What's the difference between HBOT and PRP?

PRP (platelet-rich plasma) concentrates growth factors from your own blood and injects them into a specific injured tissue site. HBOT is systemic — it raises oxygen levels throughout your body. PRP targets a precise injection point. HBOT affects all tissue with blood supply.

Is PRP or HBOT covered by insurance for joint injuries?

PRP for most orthopedic uses (knee OA, rotator cuff) is not covered by insurance, with limited exceptions. HBOT for musculoskeletal injuries is off-label and not covered. Both are typically out-of-pocket for these applications.

Can HBOT and PRP be used together?

Some sports medicine and wound care practices combine both. The theoretical rationale is that HBOT creates an oxygen-rich environment that may support the tissue response to PRP's growth factors. Clinical trials on this combination are small and preliminary.

Which has more evidence for musculoskeletal injuries?

PRP has more randomized controlled trial data for specific musculoskeletal applications like knee osteoarthritis and lateral epicondylitis. HBOT has stronger evidence for wound healing and FDA-approved medical conditions. For musculoskeletal use specifically, both are investigational with neither having a clear evidence advantage overall.

How much does PRP cost compared to HBOT?

PRP injections typically cost $500-$2,500 per injection, depending on the joint and provider. HBOT for musculoskeletal use runs $250-$450 per session, typically 10-20 sessions for athletic recovery protocols. Both are out-of-pocket costs.

HBOT vs. PRP: Two Different Approaches to Tissue Repair

Both HBOT and PRP appear regularly in sports medicine and orthopedic recovery discussions. They aren’t competing treatments. They work through different mechanisms, target tissue repair differently, and have their own evidence profiles. Here’s an honest look at each.

How PRP Works

PRP starts with a blood draw — typically 30 to 60 mL of your own blood. A centrifuge spins it down to concentrate platelets, which contain growth factors: platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), vascular endothelial growth factor (VEGF), and others.

The concentrated platelet solution is injected directly into the injured tissue — a specific tendon, joint space, or muscle. The growth factors are delivered at a precise location and signal local cells to initiate repair processes.

PRP’s effect is local. The injection site gets the concentrated growth factor signal. Surrounding tissue doesn’t.

How HBOT Works for Tissue Repair

HBOT is the opposite approach. It’s not local at all. At 2.0 to 3.0 ATA with 100% oxygen, dissolved oxygen levels rise throughout your entire circulatory system. Every tissue with blood supply gets elevated oxygen delivery.

The systemic effects include increased angiogenesis (new blood vessel formation), stimulated growth factor production throughout the body (including VEGF, similar to PRP), anti-inflammatory cytokine modulation, and stem cell mobilization from bone marrow.

HBOT can’t target a specific tendon. It can create a systemic environment that supports tissue repair everywhere. When combined with PRP, the idea is that HBOT’s oxygen-rich environment supports the local tissue response that PRP’s growth factors initiate.

Evidence Comparison for Musculoskeletal Use

PRP has more RCT data for specific musculoskeletal applications than HBOT does in this area. Multiple trials have studied PRP for knee osteoarthritis, lateral epicondylitis (tennis elbow), rotator cuff injuries, and Achilles tendinopathy. Results are mixed across applications — stronger evidence for knee OA and lateral epicondylitis, weaker for others. FDA has cleared specific devices for PRP preparation.

HBOT’s musculoskeletal evidence comes primarily from athletic recovery studies and case series. The stronger HBOT evidence base is in wound healing, CO poisoning, and other FDA-approved medical indications. For musculoskeletal and athletic use, HBOT is investigational.

Neither PRP nor HBOT has unambiguous RCT evidence establishing superiority for most musculoskeletal conditions. Both are used widely in sports medicine based on mechanism-level reasoning and clinical experience rather than definitive trial data.

The Insurance Reality

PRP for orthopedic uses is not covered by most insurance plans. A small number of plans cover it for specific applications with documentation. Expect $500 to $2,500 per injection out-of-pocket, depending on the joint and provider.

HBOT for musculoskeletal and athletic recovery is off-label. No insurer covers it for this purpose. Expect $250 to $450 per session, with typical athletic recovery protocols running 10 to 20 sessions, for a total of $2,500 to $9,000.

Neither is a cheap intervention for most patients.

When Clinicians Combine Both

Some sports medicine practices and wound care centers use HBOT before or after PRP injections. The rationale: HBOT raises tissue oxygen in hypoxic or ischemic areas, potentially improving the environment for the growth factor signal that PRP delivers.

This combination is used clinically but studied in small trials. Everts et al. have published on the combination for wound care with encouraging results, but large RCTs are lacking. Don’t expect insurance to cover a combined protocol for musculoskeletal use.

What Neither Can Do

Neither PRP nor HBOT is a substitute for surgery when surgery is indicated. Torn ligaments that require reconstruction, severe osteoarthritis that requires joint replacement, and fractures with instability need surgical care. Regenerative therapies work best when structural integrity is intact.

Both are better suited as adjuncts to physical therapy and rehabilitation than as standalone treatments. Talk to an orthopedic surgeon before choosing between or combining these treatments for a specific injury.

See our condition page on athletic recovery for more on HBOT in sports medicine.

FAQ

Should I get PRP or HBOT first for a tendon injury? This depends on your specific injury, your orthopedist’s recommendation, and your goals. There’s no established protocol that definitively answers this. Some practices prefer HBOT before PRP to optimize tissue oxygenation. Ask a sports medicine physician who uses both.

Is PRP safer than HBOT? Both are generally safe when administered correctly. PRP uses your own blood, eliminating rejection risk. Risks include injection site pain, infection, and temporary flare. HBOT risks include ear barotrauma, temporary myopia, and claustrophobia. Neither is high-risk in appropriate candidates.

My orthopedist recommends PRP but hasn’t mentioned HBOT. Should I ask? You can ask. Not all orthopedic practices use or are familiar with HBOT. If you’re seeing a sports medicine physician or physiatrist, they may be more familiar with the combination approach.

Does HBOT improve recovery from orthopedic surgery? This is an area of growing interest. Some practices use HBOT post-operatively for faster recovery, particularly for complex procedures. It’s off-label and out-of-pocket. See How Many HBOT Sessions for protocol context.

Medical Disclaimer: The content on this page is for informational purposes only. It is not medical advice and does not create a doctor-patient relationship. HBOT for musculoskeletal conditions is off-label and not FDA-approved for this use. Consult a licensed physician before starting any regenerative therapy for injury or joint conditions.