In this video, I discuss hyperbaric oxygen treatments for muscle injuries, like contusions, strains or tears of the quadriceps, hamstrings, calves, and more. I talk about the research on the effectiveness of hyperbaric oxygen as a treatment modality, as well as side effects and treatment regimen.
Please understand, in this video, I am not giving you medical advice. This is meant for general information and educational purposes only.
Hyperbaric oxygen therapy has become popular among injured athletes because of its hypothetical benefits on accelerated recovery, especially among professional athletes. If we are going to discuss the role of hyperbaric oxygen as a potential treatment for muscle and other orthopedic injuries, we have to start by explaining exactly what it is.
What is hyperbaric oxygen?
Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized environment. It involves lying in a chamber, breathing pure oxygen in a pressurized environment. For it to be effective, the Undersea and Hyperbaric Medical Society indicates that pressurization should be 1.4 ATA or higher. Within most hyperbaric oxygen therapy chambers, the air pressure is 2 to 3 times higher than normal air pressure. Your lungs absorb more oxygen and deliver it to the rest of the body than they do under normal conditions. When your blood carries extra oxygen throughout your body, it stimulates healing of tissues.
Hyperbaric oxygen therapy is a proven treatment for decompression sickness from scuba diving. It can also be used to treat non-healing wounds, infections and carbon monoxide poisoning.
The significance of muscle injuries and the need to find an effective treatment
Muscle injuries exist along a broad spectrum of pathologies – muscle cramps, delayed-onset muscle soreness, muscle contusion and muscle strains or tears. Muscle strains and tears are among the most common musculoskeletal injuries in sports. They cause athletes to miss a long time from their sports.
A recent study looked at the most common injuries suffered by college athletes that led to more than 21 days missed from practice and competition, and muscle strains were the second most common of those injuries.
How does hyperbaric oxygen therapy work?
Hyperbaric oxygen therapy has both short- and long-term effects. In the short-term, it enhances oxygen delivery to the injured tissue. It reduces edema, improves neutrophil phagocytic function, meaning that damaged tissue and debris are removed. Hyperbaric oxygen has anti-inflammatory effects. And it counters tissue damage from ischemia–reperfusion injury, or a lack of blood flow to an area with sudden return of blood flow. Over longer periods of time, with multiple sessions, it induces the formation of new blood vessels and stimulates collagen production. All of these effects could enhance the recovery and rehabilitation of an injured muscle.
Hyperbaric oxygen also appears to have cellular and growth factor effects. Treatments produce free radicals in the body, and reactive oxygen and nitrogen species. These activate cellular processes and pathways that appear to increase growth factors, like vascular endothelial growth factor and stromal-derived factor 1. It also appears to increase bone marrow-derived stem cells, such as CD34.
To understand why hyperbaric oxygen would be helpful for muscle healing and recovery specifically, we need to understand what happens when a muscle is injured. In the acute phase of healing, the body releases inflammatory cytokines. The blood vessels in the area of muscle damage open up, allowing more blood flow, bringing neutrophils to the muscle and causing the muscle to swell.
In the setting of muscle damage, hyperbaric oxygen accelerates the transition from an inflammatory state to a proliferative state. It accelerates the transition of macrophages recruited to the area from pro-inflammatory M1 macrophages to anti-inflammatory M2 macrophages.
Hyperbaric oxygen also promotes a higher number of proliferating and differentiating satellite cells. Satellite cells can undergo transformation to myoblasts (muscle forming cells) to initiate muscle regeneration. This can lead to improved muscle fiber regeneration and strength.
What does the research say about hyperbaric oxygen for muscle injuries?
Let’s start with delayed-onset muscle soreness. This is the condition most of us have experienced at some point in our lives like lifting weights for the first time in a while. Your muscles experience tremendous soreness 24 to 48 hours after heavy physical exertion.
In terms of using hyperbaric oxygen treatments to accelerate recovery from or prevent delayed-onset muscle soreness, one study did show that patients who used hyperbaric oxygen had faster recovery from delayed-onset muscle soreness. But other studies have shown inconsistent results. In fact, one study showed patients who used hyperbaric oxygen actually had higher pain scores at 48 and 72 hours.
How about muscle strain or tears or muscle contusions? Well, there haven’t been any published research studies on hyperbaric oxygen treatments for humans with either a muscle strain or tear or a muscle contusion.
Several studies have been done in the lab using animals.
One study in rats showed that compared to control rats, the rats who underwent hyperbaric oxygen treatments had lower levels of creatinine kinase, a marker of muscle damage. Those rats also had higher muscle weight 72 hours after injury compared to the control rats.
A 2020 rat study showed that after a muscle contusion, rats treated with hyperbaric oxygen had increased formation of new blood vessels in the area due to increased nitric oxide and improved muscle regeneration through vascular endothelial growth factor and fibroblast growth factor.
And finally, a 2020 study in mice found that the mice who did 14 days of hyperbaric oxygen had increases in the myoblast growth rate and myogenin and actin production, leading to muscle cells and fibers that performed better physiologically and had increased strength.
What is the treatment regimen for hyperbaric oxygen?
Most clinics which use hyperbaric oxygen for patients typically use between 2 and 2.8 atmospheres of pressure. Each session takes between 60 and 120 minutes. There is some debate about how long patients need to do it. A rat study performed last year showed that either five daily hyperbaric oxygen treatments or three treatments within three days of injury promote muscle regeneration.
Side effects of hyperbaric oxygen
Hyperbaric oxygen therapy is believed to be safe. If negative side effects occur, they are generally mild and reversible.
There are two main concerns with hyperbaric oxygen. One pertains to an inability to balance pressure between the pressurized environment and any gas-filled space in the body, also known as barotrauma. The other relates to oxygen toxicity.
In terms of barotrauma, the middle ear is the most commonly affected. Tympanic membrane – or what we call the ear drum – and tympanic membrane rupture can occur. Also, air can be trapped in the sinuses of people with a polyp, nasal or sinus obstruction or inflammation can also cause problems after hyperbaric oxygen.
Oxygen toxicity can result from breathing oxygen at increased pressures. Theoretically, hyperbaric oxygen can generate so many free radicals that it can affect the central nervous system, potentially leading to visual changes, ringing in the ears, nausea, twitching, anxiety, confusion, and dizziness, and occasionally a seizure.
Caution about the research
Please understand that research into hyperbaric oxygen and its effectiveness for muscle injuries and other orthopedic injuries is tricky. It is very hard to design human studies with control groups because each participant would easily know if they were in the treatment of control group. Some studies have tried to use sham treatments in which participants lied in chambers with pressures of 1.1 to 1.3 ATA of pressure, but even those have been difficult to truly blind participants to know whether or not they are receiving hyperbaric oxygen.
Hyperbaric oxygen therapy appears to be able to enhance oxygen delivery to injured muscle, reduce edema and swelling as well as abnormal inflammation in the tissue, improve blood flow to the area, and increase collagen synthesis. As a result, it is fair to say that hyperbaric oxygen might have the potential to help the process of healing among injured athletes. But since human studies are few and far between, we need more and better designed human research to truly prove that hyperbaric oxygen can facilitate the return to play of athletes after muscle injury.
Links to studies in the comments
If you would like to read the studies I mentioned in the video, here are links to them:
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