Hyperbaric oxygen therapy for soft tissue injury and delayed onset muscle soreness. A systematic review


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.


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

Search strategy

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.

Selection criteria

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).

Data collection & analysis

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.

Main 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, in functional outcomes, pain or swelling. There was no difference between the two groups in the knee function scores in the second acute injury trial: however, intention-to-treat analyses was not possible for this trial.
Pooling of the data available 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.
There was no report of adverse effects of HBOT but the careful selection of participants was evident in most trials.

Reviewers' 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 preceded by carefully conducted randomised controlled trials.

Citation: Bennett M, Babul S, Best TM, Lepawsky M, Taunton J. Hyperbaric oxygen therapy for delayed onset muscle soreness and closed soft tissue injury. The Cochrane Database of Systematic Reviews 2005, Issue 3.