Hyperbaric Oxygen and Sports Hyperbaric Oxygen and Sports

IntroductionIntroduction

In recent years, the development of new In recent years, the development of new rehabilitation techniques and regimes for rehabilitation techniques and regimes for sports players with injuries has advanced sports players with injuries has advanced rapidly. rapidly. Conventionally HBO has been used in medical Conventionally HBO has been used in medical treatments such as cerebral infarction, carbon treatments such as cerebral infarction, carbon monoxide poisoning and the bends monoxide poisoning and the bends (decompression disease). (decompression disease). HBO was first tried on a sports injury in HBO was first tried on a sports injury in Scotland, where it was used to treat the Scotland, where it was used to treat the injuries of professional soccer and golf players injuries of professional soccer and golf players in the late 1980s. in the late 1980s.

James et al. reported that the disease period of James et al. reported that the disease period of the damage was shortened by 70%. the damage was shortened by 70%.

The interest in HBO treatment for sports The interest in HBO treatment for sports injuries has since spread, especially in Japan. injuries has since spread, especially in Japan.

Physical Solution of OxygenPhysical Solution of Oxygen – Henry's Law: OHenry's Law: O22 dissolved (mL O dissolved (mL O22/dL) = O/dL) = O22 sol. (mL sol. (mL

OO22/dL per mm Hg) /dL per mm Hg) ×× pO pO22 (mm Hg) (mm Hg)

dissolved Odissolved O22 is a linear function of pO is a linear function of pO22

OO22 solubility = slope of line solubility = slope of line

– OO22 solubility in blood is very low, hence dissolved solubility in blood is very low, hence dissolved OO22

content is very low at normal pOcontent is very low at normal pO22 = 100 mm Hg = 100 mm Hg

OO22 solubility = 0.003 mL/dL per mm Hg (a constant solubility = 0.003 mL/dL per mm Hg (a constant

independent of prevailing pOindependent of prevailing pO22) )

OO22 content = 0.3 mL O content = 0.3 mL O22/dL (a variable dependent /dL (a variable dependent

upon prevailing pOupon prevailing pO22) )

Oxygen effectsOxygen effects

Oxygen is generally advantageous to tissue Oxygen is generally advantageous to tissue

formation and organizationformation and organization

Effectiveness of Oxygen Against Effectiveness of Oxygen Against Recovery from FatigueRecovery from Fatigue

Main causes and mechanisms that result in Main causes and mechanisms that result in physiological fatigue:physiological fatigue:

– Diminishment of an energy sourceDiminishment of an energy source

– Accumulation of a fatigue substanceAccumulation of a fatigue substance

– Malfunction of metabolism regulationMalfunction of metabolism regulation

Increasing the oxygen supply to a Increasing the oxygen supply to a musculoskeletal system in the state of fatigue musculoskeletal system in the state of fatigue activates cellular activity, increases adenosine activates cellular activity, increases adenosine triphosphate (ATP) synthesistriphosphate (ATP) synthesis

Promotes the metabolism of fatigue substances. Promotes the metabolism of fatigue substances.

HBO can therefore be considered as a method HBO can therefore be considered as a method of promoting recovery from fatigue.of promoting recovery from fatigue.

Hyperbaric Oxygen Therapy For Hyperbaric Oxygen Therapy For Body Injury Body Injury

BurnsBurns Abnormal InjuriesAbnormal InjuriesAmputationAmputationBroken BonesBroken BonesCrush InjuryCrush InjuryCompartment SyndromeCompartment SyndromeReperfusion InjuryReperfusion InjuryHemorrhageHemorrhageHypoxiaHypoxia

Effects of OEffects of O22 on on Sports Injuries Sports Injuries Commonest Sports Injuries include: Bone Fracture, Ligament Commonest Sports Injuries include: Bone Fracture, Ligament Rapture, Soft Tissue Damage and healing consists 3 phasesRapture, Soft Tissue Damage and healing consists 3 phases發炎期發炎期 (Inflammatory phase)(Inflammatory phase) ：此時組織因受傷發炎處於低氧：此時組織因受傷發炎處於低氧環境，環境，氧氣可促進新生血管增生 (vascularization) 。 。 增生期增生期 (Proliferative phase)(Proliferative phase) ：除了軟骨組織：除了軟骨組織 (cartilage)(cartilage) 之外，之外，提升提升氧氣濃度可促進受損組織細胞外母質 (extracellular matrix)成份的增加，例如：，例如： fibronectinfibronectin ，， proteoglycan proteoglycan 的增生，以利的增生，以利受損組織癒合。 受損組織癒合。 修復期修復期 (Remodeling phase)(Remodeling phase) ：此時受損組織進入費時甚久的修：此時受損組織進入費時甚久的修復期，復期，若無足夠的氧氣濃度，受損部份其結痂組織將會大量取代正常組織，妨礙其癒合與延緩癒合時間，妨礙其癒合與延緩癒合時間，更重要的是組，更重要的是組織強度與功能恢復相對會減弱。但除了軟骨組織織強度與功能恢復相對會減弱。但除了軟骨組織 (cartilage)(cartilage) 之之外，因其需低氧環境以維持其低磨擦係數外，因其需低氧環境以維持其低磨擦係數 (low frictional (low frictional coefficient)coefficient) 。。So OSo O22 play an important role in these phases play an important role in these phases

Clinical ImplicationsClinical Implications血液中氧氣分壓可提升至接近血液中氧氣分壓可提升至接近 1000mmHg1000mmHg 。 。 高壓氧治療於組織受損的治療作用包括 高壓氧治療於組織受損的治療作用包括 – 1.1. 減低軟組織水腫 減低軟組織水腫 (Reduces tissue edema) (Reduces tissue edema)

– 2.2. 加速傳統治療於韌帶受損及骨折的療效 加速傳統治療於韌帶受損及骨折的療效 (Promote (Promote medical treatment ligament damage and fracture)medical treatment ligament damage and fracture)

– 3.3. 減低組織受損導致循環缺血與疼痛的產生減低組織受損導致循環缺血與疼痛的產生 (Reduce the (Reduce the pain cause by tissue damage induced ischemia) pain cause by tissue damage induced ischemia)

– 4.4. 避免組織感染避免組織感染 (Avoid tissue infection) (Avoid tissue infection)

Therapy within 48 hours after the injury Therapy within 48 hours after the injury

To be most effectiveTo be most effective, , treatment should be started treatment should be started within the first 4 to 6 hourswithin the first 4 to 6 hours

HBO SafetyHBO SafetyOxygen therapy should not be performed Oxygen therapy should not be performed unnecessarily and superfluously because of its unnecessarily and superfluously because of its benefits in recovery promotion from fatigue. benefits in recovery promotion from fatigue.

Increased levels of oxygen in the blood can cause Increased levels of oxygen in the blood can cause tissue damage by oxidation. tissue damage by oxidation.

It is necessary to maintain optimal oxygen balance It is necessary to maintain optimal oxygen balance by considering factors such as application times, by considering factors such as application times, concentration and pressure, which are developed concentration and pressure, which are developed from the understanding of the theoretical from the understanding of the theoretical background of HBO.background of HBO.

Principles of Hyperbaric Oxygen Principles of Hyperbaric Oxygen (HBO) Treatment(HBO) Treatment

Since the oxygen absorption of haemoglobin is Since the oxygen absorption of haemoglobin is low at 100mm Hg, the oxygen saturation is low at 100mm Hg, the oxygen saturation is limited by the haemoglobin concentration in limited by the haemoglobin concentration in the blood. the blood.

Consequently, using pure oxygen with twice Consequently, using pure oxygen with twice the atmospheric pressure, it becomes possible the atmospheric pressure, it becomes possible to raise the partial pressure of oxygen to near to raise the partial pressure of oxygen to near the 1000mm Hg. This is essentially the the 1000mm Hg. This is essentially the conditions of application of HBO for medical conditions of application of HBO for medical treatment.treatment.

OO2 2 Saturation/Dissociation CurveSaturation/Dissociation Curve

Hb takes up OHb takes up O22 in the in the

lungs and releases it to lungs and releases it to interior tissuesinterior tissues

At pOAt pO22of 100 mmHg, of 100 mmHg,

Hb is saturatedHb is saturated

At pOAt pO22 of 20 mmHg, Hb of 20 mmHg, Hb

loses most of its O2loses most of its O2

Even at 40 mmHg Hb is Even at 40 mmHg Hb is loosing some of it's Oloosing some of it's O22

Normal O2 Pressures:

LocationApproximate pO2 (mmHg)

Comments

Air 150Normal atmospheric pressure at sea level

Lung Capillaries 100Where direct gas exchange occurs

Venous Blood 40Where gas exchange to tissues occurs

Muscle 20 Under normal activity

O2-Deprived Muscle >5Under conditions of strenuous exercise

 

Effect on Lactate MetaboliteEffect on Lactate MetaboliteFisher’s tennis player study:Fisher’s tennis player study:

Hyperbaric OHyperbaric O22 reduce blood ammonia after reduce blood ammonia after

trainingtraining

1 ATA normal oxygenation for 45 min reduce 1 ATA normal oxygenation for 45 min reduce 61% BLA61% BLA

1 ATA High oxygenation for 45 min reduce 1 ATA High oxygenation for 45 min reduce 64% BLA64% BLA

2 ATA High oxygenation for 45 min reduce 2 ATA High oxygenation for 45 min reduce 70% BLA70% BLA

Best experience of HBO use as a Best experience of HBO use as a recovery method recovery method

Nagano Winter Olympics with seven Nagano Winter Olympics with seven participating athletes participating athletes

After physical activity, the athletes received After physical activity, the athletes received HBO treatment for 30-40 minutes at 1.3 ATA, HBO treatment for 30-40 minutes at 1.3 ATA, with a maximum of six times per athlete and with a maximum of six times per athlete and an average of two times per athlete. an average of two times per athlete.

Tension and sharp pain of the abdominal Tension and sharp pain of the abdominal muscles (-) / anterior knee pain (-) / Adverse muscles (-) / anterior knee pain (-) / Adverse effect (-)effect (-)

The Effect of HBO on Recovery The Effect of HBO on Recovery Promotion of an InjuryPromotion of an Injury

The injured body part has a shortage of oxygen as The injured body part has a shortage of oxygen as a result of inhibited blood flow, swelling and a a result of inhibited blood flow, swelling and a drop in capillary blood vessel permeability. drop in capillary blood vessel permeability.

The main focus of HBO treatment is to cancel the The main focus of HBO treatment is to cancel the shortage of oxygen in a damaged body part. shortage of oxygen in a damaged body part.

Kivisaari and Niinikoski (1975) have reported Kivisaari and Niinikoski (1975) have reported measurement of pO2 in subcutaneous tissue in measurement of pO2 in subcutaneous tissue in rats. The pO2 of injured tissue is generally about rats. The pO2 of injured tissue is generally about 5-15mm Hg, which is low compared with normal 5-15mm Hg, which is low compared with normal tissue (40-45mm Hg).tissue (40-45mm Hg).

Webster et alWebster et al– Rat’s knee injury, 2ATA, 1.5h/dX4wks,↑tissue Rat’s knee injury, 2ATA, 1.5h/dX4wks,↑tissue

elasticity & fracture intensityelasticity & fracture intensity

Mashitori et al (2004)Mashitori et al (2004)– 7d & 14d Hi O2, ↑pro-collagen gene expression7d & 14d Hi O2, ↑pro-collagen gene expression

Medial Collateral Knee LigamentMedial Collateral Knee Ligament

Taiwanese Study on HBO Taiwanese Study on HBO

HBO activates DDR2 expression in cultured rat HBO activates DDR2 expression in cultured rat vessel smooth muscle cells (VSMC)s. vessel smooth muscle cells (VSMC)s.

HBO- induced DDR2 is mediated by HBO- induced DDR2 is mediated by Tumor Tumor necrosis factor (TNF-α) and at least in part necrosis factor (TNF-α) and at least in part through the p38 MAPK and Myc promoter through the p38 MAPK and Myc promoter ((cellular signal transducer and activator of transcriptioncellular signal transducer and activator of transcription))– Discoidin domain receptor family, member 2 (DDR2) Discoidin domain receptor family, member 2 (DDR2)

is a human gene receptor to tyrosine kinase (RTKs) is a human gene receptor to tyrosine kinase (RTKs) play a key role in the communication of cells with play a key role in the communication of cells with their microenvironmenttheir microenvironment

Are involved in the regulation of cell growth, Are involved in the regulation of cell growth, differentiation, and metabolismdifferentiation, and metabolismIn several cases the biochemical mechanism In several cases the biochemical mechanism by which RTKs transduce signals across the by which RTKs transduce signals across the membranemembraneLigand induced receptor oligomerization and Ligand induced receptor oligomerization and subsequent intracellular phosphorylation subsequent intracellular phosphorylation This autophosphorylation leads to This autophosphorylation leads to phosphorylation of cytosolic targets as well as phosphorylation of cytosolic targets as well as association with other molecules, which are association with other molecules, which are involved in involved in pleiotropicpleiotropic effects of signal effects of signal transductiontransduction

Staple and ClementStaple and Clement– N=66, Hi ON=66, Hi O22 to QC DOMS, NSD than placebo to QC DOMS, NSD than placebo

Borromeo et al (1997)Borromeo et al (1997)– N=32, Hi ON=32, Hi O22 to acute ankle joint sprain, NSD than to acute ankle joint sprain, NSD than

controlcontrol

It seems that there is not such a large improvementIt seems that there is not such a large improvement

Further research is needed to evaluate HBO due to Further research is needed to evaluate HBO due to the poor system for evaluating the effect on the poor system for evaluating the effect on patientspatients

Clinical research using human Clinical research using human subjectssubjects

AdministrationAdministration

May Augment oxygen radical to damage DNAMay Augment oxygen radical to damage DNA

Oxygen Poisoning main target to the lung and Oxygen Poisoning main target to the lung and CNS, Clinical symptoms: Front chest CNS, Clinical symptoms: Front chest uneasiness, vomiting, dizziness, tinnitus. uneasiness, vomiting, dizziness, tinnitus.

There was no significant differences in plasma There was no significant differences in plasma GH or plasma TSH between the HBO group GH or plasma TSH between the HBO group and the control group at 1 and 2 weeks.and the control group at 1 and 2 weeks.

These results suggest that HBO has influenced These results suggest that HBO has influenced the whole body weight in the adolescent rats the whole body weight in the adolescent rats during HBO application.during HBO application.

This was a temporary response and did not This was a temporary response and did not influence plasma hormone level in the blood. influence plasma hormone level in the blood.

Further studies are needed, but it appears we Further studies are needed, but it appears we have to take care with the use of HBO for have to take care with the use of HBO for young athletes.young athletes.

ConclusionsConclusionsHBO treatment has been shown to be HBO treatment has been shown to be promising for tissue remodeling after promising for tissue remodeling after injury and for the recovery of fatigue. injury and for the recovery of fatigue.

However, further research is required, However, further research is required, focusing on tailoring treatment to an focusing on tailoring treatment to an individual’s condition, which will allow individual’s condition, which will allow efficient use of HBO.efficient use of HBO.

DiscussionDiscussion

How you deal with your athlete with injuries, How you deal with your athlete with injuries, if you have HBO. What it’s effect you would if you have HBO. What it’s effect you would expect.expect.

In your viewpoint, what is HBO as the most In your viewpoint, what is HBO as the most useful practice in health promotion?useful practice in health promotion?

Is there any exercise training can combine Is there any exercise training can combine HBO as a means to gain a maximum training HBO as a means to gain a maximum training effect. effect.