., Cervaens, M., Resende, R., Camacho, Ó., & Marques, F. (2011). Hyperbaric oxygen effects on sports injuries. Therapeutic Advances in Musculoskeletal Disease, 3(2), 111–121.

  • Best, T. M., Loitz-Ramage, B., Corr, D. T., & Vanderby, R. (1998). Hyperbaric oxygen in the treatment of acute muscle stretch injuries. Results in an animal model. The American Journal of Sports Medicine, 26(3), 367–372.

  • Botha, D. M., Coopoo, Y., Lynch, E., Botha, M. K., Collins, R., & Van Niekerk, R. L. (2015). The effect of hyperbaric oxygen and blood platelet injection therapy on the healing of hamstring injuries in rugby players: a case series report. African Journal for Physical Health Education, Recreation and Dance, 21(sup-1), 29–39.

  • Camporesi, E. M. (2014). Side effects of hyperbaric oxygen therapy. Undersea & Hyperbaric Medicine, 41(3), 253–257.

  • Cannellotto, M., Yasells García, A., & Landa, M. S. (2024). Hyperoxia: Effective mechanism of hyperbaric treatment at mild-pressure. International Journal of Molecular Sciences, 25(2), 777.

  • Chaillou, T., & Lanner, J. T. (2016). Regulation of myogenesis and skeletal muscle regeneration: effects of oxygen levels on satellite cell activity. FASEB, 30(12), 3929–3941.

  • Chen, C. Y., Chou, W. Y., Ko, J. Y., Lee, M. S., & Wu, R. W. (2019). Early recovery of exercise-related muscular injury by HBOT. BioMed Research International, 2019(1), 6289380.

  • Fujita, N., Ono, M., Tomioka, T., & Deie, M. (2014). Effects of hyperbaric oxygen at 1.25 atmospheres absolute with normal air on macrophage number and infiltration during rat skeletal muscle regeneration. PloS One, 9(12), e115685.

  • Horie, M., Enomoto, M., Shimoda, M., Okawa, A., Miyakawa, S., & Yagishita, K. (2014). Enhancement of satellite cell differentiation and functional recovery in injured skeletal muscle by hyperbaric oxygen treatment. Journal of Applied Physiology (Bethesda, Md.: 1985), 116(2), 149–155.

  • Horn, P. C., Webster, D. A., Amin, H. M., Mascia, M. F., Werner, F. W., & Fortino, M. D. (1999). The effect of hyperbaric oxygen on medial collateral ligament healing in a rat model. Clinical Orthopaedics and Related Research, (360), 238–242.

  • James, P. B., Scott, B., & Allen, M. W. (1993). Hyperbaric oxygen therapy in sports injuries. Physiotherapy, 79(8), 571–571.

  • Kanhai, A., & Losito, J. M. (2003). Hyperbaric oxygen therapy for lower-extremity soft-tissue sports injuries. Journal of the American Podiatric Medical Association, 93(4), 298–306.

  • Kim, D. J., Choi, W. J., & Son, K. H. (2019). Effect of hyperbaric oxygen therapy on the pain, range of motion and muscle fatigue recovery of delayed onset muscle soreness. Journal of Korean Physical Therapy Science, 26(2), 51–60.

  • Kot J, Desola J, Lind F, Mueller P, Jansen E, Burman F, Working Group WG. A European code of good practice for hyperbaric oxygen therapy – Review 2022. Diving Hyperb Med. 2023 Dec 20;53(4)(Suppl) :1-17

  • Leite, C. B., Tavares, L. P., Leite, M. S., & Demange, M. K. (2023). Revisiting the role of hyperbaric oxygen therapy in knee injuries: Potential benefits and mechanisms. Journal of Cellular Physiology, 238(3), 498–512.

  • Oyaizu, T., Enomoto, M., Yamamoto, N., Tsuji, K., Horie, M., Muneta, T., Sekiya, I., Okawa, A., & Yagishita, K. (2018). Hyperbaric oxygen reduces inflammation, oxygenates injured muscle, and regenerates skeletal muscle via macrophage and satellite cell activation. Scientific Reports, 8(1), 1288.

  • Soolsma, S. J. (1996). The effect of intermittent hyperbaric oxygen on short term recovery from grade II medial collateral ligament injuries (Doctoral dissertation, University of British Columbia).

  • Takeyama, N., Sakai, H., Ohtake, H., Mashitori, H., Tamai, K., & Saotome, K. (2007). Effects of hyperbaric oxygen on gene expressions of procollagen, matrix metalloproteinase and tissue inhibitor of metalloproteinase in injured medial collateral ligament and anterior cruciate ligament. Knee Surgery, Sports Traumatology, Arthroscopy, 15(4), 443–452.

  • Yagishita, K., Oyaizu, T., Aizawa, J., & Enomoto, M. (2017). The effects of hyperbaric oxygen therapy on reduction of edema and pain in athletes with ankle sprain in the acute phase: A pilot study. Sports and Exercise Medicine, 3(1), 10–16.

  • Yuan, Y. Y., Salim, N. S. M., Shaharudin, S., Chen, C. K., & Rahman, N. H. N. A. (2016). Comparison of the effects of hyperbaric oxygen therapy and physiotherapy on pain and isokinetic ankle strength in individuals with acute grade I ankle sprain: a case study. International Journal of Applied Sports Sciences, 28(2), 175–183.

 

Elizabeth Gaffney https://www.sourceprojects.co
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