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Hyperbaric Oxygen Therapy For Sports Recovery

What is Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy (HBOT) is a procedure in which patients breathe 100% oxygen when the entire body is subjected to a pressure greater than the atmospheric pressure at sea level. Increasing the ambient pressure reduces the volume of gas-filled space and, therefore, increases the partial pressure of oxygen resulting in hyperoxygenation of tissues. This process stimulates healing and enhances various physiological functions.

How does HBOT work?

The mechanistic action of HBOT works by hyperoxia, hyperoxic vasoconstriction, and relative hypoxia.

  • Hyperoxia

Hyperoxia is a state where the cells, tissues, and organs in our body receive an excess supply of oxygen as a result of HBOT. Hyperoxygenation from HBOT increases the oxygen tension in the bloodstream for the diffusion of oxygen into cells and tissues; diffusion of oxygen from the blood to tissues is increased as the difference in oxygen tension increases.

When breathing air under ambient atmospheric pressure, the differential oxygen tension between the bloodstream and tissues is 45 mmHg. At higher atmospheric pressure, the differential oxygen tension can increase up to 1500 mmHg, increasing oxygen diffusion by up to four times.

Lastly, a state of hyperoxia is critical in stimulating fibroblast activity and increasing collagen deposition.

  • Hyperoxic Vasoconstriction

One of the primary functions of oxygen is to cause constriction of the blood vessels to divert blood flow from well-oxygenated tissues to areas tissues that are poorly oxygenated. The constriction of blood vessels due to hyperoxia also helps to reduce swelling.

  • Relative hypoxia

Hypoxia, a state when there is a lack of oxygen is a key stimulating factor in the development of new blood vessels (angiogenesis). Regular 60-90 min treatment sessions of HBOT, results in a period of relative hypoxia whilst the patient is outside the oxygen chamber, this provides the stimulus required for angiogenesis.

This alternating state of hyperoxia and hypoxia results in maximal fibroblast proliferation, collagen production, and keratinocyte differentiation.

HBOT and its role in sports

Hyperbaric oxygen has been used as an adjunct to accelerate sports-related injury, improve recovery after workouts, and enhance performance in professional athletics teams such as hockey (NHL), football (NFL), basketball (NBA), and soccer (MLS). Many Olympic athletes such as Michael Phelps, LeBron James, Usain Bolt, Serena Williams, and Maria Sharapova, have employed the use of HBOT in their training and recovery regime due to its enormous benefits.

Early recovery from muscular injury is crucial for elite athletes. HBOT accelerates cell recovery and tissue repair, which helps to eliminate fatigue and recover stamina. It can also improve the mental clarity, alertness, and focus needed for peak performance.

HBOT can play an adjunctive role in sports such as:

  • Reduce sports-related post-injury swelling and improve recovery

Sport injury is not uncommon, and optimizing the recovery process is vital. In a review article by Wolde et el., studies have shown that HBOT has an anti-inflammatory effect, decreasing pro-inflammatory markers that impede recovery, and promoting the release of angiogenesis-promoting cytokines and growth factors, expediting recovery. The study showed that HBOT can promote recovery by reducing pro-inflammatory markers such as high-sensitivity CRP (hs-CRP), interferon-γ, nuclear factor kappa B, and Tissue necrosis factor-α. HBOT also accelerates recovery with the increase of pro-angiogenesis growth factors such as epidermal growth factor, hematopoietic growth factor, keratinocyte growth factor, placental growth factor, and vascular endothelial growth factor.

Furthermore, HBOT also aids in the recovery of sports injuries by reducing tissue swelling. Injured tissues require more oxygen and this causes relative hypoxia, leading to hypoxic vasodilatation diverting more blood to injured tissue to increase oxygen delivery. Tissue swelling is an unwanted side effect of hypoxic vasodilation, in addition to increased blood vessel permeability which worsens tissue edema. With HBOT, more oxygen is dissolved in the blood, which not only mitigates the need for hypoxic vasodilation, but it results in hyperoxic vasoconstriction, shunting blood away from injured tissues to other areas that are lacking in oxygen, drastically reducing post-injury swelling.

  • Improvement in the recovery of muscle strain and contusion

Muscle strain and contusion is a common muscular injury that an athlete can sustain when participating in sports and training, early recovery is crucial for elite athletes with highly intensive training and competition. A study conducted by Chen et al. demonstrated the safety and efficacy of HBOT in facilitating early recovery of exercise-related muscular strain and contusion. HBOT was performed at 2.5 atmospheric absolute (ATA) and 100% oxygen for 100 minutes twice per week. At the end of ten sessions, elite athletes who received HBOT had a significant reduction in the biomarkers of muscle injury such as phosphokinase (CK), glutamic oxaloacetate transaminase (GOT), and myoglobin (MB), and these lasted for 2 weeks compared to athletes who did not receive HBOT. This reduction in biomarkers also translates to a reduction in pain intensity and pain interference.

  • Accelerate the recovery of delayed onset muscle soreness (DOMS)

DOMS is a common phenomenon that manifests after exercise that is of a higher-than-normal intensity. Common symptoms include pain, and stiffness of the affected muscles that typically occurs a few hours after the exercise, reaching peak levels in 24-48 hours and resolves in 5-7 days. Although DOMS is considered a mild type of injury, it is one of the most common reasons for compromised sportive performance, hence improving the recovery of DOMS is vital for an elite athlete’s overall performance.

Weber et al. conducted a study where the team recruited healthy male students, of whom all underwent a strenuous eccentric exercise protocol designed to elicit muscle damage to the right gastrocnemius muscle. Subjects who received HBOT treatment after the exercise protocol reported faster recovery in isometric peak torque, pain sensation, and unpleasantness.

  • Enhance outcomes after intervention of ligament and tendon injury

Ligament and tendon injury can be a significant impediment in an athlete’s career and performance. HBOT can be used as an adjunct to enhance the recovery of ligament and tendon injury after definitive intervention. Numerous animal studies have shown that HBOT increases the expression of matrix metalloproteinases (MMPs) and type I procollagen, important biomarkers indicating the beginning of the proliferative phase in ligament healing. This improvement in biomarkers with HBOT also translated to mechanical outcomes such as higher maximal pullout strength in the HBOT group and a 34.8% increase in ultimate tensile load.

The improvement was also seen in human studies conducted by Yagishita et al. who recruited professional or semi-professional rugby players with grade 2 MCL injury of the knee. The study showed that HBOT resulted in a reduction in pain scores, and accelerated the return to play.

  • Improve sports performance by increasing endurance, speed, and power, enhance mental focus, and reduce fatigue

Hypoxic training results in metabolic changes that cause stress at a cellular level and promote mitochondrial adaptation. It has been theorized that HBOT can enhance athletic performance through repeated intermittent hyperoxic exposures resulting in relative hypoxia when a patient is outside the oxygen chamber. The relative hypoxic conditions created by HBOT induce physiological adaptions, inducing changes in the mitochondria, and promoting performance, without the negative effects of a true hypoxic environment.

Hadanny et al. recruited healthy middle-aged master athletes and conducted a blinded randomized controlled trial, demonstrating that HBOT exposure led to a significant increase in maximal oxygen consumption (VO2Max), anaerobic threshold (VO2AT), maximal oxygen phosphorylation capacity, maximal uncoupled capacity, and mitochondrial mass marker; markers commonly used to assess aerobic fitness.

In summary, elite athletes use HBOT as a proactive measure to reduce the risk of injury and optimize recovery after intense training or competition. Regular HBOT sessions may help maintain tissue health, enhance immune function, and mitigate the effects of overtraining. This is why Hyperbaric Oxygen Therapy has become increasingly popular amongst elite international sportspersons.

What do we use to deliver HBOT in the Clifford Clinic?

The O2genes Soft Shell Cocoon® developed by Dr. Josh Lim (PhD) will be used to deliver HBOT during your session here in the Clifford Clinic. The material used to create the Soft Shell Cocoon is non-toxic and child-safe as it is made with 100% thermoplastic polyurethane (TPU). The pressure valves are made in Germany to ensure the highest standard of safety during your HBOT experience.

As safety is the top priority in the Clifford Clinic, the staff who will be operating the Soft Shell Cocoon in the clinic have been personally trained by Dr. Josh who is accredited by the Singapore Hyperbaric and Underwater Medicine.

What to Expect During the Treatment

There is little sensation or discomfort during an HBOT treatment. However, during the pressurization phase, you would get a feeling of “fullness” in your ears due to the change in the pressure. This sensation is similar to the one you would feel when diving underwater or flying on an airplane.

The pressurization phase would typically last about 10-15 minutes. During this time, if you have the feeling of “fullness” in your ears, you can swallow saliva or breath out forcefully with your nose pinched and mouth closed.

Once the cocoon is pressurized, the sensation of increased ear pressure would slowly subside. During this time, you can practice breathwork to maximize the effects of HBOT and further optimize your recovery.

Towards the end of your treatment session, the pressure inside the cocoon would start to decrease gradually over 10-15 minutes. During this period, you may experience a popping sensation in the ears due to the decrease in pressure. This popping sensation is a normal result of the decrease in air pressure inside your ear.

In summary, HBOT is a potential game-changer in the realm of sports recovery, offering athletes a multifaceted approach to optimizing their performance. By accelerating healing, reducing inflammation, and enhancing oxygen delivery to tissue, HBOT can enable athletes to recover faster, minimize the risk of injuries, and achieve peak performance levels.

If you have any further queries regarding the use of HBOT for sports recovery, or other potential benefits of HBOT, please feel free to book an appointment with us!


One session takes about 60 minutes to complete.

Depending on the severity of the condition, one may require multiple sessions to see beneficial effects.

If you are pregnant, have untreated Pneumothorax and Chronic Obstructive Pulmonary Disease, a history of burst lung, implanted electronic medical device such as pacemaker, history of seizures, chest surgery or heart failure, HBOT is not recommended.