Hyperbaric Oxygen and Sports

1. Hyperbaric Oxygen and Sports

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

3. James et al. reported that the disease period of the damage was shortened by 70%. • The interest in HBO treatment for sports injuries has since spread, especially in Japan.

4. Physical Solution of Oxygen • Henry's Law: O2 dissolved (mL O2/dL) = O2 sol. (mL O2/dL per mm Hg) × pO2 (mm Hg) • dissolved O2 is a linear function of pO2 • O2 solubility = slope of line • O2 solubility in blood is very low, hence dissolved O2 content is very low at normal pO2 = 100 mm Hg • O2 solubility = 0.003 mL/dL per mm Hg (a constant independent of prevailing pO2) • O2 content = 0.3 mL O2/dL (a variable dependent upon prevailing pO2)

5. Oxygen effects • Oxygen is generally advantageous to tissue formation and organization

6. Effectiveness of Oxygen Against Recovery from Fatigue • Main causes and mechanisms that result in physiological fatigue: • Diminishment of an energy source • Accumulation of a fatigue substance • Malfunction of metabolism regulation

7. Increasing the oxygen supply to a musculoskeletal system in the state of fatigue activates cellular activity, increases adenosine triphosphate (ATP) synthesis • Promotes the metabolism of fatigue substances. • HBO can therefore be considered as a method of promoting recovery from fatigue.

8. Hyperbaric Oxygen Therapy For Body Injury • Burns • Abnormal Injuries • Amputation • Broken Bones • Crush Injury • Compartment Syndrome • Reperfusion Injury • Hemorrhage • Hypoxia

9. Effects of O2 onSports Injuries • Commonest Sports Injuries include: Bone Fracture, Ligament Rapture, Soft Tissue Damage and healing consists 3 phases • 發炎期(Inflammatory phase)：此時組織因受傷發炎處於低氧環境，氧氣可促進新生血管增生(vascularization)。 • 增生期(Proliferative phase)：除了軟骨組織(cartilage)之外，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：fibronectin，proteoglycan 的增生，以利受損組織癒合。 • 修復期(Remodeling phase)：此時受損組織進入費時甚久的修復期，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，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(cartilage)之外，因其需低氧環境以維持其低磨擦係數(low frictional coefficient)。 • So O2 play an important role in these phases

10. Clinical Implications • 血液中氧氣分壓可提升至接近1000mmHg。 • 高壓氧治療於組織受損的治療作用包括 • 1.減低軟組織水腫 (Reduces tissue edema) • 2.加速傳統治療於韌帶受損及骨折的療效 (Promote medical treatment ligament damage and fracture) • 3.減低組織受損導致循環缺血與疼痛的產生(Reduce the pain cause by tissue damage induced ischemia) • 4.避免組織感染(Avoid tissue infection) • Therapy within 48 hours after the injury • To be most effective, treatment should be started within the first 4 to 6 hours

11. HBO Safety • Oxygen therapy should not be performed unnecessarily and superfluously because of its benefits in recovery promotion from fatigue. • Increased levels of oxygen in the blood can cause tissue damage by oxidation. • It is necessary to maintain optimal oxygen balance by considering factors such as application times, concentration and pressure, which are developed from the understanding of the theoretical background of HBO.

12. Principles of Hyperbaric Oxygen (HBO) Treatment • Since the oxygen absorption of haemoglobin is low at 100mm Hg, the oxygen saturation is limited by the haemoglobin concentration in the blood. • Consequently, using pure oxygen with twice the atmospheric pressure, it becomes possible to raise the partial pressure of oxygen to near the 1000mm Hg. This is essentially the conditions of application of HBO for medical treatment.

13. O2 Saturation/Dissociation Curve • Hb takes up O2 in the lungs and releases it to interior tissues • At pO2of 100 mmHg, Hb is saturated • At pO2 of 20 mmHg, Hb loses most of its O2 • Even at 40 mmHg Hb is loosing some of it's O2

14. Normal O2 Pressures:

15. Effect on Lactate Metabolite • Fisher’s tennis player study: • Hyperbaric O2 reduce blood ammonia after training • 1 ATA normal oxygenation for 45 min reduce 61% BLA • 1 ATA High oxygenation for 45 min reduce 64% BLA • 2 ATA High oxygenation for 45 min reduce 70% BLA

16. Best experience of HBO use as a recovery method • Nagano Winter Olympics with seven participating athletes • After physical activity, the athletes received HBO treatment for 30-40 minutes at 1.3 ATA, with a maximum of six times per athlete and an average of two times per athlete. • Tension and sharp pain of the abdominal muscles (-) / anterior knee pain (-) / Adverse effect (-)

17. The Effect of HBO on Recovery Promotion of an Injury • The injured body part has a shortage of oxygen as a result of inhibited blood flow, swelling and a drop in capillary blood vessel permeability. • The main focus of HBO treatment is to cancel the shortage of oxygen in a damaged body part. • Kivisaari and Niinikoski (1975) have reported measurement of pO2 in subcutaneous tissue in rats. The pO2 of injured tissue is generally about 5-15mm Hg, which is low compared with normal tissue (40-45mm Hg).

18. Medial Collateral Knee Ligament • Webster et al • Rat’s knee injury, 2ATA, 1.5h/dX4wks,↑tissue elasticity & fracture intensity • Mashitori et al (2004) • 7d & 14d Hi O2, ↑pro-collagen gene expression

19. Taiwanese Study on HBO • HBO activates DDR2 expression in cultured rat vessel smooth muscle cells (VSMC)s. • HBO- induced DDR2 is mediated by Tumor necrosis factor (TNF-α) and at least in part through the p38 MAPK and Myc promoter (cellular signal transducer and activator of transcription) • Discoidin domain receptor family, member 2 (DDR2) is a human gene receptor to tyrosine kinase (RTKs) play a key role in the communication of cells with their microenvironment

20. Are involved in the regulation of cell growth, differentiation, and metabolism • In several cases the biochemical mechanism by which RTKs transduce signals across the membrane • Ligand induced receptor oligomerization and subsequent intracellular phosphorylation • This autophosphorylation leads to phosphorylation of cytosolic targets as well as association with other molecules, which are involved in pleiotropic effects of signal transduction

21. Clinical research using human subjects • Staple and Clement • N=66, Hi O2 to QC DOMS, NSD than placebo • Borromeo et al (1997) • N=32, Hi O2 to acute ankle joint sprain, NSD than control • It seems that there is not such a large improvement • Further research is needed to evaluate HBO due to the poor system for evaluating the effect on patients

22. Administration • May Augment oxygen radical to damage DNA • Oxygen Poisoning main target to the lung and CNS, Clinical symptoms: Front chest uneasiness, vomiting, dizziness, tinnitus. • There was no significant differences in plasma GH or plasma TSH between the HBO group and the control group at 1 and 2 weeks.

23. These results suggest that HBO has influenced the whole body weight in the adolescent rats during HBO application. This was a temporary response and did not influence plasma hormone level in the blood. Further studies are needed, but it appears we have to take care with the use of HBO for young athletes.

24. Conclusions HBO treatment has been shown to be promising for tissue remodeling after injury and for the recovery of fatigue. However, further research is required, focusing on tailoring treatment to an individual’s condition, which will allow efficient use of HBO.

25. Discussion • How you deal with your athlete with injuries, if you have HBO. What it’s effect you would expect. • In your viewpoint, what is HBO as the most useful practice in health promotion? • Is there any exercise training can combine HBO as a means to gain a maximum training effect.