Hyperbaric Oxygen Therapy & Athletics

Hyperbaric Oxygen has been studied in Sports Injury & Recovery

Background: 

As the intensity of competitive sports increases, as have the incidence of injuries to the athletes. Injuries of course are on a continuum:  ranging from broken bones to disrupted muscles, tendons and ligaments, in addition to brain injury. 

There is certainly a need to discover the fastest treatments that will allow an injured athlete to return to competition faster than the normal course of rehabilitation, or natural course of injury without the use of chemical or hormonal interventions. 

The main effect of Hyperbaric Oxygen Therapy is "hyperoxia," that is, oxygen is dissolved physically in the blood plasma. For instance, breathing pure oxygen under Hyperbaric conditions at 2.0 ATA, the oxygen content in plasma is 10 times higher than when breathing air at sea level (Therapeutic Hyperbaric Pressures are often between 1.5 ATA and 2.5 ATA versus sea level at 1.0 ATA). 

With regards to sports injury, under Hyperbaric conditions, Oxygen tensions in muscle tissue remains elevated for 1-2 hours post Hyperbaric exposure and remain elevated for up to 4 hours post exposure in subcutaneous tissues. Furthermore,  reduction of edema, an anti-inflammatory effect, neovascularization (new blood vessel formation), osteoneogenesis (bone formation) as well as stimulation of collagen production by fibroblasts and stem cell release are well known Hyperbaric effects that are applicable to sports injury. 

Human Data

Fatigue:

Ishii et al (2005) reported that the use of Hyperbaric Therapy for muscular fatigue in athletes during the Nagano Olympics. Seven Olympic athletes received Hyperbaric Oxygen treatment for 30–40 minutes at 1.3 ATA with an average of 2 treatments and a maximum of six per athlete. It was found that all seven athletes benefited from Hyperbaric treatment with faster recovery rates. 

Similarly, Fischer et al.(1988) found HBO treatment between tennis games, leads to quicker recovery from fatigue, and prepares the player for the next game (presumably through removing ammonia from the blood).

Injury: 

A study from 1993 by James looked at 20 soccer players with injury and their original estimated recovery time using 2.0 ATA Hyperbaric treatment. The average "saving in injury time" was 70%.

Three case reports from James (1993): 

Patient 1: Acute Achilles tendonitis that was expected to take four days to resolve. A single session of hyperbaric oxygen therapy allowed him to resume full training after one day.

Patient 2: Ankle sprain that was estimated to take three weeks to heal. After two HBOT sessions he was able to resume training in 4 days.

Patient 3: Strained hamstring with significant local tenderness. He was thought to have to recooperate for at least one week but he resumed training on the third day after Hyperbaric treatment. 

Ishii et al (1999) looked at 22 athletes with various injuries including seven leg joint sprains, four knee ligament damages, four partial muscle ruptures, three peripheral nerve injuries, two fractures and two categorized as "other injuries." Hyperbaric treatment was set between 1.3 and 2.0 ATA, with dives from 30 to 90 minutes. More than 70% of the patients experienced improvement. 

HBOT in Athletes (Ishii 1999)

Joint Injury:

In Soolsma (1996) the effect of Hyperbaric Oxygen was studied on the recovery of a grade II medial collateral ligament within 3 days of injury.

After one group was exposed to Hyperbaric Oxygen at 2.0 ATA for 1 hour and the control group at 1.2 ATA, of Hyperbaric air for 10 sessions. 

At 6 weeks, HBOT group had improve pain and functional outcomes, such as decreased edema, better range of motion and maximum flexion. 

A 2019 study, by Yagishita looked at 32 rugby players (professional or semi-professional) with grade 2 MCL injury as well. The time to return to play was 31 days in the Hyperbaric group and 42.days in the non-Hyperbaric group. 

A 1995 a study suggested that ankle sprain patients treated with Hyperbaric Oxygen Therapy improved approximately 30% faster than a control group (Staples 1996)

Hyperbaric Oxygen for Sports injury

Sports & Brain Injury

A lack of appropriate treatment for traumatic brain injury (TBI) and chronic traumatic encephalopathy (CTE) exists within contact sports such as boxing and football. It is speculated that idling neurons in the penumbra zone remain viable several years after injury and might be reactivated by enhanced oxygenation. 

Two case reports on sports related TBI/CTE were published in 2011 by Stoller. 

A retired NFL player, at the time, in his early 50's with numerous concussions in his career and a history of numerous brain surgeries was studied. He was treated at 1.5 ATA for 40 treatments at 60 minutes per treatment.

Marked improvements were seen in processing speed, cognitive function, memory and reasoning. 

A 15 year old high school football player that had two concussions two weeks apart who lost his ability to read and suffered from post concussive migraines was treated with the identical protocol.  

After 40 Hyperbaric treatment sessions he is almost matching High school mean scores, his visual motor speed improved 35% , reaction time 25%, as well as an 80% reduction in frequency and severity of headaches and a complete resolution of nausea.

Naturopathic Sports Medicine:

Various nutrients (Vitamins, Minerals and Amino acids) are initimately involved in the healing process so it's easy to understand that the Naturopath approach to sports injury looks to have a strong nutritional foundation. 

Vitamin C improves tissue integrity, and plays a key role in wound healing by promoting collagen synthesis, and enhances immune function. Zinc also plays a role in wound healing (through its effects on nucleic acid and protein synthesis) and also enhances immune function. Vitamin A appears to increasing collagen production and cross-linking and of course is involved in immune function as well. It's common for our Naturopathic Doctors to use Vitamin C, A and Zinc in injured patients. 

Similarly, iron, B5 and B6 play a role in collagen formation and Vitamin B12 participates in protein synthesis so it's common to check for iron adequacy and use a multi-vitamin for injury. 

Fish oil, Curcumin, Vitamin D, Magnesium, Zinc and Vitamin E are considered in atheletes with brain injury as these have data supporting their use in TBI.

Intravenous (IV Therapy) Interventions can be used to enhance levels of Vitamin C, Zinc, Copper, all the B Vitamins as well as key amino acids (Proline and Lysine in particular) for enhancing tissue repair. IV Therapy for sports injuries is usually suggested at a 1-2x weekly frequency and is supported by oral supplementation of similar nutrients in addition to sufficient protein intake and rest. 

Proteolytic enzymes are a mainstay of acute Naturopathic sports tissue injury treatment as numerous trials have demonstrated that oral administration decreases the amount of edema and pain associated with soft-tissue injuries and accelerated recovery. 

Proteolytic enzymes may work by enhancing the degradation of fibrin deposits, thereby improving drainage, and allowing more oxygen and nutrients to reach the injury site so it's fairly easy to see how these would be synergistic with Hyperbaric Oxygen. 

For example, seventy-four boxers with bruises of the face (eyes, lips, ears) as well as chest, and arms were given bromelain. Seventy-two other boxers were given placebo. All signs of bruising disappeared within 4 days in 78% of the boxers receiving bromelain and in 14% of those given placebo

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