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HBOT uses and recommendations for Sports Medicine

More than 50% of athletes suffer at least one injury each year. Traditional treatment recommendations focus in most cases on rest, rest and more rest. Recent studies show that HBOT can play an essential role in shortening recovery time by up to 70%.

In performance sports, the body is subjected to a high degree of physical stress which can cause inflammation and pain. These symptoms can affect training and sports performance, especially when sports injuries that require long recovery times can delay an athlete's readiness. For competitive athletes, every day they don't train or compete is very important.

Because of the major benefits reported for athletes but also because the therapy is permitted by all major anti-doping organisations, hyperbaric oxygen therapy (HBOT) is increasingly used and recommended in sports medicine.

How does it work?

Under conditions of 3ATA hyperbaric pressure (absolute pressure) and administration of 100% pure oxygen, blood oxygen and haemoglobin levels are increased up to 20-fold and oxygen can diffuse up to 3 times deeper into tissues than normal. Thus, hyperbaric oxygen therapy contributes significantly to oxygen diffusion in hypo-perfused tissues promoting cellular metabolism and accelerated healing.

According to a recent study involving middle-aged athletes, hyperbaric oxygen therapy (HBOT) was found to significantly improve physical performance. These improvements include increasing VO2max (a measure of the body's ability to use oxygen) and VO2AT (the point at which oxygen uptake by the body reaches plateaus during exercise). These improvements are due to an increase in the mass and function of mitochondria, which are responsible for producing energy in the body through respiration.

Hyperbaric therapy can be used effectively to improve athletic performance but also to treat various athlete-specific medical conditions, including joint, muscle, ligament and tendon injuries. Used in conjunction with physiotherapy, hyperbaric oxygen therapy has the ability to reduce the body's recovery time by about 70%.

General physiological effects of HBOT

The hyperoxic effect (exposure to high levels of oxygen) due to hyperbaric oxygen therapy can have various physiological effects on the body that are beneficial in treating certain medical conditions in sports medicine. The effects include:

  • Effects on oxidative stress: Hyperbaric oxygen therapy (HBOT) can have a beneficial effect on oxidative stress by increasing the amount of oxygen available in tissues, reducing inflammation and stimulating the release of detoxifying enzymes and antioxidant molecules, which can help neutralize free radicals and maintain a healthy redox balance in the body.
  • Vasoconstriction: Hyperbaric oxygen can reduce inflammation in the central and peripheral nervous system, which can help relax blood vessels and improve blood circulation. HBOT can also increase tissue oxygenation, which can have a beneficial effect on vasoconstriction.
  • Stimulating fibroblast activity: Fibroblasts are cells that produce collagen and other connective tissue components. They play an important role in tissue repair and healing processes. HBOT can increase oxygen levels necessary for optimal collagen synthesis, which can be beneficial during the wound healing process.
  • Angiogenesis: An important mechanism by which HBOT can stimulate the formation of new blood vessels and increase their density is by stimulating vascular endothelial growth factors during the wound healing process.
  • Neovascularisation: Hyperbaric oxygen therapy (HBOT) can help to form new blood vessels by increasing the amount of oxygen available to tissues and by stimulating growth factors such as vascular endothelial growth factor (VEGF).
  • Stem cell stimulation: HBOT can stimulate the release and differentiation of stem cells by stimulating nitric oxide synthesis. Nitric oxide is a gas that is naturally produced in the body and has vasodilatory and anti-inflammatory effects.
  • Stimulation of PMN activity: HBOT can increase the production of free radicals by the PMN, which can stimulate cellular immunity. Polymorphonuclear cell (PMN) activity is a measure of the number of polymorphonuclear leukocytes (infection-fighting white blood cells) present in the body. PMNs are involved in the body's defence against infection and other types of tissue damage through the production of free radicals and phagocytosis (the process by which white blood cells ingest and destroy bacteria and other foreign particles). Regarding the relationship between PMN activity and hyperbaric oxygen therapy (HBOT), some studies have suggested that HBOT may have a beneficial effect on PMN activity by improving blood circulation and increasing oxygen availability in tissues.

Benefits of HBOT use by athletes

Some of the most important benefits of hyperbaric oxygen therapy (HBOT) for athletes include:

  • Accelerated wound healing: HBOT can increase oxygen levels in the blood, which can promote the growth of new blood vessels and stimulate collagen production, helping to speed up the wound healing process.
  • Reduced inflammation: HBOT can help reduce inflammation in the body, which can be beneficial for athletes recovering from injuries or surgery.
  • Improved recovery time: HBOT can help athletes recover faster after strenuous exercise by speeding up the elimination of lactic acid that causes muscle fatigue.
  • Improved immune system function: HBOT can strengthen the immune system, helping to protect athletes from disease and infection.
  • Improved cardiovascular function: HBOT can improve cardiovascular function by increasing blood oxygen levels, which can help improve athletic performance.
  • Improved sleep quality: HBOT can help improve sleep quality, which can be beneficial for athletes who need to get adequate rest for optimal performance.
  • Improved mental clarity: HBOT can help improve cognitive function and concentration, which can be beneficial for athletes who need to make quick decisions under pressure.

The benefits of HBOT are becoming increasingly popular with sports doctors and rehabilitation teams, with more and more specialist doctors recommending the therapy to athletes. Footballers, basketball players and professional tennis players have had success with hyperbaric oxygen therapy for increased sports performance, injury recovery and more. But HBOT can help all types of athletes. There are also boxers, bodybuilders, swimmers, golfers, hockey players and many others. Novak Djokovic, Michael Phelps, LeBron James, Cristiano Ronaldo and Neymar are just some of the athletes who have integrated hyperbaric therapy into their recovery and performance enhancement protocol.

HBOT Safety and Efficiency

To safely benefit from the studied effects of hyperbaric oxygen therapy it is important to make sure of three things:

To find out more details about the most important scientific studies in the field of hyperbaric medicine, visit this section: Scientific references

Safety and effectiveness of HBOT

The information provided by the FDA as well as numerous studies show that when applied properly, in accredited medical centers, hyperbaric therapy can be considered one of the safest medical treatments available.

To safely benefit from the studied effects of hyperbaric oxygen therapy it is important to ensure at least three things:

  • The hyperbaric chamber is medically accredited and operated by certified personnel according to the regulations in force.
  • The pressure in the chamber can reach 3 ATA. (ATA pressure is composed of the value of the atmospheric pressure 1 bar + the value of the additional pressure in the hyperbaric chamber)
  • Oxygen inspired during therapy must have a purity greater than 99.5%. For more technical details but also for information on the different types of hyperbaric chambers, click here: Medical HBOT or mild HBOT chambers?

The European Commission of Hyperbaric Medicine also divides the conditions in which hyperbaric oxygen therapy is recommended into 3 categories:

Grade 1: Strict recommendation Grade 2: Recommended Grade 3: Optional Other indications:
  • Carbon monoxide poisoning
  • Crush syndrome, polytrauma
  • Prevention of dental osteoradionecrosis
  • Inflammation (cystitis, prostatitis)
  • Decompression accident
  • Gas embolism
  • Anaerobic bacterial or mixed infections
  • Diabetic foot injury
  • Skin grafts and musculocutaneous flap
  • Osteoradionecrosis
  • Radiotherapy-induced proctitis / enteritis
  • Radiotherapy-induced soft tissue injury
  • Aseptic necrosis of femoral head, knee, ankle
  • Sudden hearing loss
  • Ischemic ulcer
  • Chronic and refractory osteomyelitis
  • Neuroblastoma Stage IV
  • Post-anoxic encephalopathy
  • Radionecrosis of the larynx
  • Radiotherapy-Induced Central Nervous System Injury
  • Reperfusion syndrome in post-vascular procedure
  • Limb reimplantation
  • Burns > 20% of surface area and grade 2
  • Acute ischaemic ophthalmic disorders
  • Skin plaques secondary to inflammatory processes
  • Post sternotomy mediastinitis
  • Fat cell disease
  • Otitis
  • Acute myocardial infarction
  • Retinitis pigmentosa
  • Stroke
  • Multiple sclerosis
  • Fetoplacental insufficiency
  • Facial palsy (Bell's)
Grade 1: Strict recommendation
  • Carbon monoxide poisoning
  • Crush syndrome, polytrauma
  • Prevention of dental osteoradionecrosis
  • Inflammation (cystitis, prostatitis)
  • Decompression accident
  • Gas embolism
  • Anaerobic bacterial or mixed infections
Grade 2: Recommended
  • Diabetic foot injury
  • Skin grafts and musculocutaneous flap
  • Osteoradionecrosis
  • Radiotherapy-induced proctitis / enteritis
  • Radiotherapy-induced soft tissue injury
  • Aseptic necrosis of femoral head, knee, ankle
  • Sudden hearing loss
  • Ischemic ulcer
  • Chronic and refractory osteomyelitis
  • Neuroblastoma Stage IV
Grade 3: Optional
  • Post-anoxic encephalopathy
  • Radionecrosis of the larynx
  • Radiotherapy-Induced Central Nervous System Injury
  • Reperfusion syndrome in post-vascular procedure
  • Limb reimplantation
  • Burns > 20% of surface area and grade 2
  • Acute ischaemic ophthalmic disorders
  • Skin plaques secondary to inflammatory processes
Other indications:
  • Post sternotomy mediastinitis
  • Fat cell disease
  • Otitis
  • Acute myocardial infarction
  • Retinitis pigmentosa
  • Stroke
  • Multiple sclerosis
  • Fetoplacental insufficiency
  • Facial palsy (Bell's)