Professional sports men and women are constantly pushing their bodies further to achieve the edge over their opponents. As the physical demands of training and competition continue to increase, so do the number of injuries that individuals are suffering. Hyperbaric Oxygen as an adjunct to physiotherapy in the healing process still remains underused amongst sports professionals.
It is important initially, to understand the basic principles of Hyperbarics. At atmospheric pressure there is about 21% of oxygen in the air. By breathing 100% oxygen through an oro-nasal mask provides that person with five times their normal intake of oxygen. In a hyperbaric chamber, where the pressure may be increased to between 2 and 3 times atmospheric pressure, the dosage will be further increased to 10 to 15 times normal oxygen intake. At atmospheric pressure, oxygen is normally inhaled and mainly picked up by the haemoglobin in the blood for distribution around the body. An oxygen pulsometer, often placed on the finger tip when undergoing medical examination will show the percentage of oxygen saturation of the haemoglobin at the extremities and normally reads in a healthy person at above 96%. If the reading is lower, then oxygen is provided to the patient through a mask. That is just the beginning of the story – at atmospheric pressure.
When however, the body is subjected to higher pressures, not only the haemoglobin, but all the plasma in the blood, have an increased capacity to take in oxygen. It is not only the blood, however that benefits, but all the soft tissues around the body, the spinal fluids, the fluids in the brain, the muscles. tendons, ligaments etc. With oxygen being the healing agent in the body, higher amounts of oxygen lead to better penetration into the tissues of the body and therefore faster healing.
Now that one understands more about the effect of hyperbaric oxygen on the body, how does it help?
Hyperbaric Oxygen Therapy (HBOT) has several effects on the body that improve the faster healing of sports injuries. The counteraction of Vasoconstriction (which is the constriction of blood vessels), HBOT through oxygen enrichment results in decreased inflammation without hypoxia, a mechanism by which hyperbaric oxygen is believed to improve crush injuries, thermal burns, and compartment syndrome. (1, 2)
HBOT also promotes the development of new blood cells and epithelial cells, which work more effectively in a high-oxygen environment (3). These effects (Neovascularisation & Epithelialisation) have proven effective in treating tissue ulcers and skin grafts (4).
Collagen deposition, wound strength, and the rate of wound healing are affected by the amount of available oxygen. HBOT increases tissue levels of oxygen, allowing for fibroblasts and osteoclasts to function appropriately (3, 5).
HBOT can also improve Immune response and resistance to infection. When oxygen tensions fall to very low levels, host responses to infection and ischemia are compromised (6). Studies have shown that the local tissue resistance to infection is directly related to the level of oxygen found in the tissue (6, 7).
It is thought that maintaining high-energy phosphate bonds can also aid by helping to prevent tissue damage by decreasing the tissue lactic acid level and helping maintain levels of adenosine tri-phosphate (ATP).
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Which Sports Injuries are treated using HBOT?
HBOT is already used widely in many countries for treating crush Injuries and wound healing, especially those suffering from diabetes. As HBOT reduces swelling, many sports men and women have reported a reduction in recovery time from many injuries including bone, joint, muscle, ligament, tendon and other tissue injuries. In Scotland, when HBOT was used in conjunction with physiotherapy, the time to recovery was reduced by 70% (8), however the absence of a control group and objective measures to assess the injury weaken the encouraging findings of the study. Boromeo et al. conducted a randomised double-blind study of 32 patients who had acute ankle sprains to compare HBOT treatment at 2ATA, with a placebo treatment, finding an improvement in joint function was greater in the HBOT group compared to the placebo group.
Hyperbaric Oxygen Therapy.. A Competitive Advantage?
Although treatment for Sports injuries is still relatively rare, some sports clubs, such as Glasgow Celtic FC in Scotland have been treating sports injuries since 1991. Other Football Clubs such as Manchester United have their own Hyperbaric Chamber and several London based Football clubs use Multiplace chamber facilities based in London. As a result of regular treatments, staff have reported rapidly reduced healing times. This includes Manchester United and England International, Wayne Rooney, who used hyperbarics after breaking a metatarsal shortly before the 2006 World Cup. He was back in training just six weeks after getting injured. Tiger Woods, David Beckham and Lance Armstrong have also used hyperbarics to accelerate healing.
Other high profile sportsmen have been treated using the SOS Hyperlite Portable Hyperbaric Chamber, showing a significantly reduced healing time. The major advantages of the Hyperlite are that it is lightweight, portable and capable of full hyperbaric oxygen therapy. Several American Football players have purchased mild hyperbaric chambers to treat themselves in their own homes and have reported positive results. Some of those chambers are air filled and pressurise to a maximum of 1.3 ATA. Although they may benefit the user marginally, they would only receive a 1/3 increased oxygen intake, compared to up to 15 times the increase in a Hyperlite or other medically approved treatment chamber.
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References :
1. Clark JM, Lambertsen CJ: Alveolar-arterial O2 differences in man at 0.2, 1.0, 2.0 and 3.5 Ata inspired PO2. J Appl Physiol 1971; 30 (5): 753-763
2. Boerema I, Meyne NG, Brummelkamp WK, et al: Life without blood: a study of the influence of high atmospheric pressure and hypothermia on dilution of the blood. J Cardiovasc Surg 1960; 1: 161-164
3. Bird AD, Telfer AM: Effect of hyperbaric oxygen on limb circulation. Lancet 1965; 13 (1): 355-356
4. Bouachour G, Cronier P, Gouello JP, et al: Hyperbaric Oxygen Therapy in the management of crush injuries: a randomized double-blind placebo controlled clinical trial. J Trauma 1996; 41 (2): 333-339
5. Davis JC, Hunt TK (eds): Problem Wounds: The Role of Oxygen, New York City, Elsevier, 1988, pp 5- 30
6. Hammarlund C: The physiologic effects of hyperbaric oxygenation, in Whelan HT, Kindwall EP (eds): Hyperbaric Medicine Practice, ed 2. Flagstaff, Arizona, Best Pub Co, 1995, pp 16-31
7. Jonsson K, Jensen JA, Goodson WH III, et al: Tissue oxygenation, anemia, and perfusion in relation to wound healing in surgical patients. Ann Surg 1991; 214(5): 605-613
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