Hyperbaric oxygen therapy for delayed onset muscle soreness and closed soft tissue injury.
BACKGROUND
Soft tissue injuries (including muscle damage after unaccustomed exercise) are common and are often associated with athletic activity. Hyperbaric oxygen therapy (HBOT) is the therapeutic administration of 100% oxygen at environmental pressures greater than one atmosphere.


OBJECTIVE
To assess the benefits and harms of HBOT for treating soft tissue injury, including delayed onset muscle soreness (DOMS).


METHODS
We searched the following in July 2004: CENTRAL, MEDLINE, EMBASE, CINAHL, DORCTIHM and reference lists from relevant articles. Relevant journals were handsearched and researchers in the field contacted.


METHODS
Randomised trials comparing the effect on closed soft tissue injury (including DOMS) of therapeutic regimens which include HBOT with those that exclude HBOT (with or without sham therapy).


METHODS
Four reviewers independently evaluated study quality and extracted data. Most of the data presented in the review were extracted from graphs in the trial reports.


RESULTS
Nine small trials involving 219 participants were included. Two trials compared HBOT versus sham therapy on acute closed soft tissue injuries (ankle sprain and medial collateral knee ligament injury respectively). The other seven trials examined the effect of HBOT on DOMS following eccentric exercise in unconditioned volunteers. All 32 participants of the ankle sprain trial returned to their normal activities. There were no significant differences between the two groups in time to recovery, functional outcomes, pain, or swelling. There was no difference between the two groups in knee function scores in the second acute injury trial; however, intention-to-treat analysis was not possible for this trial. Pooling of data from the seven DOMS trials showed significantly and consistently higher pain at 48 and 72 hours in the HBOT group (mean difference in pain score at 48 hours [0 to 10 worst pain] 0.88, 95% CI 0.09 to 1.67, P = 0.03) in trials where HBOT was started immediately. There were no differences between the two groups in longer-term pain scores or in any measures of swelling or muscle strength. No trial reported complications of HBOT but careful selection of participants was evident in most trials.


CONCLUSIONS
There was insufficient evidence from comparisons tested within randomised controlled trials to establish the effects of HBOT on ankle sprain or acute knee ligament injury, or on experimentally induced DOMS. There was some evidence that HBOT may increase interim pain in DOMS. Any future use of HBOT for these injuries would need to have been preceded by carefully conducted randomised controlled trials which have demonstrated effectiveness.
Bennett
M
M
Prince of Wales Hospital, Department of Diving and Hyperbaric Medicine, Barker Street, Randwick, New South Wales 2031, Australia. m.bennett@unsw.edu.au
Best
T M
TM
Babul
S
S
Taunton
J
J
Lepawsky
M
M
D001265:Athletic Injuries / Q000628:therapy*; D006801:Humans; D006931:Hyperbaric Oxygenation; D009135:Muscular Diseases / Q000628:therapy*; D010146:Pain / Q000209:etiology; D059408:Pain Management; D016032:Randomized Controlled Trials as Topic; D017695:Soft Tissue Injuries / Q000628:therapy*; D013180:Sprains and Strains / Q000628:therapy*