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Is it possible for a professional athlete suffering from a sport injury, to speed the recovery process – return in his sport activities and previous levels of performance by just inhaling Oxygen? The answer is yes – as knowledge of mechanism of action of Hyperbaric Oxygen (HBO) depicts (pure Oxygen inhalation while at increased environmental pressure) and is recommended by specialists.


However, the same condition concerns the average person involved in recreational sport activities. In this scenario, a person decides to start exercising again after long times of abstention from regular practice, usually by taking part in team sports (football, basketball, etc). Suboptimal preparation of the musculoskeletal system resulting in insufficient endurance to (what once was) regular activities, plays its role here, as opposed to the professional athlete’s intensive training that leads to the same result. Both have the same need: Fast and optimal recovery – return to every day activities

The group of injuries entitled “sport injuries” is not an entirely new entity, and it is not uncommon. It includes all kinds of trauma resulting from sport activities, ranging from muscle strain and joint sprain to wound and bone fracture – injuries commonly seen by Orthopaedics. They can result from acute trauma, or from overuse of a particular body part leading to repetitive stress injury, as usually seen in professional athletes. As a result, it includes diseases that are not completely understood, do not have universally adopted management algorithms, and they are not usually treated surgically. Bone oedema, stress fracture and periostitis are some of these. In these conditions, with no obvious previous injury, a vicious circle occurs: symptoms stop the athlete from training – leading to relief – leading to return in training – leading to reappearance of symptoms etc. Similar conditions occur during periods of systematic intensive training (other than athletes), concerning Special Forces candidates and trainees, as we have repeatedly seen.

Has HBO been used to treat these conditions? Of course – Some UK Football Clubs have been using hyperbaric oxygen therapy for years, in selective cases, to speed recovery of their injured players. A study concerning professional soccer players in Scotland, suggested 55% reduction in days lost to injury, when hyperbaric oxygen was added to routine therapy. Another study conducted at Temple University, suggested that HBO treated patients returned to regular activities 30% faster than controls, after ankle sprain.

Neil Hodgson, Superbike world champion, had hyperbaric oxygen therapy after surgical repair for avascular necrosis of the scaphoid (a bone of the wrist). The number of athletes treated with HBO is increasing during the last decade, as is the need for optimal and quick recovery after an injury e.g. surgical repair of the anterior cruciate ligament. Management of such conditions in cooperation with Sports Medicine professionals (mainly Orthopaedics) gives excellent results. This is not surprising, considering that oedema and hypoxia of the injured tissues are common causes of complications that delay healing. Moreover, if infection develops at the injured site, recovery is complicated and prolonged.

In what ways does HBO contribute to the optimal management of Sport Injuries? As the ambient pressure increases and pure oxygen is inspired during HBO Therapy, things change dramatically. Inhalation of 100% Oxygen at usually prescribed pressures in a hyperbaric chamber, multiplies the amount of Oxygen carried by the blood, reaching levels that can not be achieved in normal pressure conditions. This results in increase of oxygen levels at the injury site. Furthermore, it causes vasoconstriction leading to reduced blood supply to the tissues and subsequent oedema (swelling) reduction. The combination of reduced blood supply and increased tissue oxygenation due to increased oxygen content, named “Oxygen Paradox”, is a unique property of Hyperbaric Oxygen Therapy. Besides breaking the vicious circle of inflammation – oedema – hypoxia, HBO shifts local metabolic status to aerobic (using oxygen) thus, preventing tissues from shortage of energy deposits that are necessary for uninterrupted restoration of the injured site.

Besides hyperoxia (10 times or more the normal levels of oxygen) and oedema reduction, HBO has bactericidal and bacteriostatic effects and acts synergistically with antibiotics against bacteria. HBO promotes neovascularization, osteoclast activity, collagen formation and fibroblast proliferation. These actions of HBO are very useful for the treatment of all Orthopaedic conditions where HBO is indicated. (hyperlink to Orthopaedic & HBO) These conditions are Crush Injury, Compartment Syndrome, Osteomyelitis (refractory) and delayed or non union of fractured bones (pseudarthrosis). Cases of Acute Traumatic Ischemias and Enhancement of Healing in Selected Problem Wounds may result from sport injuries as well, although rarely. HBO has significant action against Reperfusion Injury resulting in attenuation of injury from free radicals and oxidative stress. Besides these, recent trials show benefit of HBO in preconditioning.

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Conclusively, HBO Therapy is a useful tool for the successful management of Sport Injuries, aiming to:

• Reduce the time to recovery for non-surgically treated injuries • Faster – optimal recovery post surgery.. • Interrupt the vicious circle of inflammation – oedema – hypoxia in the management of chronic conditions

• Accelerate return to every day activities, especially when combined with other indicated regimen (eg physiotherapy)

• HBOT has a place in the physical preparation with progressively intensive training – stress, especially after long times of abstention from regular training, as it preserves the body energy deposits and protects from micro-injuries.

Vasileios N. Kalentzos MD, MPH