Hyperbaric Oxygen Therapy in Athletes: Optimization, Recovery, and More

As training intensity for competitive sports has increased over the past decade, so too has the incidence of injury in athletes, including broken bones and strains or tears to muscles, tendons, and ligaments. As a result of this, numerous protocols aimed at optimizing diet, training and conditioning strategies, and intensity levels have been proposed as methods to reduce injury in athletes while maintaining a high level of performance. However, these protocols aren’t perfect and they require variation depending on the athlete’s goals.

Aside from these factors to elevate performance and mitigate injury, biotechnologies have surfaced as rehabilitation or preventative method for athletes – the goal of these being to enhance recovery time, prevent injury, or lessen the risk for re-injury.

Perhaps the most studied of these over the past 30 years is hyperbaric oxygen therapy (HBOT), a therapy that has seen a substantial influx of scientific research recently, suggesting it may be beneficial for athletes1.

What is Hyperbaric Oxygen Therapy, and how does it work?

HBOT is the therapeutic administration of pure, 100% oxygen at pressures higher than the normal atmospheric pressure our bodies are exposed to on a daily basis. Specifically, the therapy involves placing the patient or athlete in a pressurized chamber for 60-120 minutes at pressures 50-100% higher than normal. While in the chamber, the athlete breathes in the pure oxygen directly through a mask.

Breathing in this pure oxygen at higher-than-normal pressures elevates the amount of oxygen in our blood. This oxygen is then dissolved into the plasma and transported into tissues in concentrations much higher than normal. Studies since the 1990s have discovered under some circumstances, HBOT can increase tissue oxygen levels as much as 10-fold2.

What does increased tissue oxygenation actually do?

First and foremost, many of our body’s cell and tissue functions are entirely dependent on oxygen. This includes our immune system and ability to fight off infection, cell replication, and overall homeostasis2. A study from 2008 even found that Hyperbaric Oxygen Therapy can improve the activity of leukocytes, or immune cells, to decrease tissue damage and enhance circulation3.

Secondly, hyperoxygenation of our tissues increases collagen deposits wherever they are required – this includes areas where tissue is heavily damaged to due injury or difficult, strenuous training. The upsurge in collagen allows for the growth of new capillary beds, setting the framework for improved blood flow throughout the body. Research has found that 2 hours of HBOT significantly enhances collagen deposition into tissues4.

The influx of oxygen in HBOT also speeds up the process of wound healing, which is the central reason why it has been proposed as a therapy to athletes for recovery from injury or high training volume.

While not entirely understood, Hyperbaric Oxygen Therapy enhances this wound healing process in two ways:

    1. Angiogenesis, or the formation of new blood vessels

      While collagen deposits increase during hyperoxygenation, tissues undergo angiogenesis in response to hypoxic, or low oxygen conditions, and this is exactly what occurs shortly after the completion of HBOT. Alterations between hyperoxia and hypoxia are responsible for maximum angiogenic stimulation in metabolic tissues like the muscles, liver, and fat and are essential for increasing the vasculature in our bodies1.

    2. Collagen Deposition

      As already discussed, increased collagen deposition in tissues increases the growth of capillaries, providing the framework for the angiogenic conditions that follow the hyper-oxygenated conditions during HBOT.

If you’d like to learn more about Hyperbaric Oxygen Therapy, register for our free virtual event, ‘Hyperbaric Oxygen Therapy (HBOT) 101.’

How can HBOT benefit athletes in competition?

Enhanced angiogenesis and tissue collagen levels following injury are likely the mechanisms by which Hyperbaric Oxygen Therapy induces its beneficial effects for an athlete. These factors are proposed to have a significant role in the recovery process in soft tissue (or muscle) injury as they can improve blood flow and nutrient transport to areas that need it more.

For example, the ankle joint is commonly injured amongst athlete’s due to its weight-bearing function and change of direction movement in a variety of sports, and in a study conducted on 32 athlete’s experiencing acute ankle sprains, individuals that underwent Hyperbaric Oxygen Therapy at atmospheric pressure of 2.0 showed significant improvements in joint function when compared to those receiving the placebo treatment. However, this study found no difference in the time of recovery for the patients5. Another investigation on 44 athletes with acute ankle sprains found that HBOT provided a short-term reduction in soft-tissue edema, swelling, and pain when compared to placebo treatment groups6.

Other than short-term improvements in muscle function and pain, research also indicates that Hyperbaric Oxygen Therapy may be an effective method to reduce muscle stiffness as well. A 2007 study from a research group in Japan found that when athletes with sustained muscle injuries that occurred during physical activity were subject to HBOT for 1 hour within 7 days of injury onset, muscle stiffness, swelling, and pain scales were significantly reduced7.

From a biochemical perspective, recent evidence suggests that hyperbaric oxygen treatment directly to myoblasts, which are the precursor cells to muscle cells, improves the growth rate and differentiation of these cells. The same research group also discovered that when HBOT was given to mice after a muscle contusion, signs of muscle regeneration and improved physiological performance were observed8.

Altogether, these studies provide some context for the benefits an athlete may experience with Hyperbaric Oxygen Therapy. Most of the improvements are highly related to the drastically increased blood and oxygen flow to the tissue, which is probably unsurprising given that is the central mechanism of the therapy itself.

With these perceived benefits in mind, the jury is still out on how much benefit an athlete can actually garnish from HBOT. Studies have been done to attempt to answer this question, but issues involving specifics of the therapy, such as length of HBOT and amount of atmospheric pressure to use, along with how quickly an athlete can undergo therapy once an injury occurs, limit the available evidence.

If you’re an athlete of any kind living in or around the New York City area visit our Brooklyn, NY location and see how Physio Logic NYC can help optimize your performance and speed up your recovery with Hyperbaric Oxygen Therapy. Just give us a call or start by filling out the form below.

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  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3382683/
  • https://pubmed.ncbi.nlm.nih.gov/8898456/
  • https://www.sciencedirect.com/science/article/pii/S0953711208000744?casa_token=j3yIWvk7im4AAAAA:V9N4qnBjBeqtTKNZa8yl7K-K5LbooCAHXO_52tup4SfUr1TmK946IPPOg_KeiLmkyxbodlC2yvNUJQ
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3382683/
  • https://pubmed.ncbi.nlm.nih.gov/9302466/
  • https://openventio.org/Volume3-Issue1/The-Effects-of-Hyperbaric-Oxygen-Therapy-on-Reduction-of-Edema-and-Pain-in-Athletes-With-Ankle-Sprain-in-the-Acute-Phase-A-Pilot-Study-SEMOJ-3-141.pdf
    Yagishita K, Yamami N, Togawa S, Nakayama T, Many Y: The effect of hyperbaric oxygen therapy on patients with muscle injury, abstract. UHMS, Inc., Annual Scientific Meeting held June 14-16, 2007. Ritz Carlton Kapalua Maui, Hawaii.
  • https://pubmed.ncbi.nlm.nih.gov/31531986/