Hyperbaric oxygen therapy (HBOT)

The peer-reviewed paper Aging published a research paper that investigated the HBOT and its potential improvement to the telomere length (TL) and decrease of immunosenescence.  In other words, the researchers found that a unique protocol of treatments with high-pressure oxygen in a pressure chamber can reverse two major processes associated with aging and its illnesses: the TL (protective regions located at both ends of every chromosome) and the accumulation of old and malfunctioning cells in the body (aka “zombie” cells). In case you are not sure what these mean please refer to the previous blog).

The word ‘hyperbaric' literally means ‘high pressure'. The use of high pressure (i.e. pressures higher than normal atmospheric pressure)and its use in medicine is often viewed today as being somewhat new and controversial. However, the concept of Hyperbaric Medicine has been in existence since as early as 1662.

The industrial revolution, when bridge and tunnel builders were working in compressed air, saw further great development in hyperbaric chambers. It was at this time when Paul Bert reported that nitrogen bubbles were forming in tissue during rapid decompression – these also sometimes referred to as “bends”

Since the latter part of the twentieth century, hyperbaric medicine has gained most of its recognition for the treatment of certain mainstream medical conditions specifically related to the diving industry, including decompression sickness and air embolism.

The benefits of hyperbaric medicine subsequently were observed for split-thickness skin graft acceptance, flap survival, and salvage, wound re-epithelization, and acute thermal burns. It is also used in treatment for post-stroke rehab, MS, and traumatic brain injury.

If you would like to read more about the Hyperbaric chambers please check the Midlands Diving Chamber website

Hyperbaric oxygen therapy (HBOT) utilizes 100% oxygen at an environmental pressure higher than one absolute atmosphere (ATA) to enhance the amount of oxygen dissolved in the body’s tissues. Repeated intermittent hyperoxic exposures, using certain HBOT protocols, can induce physiological effects that normally occur during hypoxia in a hyperoxic environment, the so-called hyperoxic-hypoxic paradox. If you are interested to read more about this, please refer to the Hadanny and Efrati. 2020, study.

It was recently demonstrated that HBOT can induce cognitive enhancements in healthy aging adults via mechanisms involving regional changes in cerebral blood flow. On the cellular level, it was demonstrated that HBOT can induce the expression of hypoxia-induced factor (HIF), vascular endothelial growth factor (VEGF) and sirtuin (SIRT), stem cell proliferation, mitochondrial biogenesis, angiogenesis, and neurogenesis.

Coming back to the study that looked at HBOT and telomere length by Hachmo et al. 2020. The findings indicated that the treatments actually reversed the aging process in two of its major aspects: The telomeres at the ends of the chromosomes grew longer instead of shorter, at a rate of 20%-38% for the different cell types; and the percentage of senescent cells in the overall cell population was reduced significantly -- by 11%-37% depending on cell type.


Limitations of the study consist of a small sample size (30 people). Also, there was no control group.

Third, the duration of the effect has yet to be determined in long-term follow-ups.

Fourth, telomerase (protein that restores telomere length) activity was not evaluated due to the method chosen for blood preservation and evaluation

Fifth, the study looked at immune cells such as natural killer cells, B-cells, T helper, and T cytotoxic cells. It would be interesting to see the change in TL in somatic cells.

Lastly, the protocol consisted of 60 daily treatments. Locally it costs £100 for one treatment of HBOT. It means the total to replicate this protocol would be 6000 pounds!!! However, a significant improvement was shown after 30 sessions. Perhaps that could be more realistic treatment option.

To sum up, this is just a pioneer study and more research is needed to prove this method as an effective way to improve health and subsequently increase longevity.

For more information on HBOT please refer to Peter Attia's podcast with Dom in 2018 and 2020

MSK physiotherapy


Aging - introduction

Is the process of becoming older. That’s the simplest explanation found on Wikipedia. We all start to age as soon as we are born. The first symptoms of aging are the loss of ability to hear high-frequency sounds (>20kHz). This happens when we hit our teenage years.

Why are we aging? At the cellular level, two key hallmarks of the aging process include Telomere Length (TL) shortening and cellular senescence (also called “zombie” cells). This video below explains it quite well.

Today telomere shortening is considered the ‘Holy Grail’ of the biology of aging.

Researchers around the world are trying to develop pharmacological and environmental interventions that enable telomere elongation or at least slow down the rate at which telomeres are shortening.

There has been multiple studies published that have shown an ability to slow down the process. Several lifestyle interventions including endurance training, diets, and supplements targeting cell metabolism and oxidative stress have reported relatively small effects (2-5%) on TL, [Toukalas et al 2019Goglin et al 2016Richards et al, 2007].

Contrary, drug abuse can increase the rate of TL shortening.

One recent study by scientists in Israel at the Tel Aviv University indicated that hyperbaric oxygen treatments (HBOT) in healthy aging adults can stop the aging of blood cells and reverse the aging process. In the biological sense, the adults' blood cells actually grow younger as the treatment progresses.

This study was published on the 28th of November at Aging and I will write a separate blog on it in coming weeks.

What can be done?

Ideas used here are not something new. From the earliest civilisations people were trying to find a proverbial fountain of youth.

However, the purpose of these series of blogs is not to promote alternative medicine or promise a longer life. The main purpose is to talk about the lifestyle changes, latest research, and ideas that may help to increase the healthspan – essentially, years with good health.

I have been inspired by people like Peter Attia (please check his website), David Sinclair, Rhonda Patrick, and Charles Brenner. Please visit their websites for some expert opinions.

Shoulder Pain

Rotator cuff related shoulder pain

The rotator cuff is a complex made of four muscles and their tendons (muscle attachments on a bone). This particular structure keeps the shoulder joint in the socket joint.

The shoulder joint is the fastest and the most mobile joint in the human body. To achieve this level of mobility sacrifices had to be made. And the sacrifice comes in a shape of stability. The shoulder joint (ball and socket) has a very shallow socket. Therefore,  the rotator cuff muscles have to work hard to keep it in its place.

It is believed that the speed of the joint was needed when we (homo sapien) evolved to stand on our two feet and started to hunt. Shoulder joint evolved to be able to throw spears and rocks to hunt animals. However, it is not designed to do repetitive overhead movements. It is very common for people that perform these actions for example painters and decorators or gardeners to develop shoulder pain. The risk of developing shoulder pain increases with age as well.


What is the best way to get rid of shoulder pain?

It is always recommended to see a specialist initially to have a diagnosis. The best current evidence is progressive loading (exercise therapy) to strengthen the whole shoulder complex.

At AMR physiotherapy, we will provide a detailed assessment and provide the latest evidence-based treatment plan that usually consists of hands-on technique and exercise therapy. Most importantly, the years of experience in an NHS setting, in MSK and Chronic pain services will ensure that we will be able to identify a serious pathology and direct you to the right place if needed.

If you wish to try some of the lower back exercises yourself please consider visiting our InstagramFacebook and Youtube pages. We have put a list of exercises that may help to improve your function and hopefully reduce the pain you are in. 

Lower Back Pain

Lower Back Pain

Lower back pain is the most common musculoskeletal condition treated by physiotherapists. Most if not all adults will develop lower back pain at some point in their lifetime. Sometimes it could be caused by trauma – sports injuries, road traffic accidents, falls etc. However, most of the time the pain starts for no particular reason.  Historically and still currently, lower back pain is highly over medicalised. Treatment and prognosis associated with lower back pain vary widely from bed rest to surgery. Invasive procedures such as surgeries, injections, and medications were and still are very common. However, in most cases, this is unnecessary and avoidable. It is known that high-income countries, such as in the UK, dangerous medication like opioids are widely used to treat lower back pain. Again, this can be avoided.

To look more into back treatment and recovery we need to answer a few key questions:

 What causes lower back pain?

  •  Non-specific back pain

Most commonly lower back can be non-specific. Meaning, the identity of the structure that causes pain, isn’t specific. Non-specific lower back pain can be caused by inflammation around the small joints in the spine, muscle spams due to change of load (routine), nerve irritation due to repetitive movement, or a combination of all these factors. There is no imaging needed in this instance. Usually, this results in episodic back pain, which lasts from a week to six weeks and tends to get better by itself.

  •  Discogenic back pain i.e. disc bulges, “slipped discs”, herniated discs

People are very worried when they find they have a disc problem. Discs anatomically are placed between two bony fragments called vertebra. The spine is made of multiple vertebrae linked with intervertebral discs. Inside these discs, we have a jelly-like substance that acts as a shock absorber. Occasionally, this soft substance pushes out from the middle onto the surface. If pressing on the nerve, this could cause back or arm or leg pain (depending on the location of this issue).  Importantly, most of the people having protruded, herniated or “slipped” (even though they never slip) discs have no pain/symptoms. Also, in most cases, the jelly-like substance returns into place within a year.

  • Arthritic or age-related changes in the spine

Over the years our joints change. Multiple factors are influencing these changes such as inadequate load, not enough recovery time, poor nutrition, and genetics. Over the years, gaps between joints become narrower leaving smaller exit holes for nerves to leave the spine or travel down. This could potentially cause pain. Alternatively, small joints in the spine, in the same way as your knee or hip joints, can cause pain themselves.

What is the best way to manage back pain?

This is a million-dollar question that modern medicine is yet to figure out. Well, not collectively or universally for everyone. The best management plan is individual. The most important thing is to have a thorough assessment to identify the issue and then work to improve function and pain levels.


Where do we come in?

At AMR physiotherapy, we will provide a detailed assessment and provide the latest evidence-based treatment plan that usually consists of hands-on technique and exercise therapy. Most importantly, the years of experience in an NHS setting, in MSK and Chronic pain services will ensure that we will be able to identify a serious pathology and direct you to the right place if needed.

If you wish to try some of the lower back exercises yourself please consider visiting our InstagramFacebook and Youtube pages. We have put a list of exercises that may help to improve your function and hopefully reduce the pain you are in.

Neck Pain

Neck pain is a very common issue these days. In most cases, these issues are caused by prolonged sedentary positions i.e. sat at the desk. In other cases, neck pain is caused by an injury like a fall, sports injury, or road traffic accident. In most cases, neck pain can be frightening and worrying. However, in most cases, it is the same as any other injury or pathology. If left unaddressed though, it could become a chronic problem.  Most of the neck symptoms consist of pain, stiffness, and muscle tightness. It is not unusual to experience tingling or numbness sensation. Occasionally, neck pain can cause headaches.

As a clinician the important questions that we try to answer with all conditions including the neck pain are:

  • What is wrong with me?
  • What can you do for me to help?
  • What can I do to help myself?
  • How long it will take to get better?

The structure of the neck and back are made up of small bones called vertebrae. These are stacked on top of each other to form the spinal column. The spinal column supports your head and protects the spinal cord. This is the main structure that links the network of nerves throughout your body. Messages travel along this network sending sensations, such as pain, to your brain. To support the spine, even more, ligaments and muscles attach to the vertebrae. Any of these structures could potentially cause discomfort or pain.

In most cases, exercises that work on movement, strength, and proprioception will make a positive effect on the pain. Besides, manual therapy provided by a clinician can help to aid the treatment.

If you wish to try some of the neck exercises yourself please consider visiting our Instagram, Facebook and Youtube pages. We have put a list of exercises that may help to improve your function and hopefully reduce the pain you are in.

Finally, to answer the question of how long it will take to get better is very subjective and depends on an individual case. Factors like your age, fitness level, diet, tobacco, and alcohol intake also play a part. However, we at AMR PhysioNottingham will help you to try to answer those four main questions and get you on the path to recovery. If you wish to book an appointment, please press on this link.

If you experience symptoms such as weakness in your arms or legs, loss of balance, bowel and bladder issues or loss of consciousness, you need to consult with your doctor immediately.