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As sports medicine has evolved in recent times, the net has been widened in the search for new forms of therapy to treat injured players.

Over the years, treatment methods have improved and have become more scientific. As a result of this, one option available to many clubs nowadays is to treat football injuries using Hyperbaric Oxygen Therapy.

Real Betis player Cristiano Piccini, currently on loan from Fiorentina, is the latest player to be treated in this way. Having sustained an injury to a hamstring tendon several weeks ago, Cristiano has not played since early February. Betis’ head of Sports Medicine, Dr Tomas Calero initiated the hyperbaric treatment a week ago in order to assist the young Italian’s recovery.

Hyperbaric Oxygen Therapy works on the principle that delivering pure oxygen to injured tissues will encourage and stimulate the healing process to promote accelerated repair. The treatment involves the injured player having to enter a pressurised unit where pure oxygen is breathed within an enclosed chamber. The player will be sealed inside the chamber, and will breathe 90 – 100% pure oxygen at a pressure two to three times higher than atmospheric pressure. This means that the oxygen is delivered to the tissues in a more effective manner and is theoretically at least able to reach the parts of the injured structures more readily.

Specifically, Hyperbaric Oxygen Therapy is thought to be able to reach areas of injured tissue where some restriction in blood flow is present and accordingly this will accelerate the healing process. If Hyperbaric Oxygen is used as a treatment modality then although the flow of blood to the injured area remains reduced, the increase in red blood cells caused by the delivery of pure oxygen ensures that the healing process is allowed to continue unhindered.

The injured tissue thus gets the benefit of oxygen stimulation which accelerates the healing process without having an adverse effect on the injury by increasing actual blood flow in the early stages. In the latter stages of injury, as in Cristiano Piccini’s case, Hyperbaric Oxygen treatment is thought to be just as effective since injured ligaments and tendons in particular are renowned for their slow healing properties as they don’t have a good blood supply anyway, hence the intervention.

With muscles, tendons and ligaments dependent on effective blood flow for healing, it’s thought that using Hyperbaric Oxygen is an ideal way to achieve this. Treatment times within the Oxygen Chamber will vary but the evidence points to roughly 90 minutes divided into two separate 45 minute sessions as being the average time required for the delivery of pure oxygen to be most effective; ideally applied daily to begin with, and as soon as possible after the injury has been sustained. The treatment times can then be ‘tapered’ as progression takes place and injury symptoms improve.

Dr Calero explained his thoughts on this method of treatment to Marca the other day. “We want to integrate hyperbaric therapy into our overall treatment protocols for dealing with muscular injuries. In addition to speeding up tissue healing and recovery times, the treatment also allows us to reduce fatigue in any players who are having hyperbaric therapy”.

Antonio Blanco, from the NISA Hospital in Sevilla where the chamber is located, explained further that Hyperbaric Oxygen treatment also helps players to recover physically from exercise because they derive more energy from the treatment. “Since more oxygen enters the cells where the energy is produced, more quantity occurs and (as a result) this increases muscle performance and improves post-match recovery”.

Use of Hyperbaric Oxygen Therapy remains mildly controversial in the sense that many physicians hold the belief that little evidence is available to support it’s use for the treatment of sports injuries. It’s been shown in the past that a professional footballer sustains injuries at an average of two per season; this equates to an average of 50 injuries per season for a club the size of Betis with a squad of 25 players. The priority, therefore, is for the club medical teams to get people fit as quickly as possible. Due to the nature of the game and the demands placed on footballers to be fit and available for selection, professional players are just not able to rest up and wait for injuries to heal.

Physiotherapy treatment for footballers is designed to bring about a speedy recovery with the minimum time away from the action and at club level every avenue is explored to make maximum use of available facilities. However, a common drawback is often that Hyperbaric Oxygen Therapy and other alternative treatments not normally used on a regular basis are rarely applied until injuries fail to recover through traditional means. Although the technique has been used by many football clubs over the years, conclusive evidence is still lacking as to it’s success.

As a recognised treatment modality in diving medicine, Hyperbaric Oxygen Therapy is used effectively to treat decompression sickness – ‘the bends’ – and it’s use is supported by current available evidence derived from numerous studies. However, as far as football is concerned, various authors have produced research which suggests the treatment has the potential to be effective, but further study is required into whether this is actually an effective treatment modality for sports injuries.

Hyperbaric Oxygen Therapy has been shown, however, to have a positive effect on any part of the body which requires an increased blood supply; and in this case the treatment of soft-tissue muscle injuries such as Cristiano Piccini’s hamstring seems wholly appropriate.


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