Broken or fractured bones are a common occurrence, but additional complications can slow the healing process or even prevent healing altogether. In a splint or a cast, a healthy body breaks down damaged bone cells while repairing and growing healthy new bone, but trauma to surrounding tissue, infection, and other factors can disrupt this process.
For patients with non-healing fractures or breaks, HBOT provides an alternative method for bone regrowth and remodeling. By flooding bone tissue with oxygen, HBOT promotes an increase in osteoblasts (cells that form new bone), as well as increase collagen production (important building block for the bone). This was supported by a study that found cellular evidence that HBOT is effective for fracture healing and bone growth. On top of these benefits, HBOT also helps prevent against infection and reduces tissue trauma in the surrounding area, promoting optimal healing of the injured area.
With tendons and ligaments specifically, injury to these areas can be especially challenging to heal because they don’t have the same level of blood-flow as other parts of the body and injury may disrupt circulation further. In order to speed up the healing process, tendons and ligaments need an ample supply of oxygen. HBOT provides a promising treatment of these areas due to its ability to oxygenate cells that are at risk of dying due to lack of oxygen. Not only does it help protect against infection, but also speed up healing.
A recent study out of Japan, which followed 32 athletes with MCL (medial collateral ligament) injury, reinforces this. The 16 athletes who underwent HBOT had reduced pain and accelerated return to activity compared to the athletes who did not use HBOT, supporting HBOT as a treatment for accelerating ligament healing and regeneration.
Cartilage, the natural cushioning for bones, is unique compared to other tissues in that it doesn’t have blood vessels to help heal and regenerate after injury. When cartilage is damaged, bone hits bone where the sensitive nerve endings are located, causing pain. Damage to cartilage should not go untreated because of the difficulty in regenerating without medical intervention. For mild cases, ice and rest are recommended to help ease pain and swelling, while more extreme damage can be repaired through minimally invasive surgery.
HBOT has shown promise as a successful adjuvant treatment to accelerate the healing of cartilage damage. While studies on humans are currently limited, animal studies have shown HBOT’s ability to accelerate healing, especially when used in addition to other forms of treatment. One rat-model study showed that HBOT helped accelerate the process of healing of cartilage lesions when treated with micro-fracture cartilage surgery.
HBOT is a promising treatment for reducing inflammation and speeding up recovery from muscle injuries. While human studies need more research, the positive role of HBOT in muscle regeneration has been shown through animal studies. One study on contused calf muscles in a rat skeletal muscle injury model demonstrated HBOT has a dual role in decreasing inflammation and accelerating myogenesis (formation of skeletal muscular tissue) in muscle contusion injuries. Rats that underwent HBOT had reduced inflammation in the acute phase after muscle injury and also induced faster recovery from injury through enhanced satellite cell proliferation and differentiation in acute phase of muscle injury (responsible for muscle tissue regeneration), compared to rats who did not undergo treatment.
Avascular Necrosis is a disease that results from the temporary or permanent loss of blood supply to the bone, meaning the bone is not getting enough oxygen to sustain itself. Although most common in the hip and knees, this can happen in any bone and eventually results in bone tissue death and bone collapse. The bone dies because it is not getting enough oxygen through the blood supply, making HBOT a promising treatment for revitalizing those tissues with oxygen. Symptoms start with minimal early joint pain and progress into increased pain as bone and joint begin to collapse, limiting range of motion. HBOT can greatly improve symptoms of AVN, as evidenced by a 2010 study of 30 necrosis patients. Patients noted a decrease in pain and increase in range of motion, with all patients remaining pain-free after 7 years and no patients needing hip reconstruction or replacement.
Osteomyelitis is an infection characterized by inflammation of the bone. It is most common in young children and can result from an infection somewhere else in the body that has spread to the bone, often as a result of injury. The traditional treatment protocol consists of surgery to remove portions of the dead bone, followed by strong doses of antibiotics. While this treatment is generally successful, patients with chronic osteomyelitis (refractory osteomyelitis) either do not improve with traditional treatment or symptoms return after.
HBOT is an effective treatment for patients with refractory osteomyelitis who don’t respond appropriately to traditional treatment. Most bacteria thrive in low oxygen environments, meaning the extra oxygen from HBOT can actually kill the bacteria and stop the spread of infection, as well as reduce swelling and stimulate diseased bone and tissue to heal and repair. This was backed up by a study of 14 patients with chronic refractory osteomyelitis. Each patient had an average 5.4 operations prior to HBOT and had not improved through antibiotic and surgical treatment. After an average of 33.6 HBOT sessions, 11 patients reported no recurrence of infection, resulting in a 79% success rate.
Spinal Stenosis is the narrowing of the spaces within the spine, putting pressure on the nerves that travel through the spine. Spinal Stenosis is most common in the lumbar spine, but also occurs in the cervical spine. Patients with lumbar spinal stenosis typically experience numbness or tingling in a foot or leg, weakness in a foot on leg, and back pain, while patients with cervical spinal stenosis experience numbness or tingling in a hand, arm, foot or leg, weakness, and neck pain.
Traditional treatments include medication, physical therapy, steroid injections, and surgery; however, HBOT has shown promising results as an effective means to improve quality of life and alleviate symptoms. In one recent study of 24 patients with lumbar spinal stenosis, patients who received HBOT showed significant improvement in walking ability, pain scale scores, and quality of life, while patients who did not receive HBOT saw no significant changes.
Myofascial pain syndrome is a chronic pain disorder in the musculoskeletal system associated with trigger points, or areas of tenderness within muscle tissue that reduce range of motion. While these trigger points can happen in muscles throughout the body, neck and back pain are extremely common. HBOT provides a potential relief from pain associated with MPS. This was backed up by a study in which MPS patients increased pain thresholds and health related quality of life after 2 weeks of treatment. Furthermore, after 3 months of treatment, patients reported decreased disability associated with MPS.
Diabetes affects more than 12 million people and is the seventh leading cause of death in the United States. With diabetes primarily affecting the small blood vessels, HBOT has been demonstrated to stimulate angiogenesis to help ameliorate compromised blood flow and prevent organ failure. Research has shown that HBOT can lower blood sugar levels by increasing cellular sensitivity to insulin and skeletal muscle reception of glucose. Furthermore, recent reports have provided evidence towards linking HBOT to regenerating pancreatic islets of Langerhans, thus potentially producing more insulin. HBOT is often beneficial in treating osteomyelitis and cellulitis, in addition to preventing systemic toxicity and permanent disability. With chronic diabetes, impaired circulation reduces wound healing capability and promotes ulcerations. HBOT increases the amount of oxygen available to ulcerated areas, leading to increased fibroblast activation.
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