Hyperbaric Oxygen Therapy in Sports Injuries
Dr. Tommy Love and Dr. Xavier Figueroa
“The financial and economic impact of injuries in the United States is serious. However, by expanding our science-based injury prevention programs, we can drastically reduce these costs and even more importantly help people live longer and healthier lives.” CDC Director, Dr. Julie Gerberding
In the United States, approximately 30 million children and 45 million adults are involved in sports. Roughly 3.5 million children and 5.5 million adults suffer from sports related injuries. The most common types of sport-related injuries in children and adults are sprains (mostly ankle), muscle strains, bone or growth plate injuries (in children), repetitive motion injuries, and heat-related illness (1).
Although death from a sports injury is rare, the leading cause of death from a sports-related injury is a brain injury. Approximately 2 out of 5 traumatic brain injuries among children are associated with participation in sports and recreational activities. In the United States a total of ~300,000 hospital admissions (2) for sports concussion injuries are recorded, and the number is expected to increase.
Although concussions and brain injuries are life altering injuries, non-brain injuries, such as cartilage, tendon, ligament and bone injuries can hamper mobility and the ability to make a living. For high performing amateur, junior and professional athletes sport injuries can side-line careers and activities. Recovery from injuries can take months with traditional therapies. In cases were surgery is required, a slow and steady physical rehabilitation regime is always recommended, but not always followed by patients eager to return to pre-injury activity levels. Re-injuries are common because the original injury take so long to heal.
In order to increase the odds of a successful recovery from injury, the sport medicine and hyperbaric community have been employing hyperbaric oxygen therapy to help accelerate healing and reduce the time to recovery. In many cases of sport injury, surgery is often required. Given that healing after surgery is the longest part of the procedure, treatments that can speed up the healing process are of great interest to patients and doctors. The advantages of HBOT are the known benefits in reducing swelling (3-7), decreasing inflammation (8-10), improving collagen deposition in the skin (11-15), increasing the growth of new blood vessels (16), increasing the number of stem cells
in circulation associated with skin repair (17-19) and limiting the damage of reperfusion injury (20). HBOT is a safe and fast acting therapy, with few risks and side effects to patients. By stimulating the body to heal, time to recovery can be substantially reduced.
HBOT: Pre- and Post-surgery treatment
Athletic injuries occur more regularly than most people would like and must be treated. HBOT treatment prior to surgery can improve surgical outcomes and decrease recovery time (3, 4), especially after cardiac surgery (21, 22). In animal models of anterior cruciate ligament (ACL) reconstruction, HBOT can improve outcomes (23) and the positive effects of HBOT have been observed in clinical case studies for over two decades. Pre-treatment can prepare the wound site by reducing inflammation, increasing anti-apoptosis protein expression in cells (24-30) and reducing swelling/edema (31-35). These benefits are carried forward after surgery and by repeated treatment with HBOT. In cases were the surgery compromises or partially blocks the blood supply of the surgical site, HBOT can decrease the amount of reperfusion injury and spare compromised tissue.
These benefits are significant in tissues that have a relative poor blood supply, even in the best of athletes. Tissues like cartilage, ligaments and tendons are not well supported by a robust vascular bed, thus limiting recovery rates. HBOT can stimulate angiogenesis and provide a sufficient amount of oxygen to support the cartilage, ligament or tendon as they heal. Bone repair and bone grafting are greatly enhanced using HBOT (36-38) , thus enhancing a rapid repair of the fracture or bone stress.
1. Control NCfIPa (2006) CDC Injury Fact Book. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.
2. Thurman DJ, Branche CM, & Sniezek JE (1998) The epidemiology of sports-related traumatic brain injuries in the United States: recent developments. (Translated from eng) J Head Trauma Rehabil 13(2):1-8 (in eng).
3. Jadhav V, et al. (2010) Hyperbaric oxygen preconditioning reduces postoperative brain edema and improves neurological outcomes after surgical brain injury. (Translated from eng) Acta Neurochir Suppl 106:217-220 (in eng).
4. Qin Z, et al. (2007) Preconditioning with hyperbaric oxygen attenuates brain edema after experimental intracerebral hemorrhage. (Translated from eng) Neurosurg Focus 22(5):E13 (in eng).
5. Babul S, Rhodes EC, Taunton JE, & Lepawsky M (2003) Effects of intermittent exposure to hyperbaric oxygen for the treatment of an acute soft tissue injury. (Translated from eng) Clin J Sport Med 13(3):138-147 (in eng).
6. Iazzetti PE & Maciel RE (1988) Effects of hyperbaric oxygen on the rat neurogenic pulmonary edema. (Translated from eng) Braz J Med Biol Res 21(1):153-156 (in eng).
7. Nylander G (1986) Tissue ischemia and hyperbaric oxygen treatment: an experimental study. (Translated from eng) Acta Chir Scand Suppl 533:1-109 (in eng).
8. Kidd PM (2009) Integrated brain restoration after ischemic stroke–medical management, risk factors, nutrients, and other interventions for managing inflammation and enhancing brain plasticity. (Translated from eng) Altern Med Rev 14(1):14-35 (in eng).
9. Wilson HD, Wilson JR, & Fuchs PN (2006) Hyperbaric oxygen treatment decreases inflammation and mechanical hypersensitivity in an animal model of inflammatory pain. (Translated from English) Brain Research 1098:126-128 (in English).
10. Vlodavsky E, Palzur E, & Soustiel JF (2006) Hyperbaric oxygen therapy reduces neuroinflammation and expression of matrix metalloproteinase-9 in the rat model of traumatic brain injury. (Translated from eng) Neuropathol Appl Neurobiol 32(1):40-50 (in eng).
11. Yuan LJ, et al. (2009) Additive effects of hyperbaric oxygen and platelet-derived growth factor-BB in chondrocyte transplantation via up-regulation expression of platelet-derived growth factor-beta receptor. (Translated from eng) J Orthop Res 27(11):1439-1446 (in eng).
12. Wattel F & Mathieu D (2005) [Oxygen and wound healing]. (Translated from fre) Bull Acad Natl Med 189(5):853-864; discussion 864-855 (in fre).
13. Niinikoski JH (2004) Clinical hyperbaric oxygen therapy, wound perfusion, and transcutaneous oximetry. (Translated from eng) World J Surg 28(3):307-311 (in eng).
14. Sheikh AY, et al. (2000) Effect of hyperoxia on vascular endothelial growth factor levels in a wound model. (Translated from English) Arch Surg-Chicago 135(11):1293-1297 (in English).
15. Williams RL & Armstrong DG (1998) Wound healing. New modalities for a new millennium. (Translated from eng) Clin Podiatr Med Surg 15(1):117-128 (in eng).
16. Velazquez OC (2007) Angiogenesis and vasculogenesis: inducing the growth of new blood vessels and wound healing by stimulation of bone marrow-derived progenitor cell mobilization and homing. (Translated from eng) J Vasc Surg 45 Suppl A:A39-47 (in eng).
17. Milovanova TN, et al. (2009) Hyperbaric oxygen stimulates vasculogenic stem cell growth and differentiation in vivo. (Translated from eng) J Appl Physiol 106(2):711-728 (in eng).
18. Yang YJ, et al. (2008) Hyperbaric oxygen induces endogenous neural stem cells to proliferate and differentiate in hypoxic-ischemic brain damage in neonatal rats. (Translated from eng) Undersea Hyperb Med 35(2):113-129 (in eng).
19. Liu ZJ & Velazquez OC (2008) Hyperoxia, endothelial progenitor cell mobilization, and diabetic wound healing. (Translated from eng) Antioxid Redox Signal 10(11):1869-1882 (in eng).
20. Al-Waili NS, Butler GJ, Petrillo RL, Carrey Z, & Hamilton RW (2006) Hyperbaric oxygen and lymphoid system function: a review supporting possible intervention in tissue transplantation. (Translated from eng) Technol Health Care 14(6):489-498 (in eng).
21. Yogaratnam JZ, et al. (2010) Hyperbaric oxygen preconditioning improves myocardial function, reduces length of intensive care stay, and limits complications post coronary artery bypass graft surgery. (Translated from eng) Cardiovasc Revasc Med 11(1):8-19 (in eng).
22. Ellestad MH (2009) Hyperbaric oxygen: its application in cardiology: a historical perspective and personal journey. (Translated from eng) Cardiol Rev 17(6):280-282 (in eng).
23. Yeh WL, et al. (2007) Effects of hyperbaric oxygen treatment on tendon graft and tendon-bone integration in bone tunnel: biochemical and histological analysis in rabbits. (Translated from eng) J Orthop Res 25(5):636-645 (in eng).
24. Palzur E, Zaaroor M, Vlodavsky E, Milman F, & Soustiel JF (2008) Neuroprotective effect of hyperbaric oxygen therapy in brain injury is mediated by preservation of mitochondrial membrane properties. (Translated from eng) Brain Res 1221:126-133 (in eng).
25. Liu Z, Jiao QF, You C, Che YJ, & Su FZ (2006) Effect of hyperbaric oxygen on cytochrome C, Bcl-2 and Bax expression after experimental traumatic brain injury in rats. (Translated from eng) Chin J Traumatol 9(3):168-174 (in eng).
26. Patel V, et al. (2005) Oxygen: from the benefits of inducing VEGF expression to managing the risk of hyperbaric stress. (Translated from eng) Antioxid Redox Signal 7(9-10):1377-1387 (in eng).
27. Vlodavsky E, Palzur E, Feinsod M, & Soustiel JF (2005) Evaluation of the apoptosis-related proteins of the BCL-2 family in the traumatic penumbra area of the rat model of cerebral contusion, treated by hyperbaric oxygen therapy: a quantitative immunohistochemical study. (Translated from eng) Acta Neuropathol 110(2):120-126 (in eng).
28. Yuan LJ, et al. (2004) Attenuation of apoptosis and enhancement of proteoglycan synthesis in rabbit cartilage defects by hyperbaric oxygen treatment are related to the suppression of nitric oxide production. (Translated from eng) J Orthop Res 22(5):1126-1134 (in eng).
29. Shinkai M, Shinomiya N, Kanoh S, Motoyoshi K, & Kobayashi H (2004) Oxygen stress effects on proliferation rates and heat shock proteins in lymphocytes. (Translated from eng) Aviat Space Environ Med 75(2):109-113 (in eng).
30. Wada K, et al. (2000) Mn-SOD and Bcl-2 expression after repeated hyperbaric oxygenation. (Translated from eng) Acta Neurochir Suppl 76:285-290 (in eng).
31. Neubauer RA (1981) Hyperbaric oxygen treatment and stroke. (Translated from eng) JAMA 246(22):2574 (in eng).
32. Pearson RR & Goad RF (1982) Delayed cerebral edema complicating cerebral arterial gas embolism: case histories. (Translated from eng) Undersea Biomed Res 9(4):283-296 (in eng).
33. Skyhar MJ, et al. (1986) Hyperbaric oxygen reduces edema and necrosis of skeletal muscle in compartment syndromes associated with hemorrhagic hypotension. (Translated from eng) J Bone Joint Surg Am 68(8):1218-1224 (in eng).
34. Borromeo CN, Ryan JL, Marchetto PA, Peterson R, & Bove AA (1997) Hyperbaric oxygen therapy for acute ankle sprains. (Translated from eng) Am J Sports Med 25(5):619-625 (in eng).
35. Veltkamp R, et al. (2005) Hyperbaric oxygen reduces blood-brain barrier damage and edema after transient focal cerebral ischemia. (Translated from eng) Stroke 36(8):1679-1683 (in eng).
36. Ueng SW, et al. (1998) Bone healing of tibial lengthening is enhanced by hyperbaric oxygen therapy: a study of bone mineral density and torsional strength on rabbits. (Translated from eng) J Trauma 44(4):676-681 (in eng).
37. Porcellini M, Bernardo B, Capasso R, Bauleo A, & Baldassarre M (1997) Combined vascular injuries and limb fractures. (Translated from eng) Minerva Cardioangiol 45(4):131-138 (in eng).
38. Sawai T, Niimi A, Takahashi H, & Ueda M (1996) Histologic study of the effect of hyperbaric oxygen therapy on autogenous free bone grafts. (Translated from eng) J Oral Maxillofac Surg 54(8):975-981 (in eng).
39. Goldstein LJ, et al. (2006) Endothelial progenitor cell release into circulation is triggered by hyperoxia-induced increases in bone marrow nitric oxide. (Translated from eng) Stem Cells 24(10):2309-2318 (in eng).
40. Thom SR, et al. (2006) Stem cell mobilization by hyperbaric oxygen. (Translated from eng) Am J Physiol Heart Circ Physiol 290(4):H1378-1386 (in eng).
Excerpt from: www.restorixfoundation.org/Media/Documents/Hyperbaric%20Oxygen%20Therapy%20in%20Sports%20Injuries.pdf
Athletes who use HBT: (Videos)
The benefits of hyperbaric therapy have made a growing impact on the performance of many professional athletes. Below are a list of some of those atheletes known to use hyperbaric chambers as a normal part of their training routine.
- Brian Jordan, Atlanta Braves
- John Smoltz, Atlanta Braves
- Paul Byrd, Boston Red Sox
- J.D. Drew, Boston Red Sox
- Ryan Braun, Milwaukee Brewers
- Carlos Gomez, Milwaukee Brewers
- Shaun Marcum, Milwaukee Brewers
- Derek Jeter, New York Yankees
- Jimmy Rollins, Philadelphia Phillies
- Ryan Klesco, San Diego Padres
- Lance Armstrong, Tour De France Winner
- Michael Freiberg, Fly V Austria
- Evander Holyfield
- Sergio Martinez
- Garnet Exelby, Atlanta Thrashers
- Ian Lapierre, Philadelphia Flyers
- Mario Lemieux, Pittsburgh Penguins
- Yannick Tremblay, Former Atlanta Thrasher
- Tiger Woods
- Scot Mendelson, World's Strongest Man
- John Sipple, Palmer Chiropractic
- Charlie Ward, Houston Rockets, '93 Heisman Trophy Winner
- Nick Anderson, Memphis Grizzlies
- Kendall Gill, Milwaukee Bucks
- Tyreke Evans, Sacramento Kings
- Sitapha Savane', CB Gran Canaria (Spain)
- Roc Shabazz, Professional Bodybuilder
- Tammy Leady, Women's Ftiness Pro
- Eric Beverly, Atlanta Falcons
- Keion Carpenter, Atlanta Falcons
- Ed Hartwell, Atlanta Falcons
- Michael Vick, Atlanta Falcons
- Todd Weiner, Atlanta Falcons
- Bryan Scott, Buffalo Bills
- Jon Corto, Buffalo Bills
- Andra Davis, Buffalo Bills
- Drayton Florence, Buffalo Bills
- Paul Poslusny, Buffalo Bills
- Dan Morgan, Carolina Panthers
- Bryan Robinson, Cincinnati Bengals
- Kenny Watson, Cincinnati Bengals
- Madieu Williams, Cincinnati Bengals
- Kenyon Coleman, Cleveland Browns
- Montario Hardesty, Cleveland Browns
- Reggie Hodges, Cleveland Browns
- Mohamed Massaquoi, Cleveland Browns
- Benjamin Watson, Cleveland Browns
- Kevin Burnett, Dallas Cowboys
- Terrell Owens, Dallas Cowboys
- Tim Tebow, Denver Broncos
- Kalimba Edwards, Detroit Lions
- Brian Cushing, Houston Texans
- Dwight Freeney, Indianapolis Colts
- Maurice Jones-Drew, Jacksonville Jaguars
- Dexter McCleon, Kansas City Chiefs
- Zach Thomas, Kansas City Chiefs
- Marques Colston, New Orleans Saints
- Michael Boley, New York Giants
- Plaxico Burress, New York Giants
- Jonathan Goff, New York Giants
- Hakeem Nicks, New York Giants
- Jeremy Shockey, New York Giants
- Justin Tuck, New York Giants
- Steve Weatherford, New York Giants
- Gibril Wilson, New York Giants
- Nick Folk, New York Jets
- Santonio Holmes, New York Jets
- Bill Flowers, Ole Miss
- Brian Westbrook, Philadelphia Eagles
- Hines Ward, Pittsburg Steelers
- Verron Hayes, Pittsburgh Steelers
- Craig Davis, San Diego Chargers
- Travis Hall, San Francisco 49ers
- Tony Parrish, San Francisco 49ers
- Jamie Winborn, San Francisco 49ers
- Russell Okung, Seattle Seahawks
- Patrick Kerney, Seattle Seahawks
- Jerome Pathon, Seattle Seahawks
- Donnie Avery, St. Louis Rams
- Jimmy Farris, Washington Redskins
- Rod Gardner, Washington Redskins
- DeAngelo Hall, Washington Redskins
- Santana Moss, Washington Redskins
- Shawn Springs, Washington Redskins
- Gilbert Arenas, Washington Wizards
- Derrick Tinsley, University of Tennessee
- Karon Riley, Former Atlanta Falcon
- Jimmy Brumbaugh, Former GA Force player
- Michael Lawson, Former GA Force player
- Trace Armstrong, Former NFL Player
- Zach Thomas, Former NFL Player
- Bill Romanowski, Former NFL Player
Mixed Martial Arts
- Thiago "Pitbull" Alves
- Vitor Belfort
- Urijah Faber
- John Howard
- Sean Loeffler
- Cody Williams
Off-Road Motorcycle Racing
- Ben Grabham, Motorex KTM (Australia
- Paul (P-Rod) Rodriguez, Jr.
- Sharon Seagrave, Olympic Runner
- Karen Shinkins, Olympic Runner