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Exploring Available Evidence for Hyperbaric Oxygen Therapy in Acute Traumatic Sports Injury

Updated: Jul 15


Current Use and Discussion of HBOT for Sports-Related Injuries


Hyperbaric oxygen therapy (HBOT) is gaining traction in sports, with professional and collegiate teams using it more frequently to accelerate recovery from injuries. From muscle contusions and ankle sprains to delayed-onset muscle soreness (DOMS), HBOT is being explored as a tool to enhance soft tissue healing. Despite its rising popularity, the evidence supporting its use in sports medicine remains limited and often controversial.¹⁰


Athletes have also turned to portable "bag chambers," frequently used at home and likely without supplemental oxygen or clinical oversight. While the visibility of HBOT is increasing, clarity around its medical effectiveness—particularly in acute sports injury recovery—is still developing. It is important to note that HBOT should always be administered under appropriate medical supervision to ensure patient safety and treatment effectiveness.


Illustration of an injured athlete mid-game representing an acute traumatic sports injury. Used to explore hyperbaric oxygen therapy (HBOT) as a recovery tool in sports medicine and wound care.


The Physiological Basis for HBO’s Potential Effectiveness


Sports injuries frequently involve damage to muscles, ligaments, tendons, and joints. These injuries can range from mild to severe and often lead to inflammation, swelling, and temporary loss of function.² ³ The injured tissues experience a disruption in microcirculation, leading to oxygen-deprived areas and the accumulation of lactic acid due to reduced adenosine triphosphate (ATP) levels.


HBOT increases the amount of oxygen dissolved in plasma, helping to maintain ATP levels and reduce lactic acid buildup.² ³ This oxygen-rich environment may reduce cellular injury, promote faster recovery, and mirror the mechanisms by which HBOT supports other ischemic or crush-related injuries.


This disruption in oxygen delivery also affects cellular repair and metabolism, which are oxygen-dependent processes.¹ ⁴ ¹⁵ HBOT has demonstrated the ability to support tissue oxygen dynamics and healing response in ischemic or injured tissues.⁴


Vasoconstriction during HBOT reduces blood flow by up to 20%, yet this is counterbalanced by significantly increased oxygen delivery. This effect can help reduce edema and limit further tissue damage if therapy is applied early—ideally within 8 to 24 hours of injury.⁸ ¹⁰ These mechanisms have been documented not only in sports medicine literature but also in broader musculoskeletal and orthopedic applications.⁷ ⁹ ¹¹


Key Studies on HBO’s Effectiveness in Treating Soft Tissue Injuries


Several small-scale studies have investigated the benefits of HBOT in treating sports-related soft tissue injuries:


  • Soccer Players in Scotland.⁵: A study reported a 70% reduction in recovery time when HBOT was used alongside physiotherapy, although the absence of a control group limits its strength.


  • Borromeo et al.⁶: A double-blind study on ankle sprains found improved joint function with HBOT at 2.0 ATA, but no significant differences in pain, swelling, or recovery time. Early intervention might have produced stronger results.


  • Abbadi and Elrefai.¹⁶: Compared outcomes at 2.0 and 2.5 ATA for acute ankle sprains. The 2.5 ATA group experienced complete pain and swelling resolution after seven treatments.


  • Staples and Clement.¹³: Unpublished study on medial collateral ligament injuries showed positive trends in pain and function over six weeks.


  • Yagishita and Yamami.²²: In a 2007 study, muscle injuries treated with 2.8 ATA HBO for up to seven sessions showed reductions in pain, muscle stiffness, and swelling, despite the lack of randomization or blinding.


Challenges in HBO Research: Small Sample Sizes and Study Limitations


Most studies conducted so far suffer from limited sample sizes, lack of randomization, delayed treatment timing, or absence of control groups. As a result, translating these findings into clinical recommendations remains difficult.


Additionally, some studies—like those on DOMS—suggest no measurable benefit or even increased pain when HBOT is administered too soon after eccentric exercise in untrained individuals.¹⁷ This highlights the importance of timing, injury type, and patient selection.


Clinical Studies on HBO for Specific Injuries: Ankle Sprains and Muscle Strains


The most promising studies focus on common injuries like ankle sprains, which represent up to 73% of all athletic joint injuries.¹⁹ ²⁰ When applied early and with sufficient frequency, HBOT appears to reduce inflammation and improve function.


However, the effectiveness varies by pressure level (ATA), timing of intervention, and overall treatment protocol. Consistency in trial design and outcome measures is needed to validate its routine use.


Additional support for early HBOT intervention is noted in podiatric sports injury cases and among unconditioned volunteers recovering from eccentric exercise.⁷ ¹² ¹⁸


Future Directions: Advancing HBO Use in Sports Medicine


To determine if HBO’s physiological benefits translate into consistent clinical outcomes for sports injuries, future studies should:


  • Begin treatment as close to the time of injury as possible (within 8–24 hours)

  • Measure post-injury edema, fibroblast proliferation, and creatine kinase (CK) levels

  • Include objective markers of functional recovery

  • Compare treatment protocols across various ATA levels and session frequencies


Final Recommendations


Soft tissue injuries are a routine concern in sports medicine. While evidence remains mixed, the most compelling data suggest HBOT is most effective when administered early—ideally within the first 8 to 24 hours post-injury.


For eligible cases, HBOT may be used as an adjunctive therapy under the Acute Traumatic Peripheral Ischemia (ATPI) protocol: 2.5 ATA for 90 minutes, with two sessions per day for the first two days, followed by daily treatments for a total of 7 to 15 sessions. Functional assessments and serum CPK monitoring may help tailor treatment and validate effectiveness.


While not yet standard practice, HBOT shows meaningful potential for supporting recovery in elite athletes with acute soft tissue injuries—and may become a valuable addition to sports medicine protocols as research evolves.

Reference


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