Recent Advances in Physiotherapy for Hemophiliacs
Physiotherapy specifically focuses on movement and the movement potential of the individual, with the purpose of restoring or maintaining maximum mobility and functional abilities throughout life. Numerous experiences have shown that physiotherapeutic procedures hold a key position for patients with hemophilia.
Risks of Damage and Their Prevention
Hemophilia is a bleeding disorder that has a significant impact on the musculoskeletal system. Bleeding − especially repeated − into joints or muscles leads to their damage. The predominant problem is hemophilic arthropathy, which in its final stage includes limited range of motion, flexion contractures, pain, and swelling. Imaging techniques, particularly MRI, show hemosiderin deposits, synovial hypertrophy, damage to cartilage and bones.
The fundamental approach in the treatment of hemophilia in individuals with bleeding manifestations is therefore the prevention of bleeding by regularly administering concentrates of the missing factors. The standard is early initiation of prophylaxis, although the effect is also seen in the case of already existing joint damage.
Balance Between Rest and Mobilization
Current recommendations concerning the treatment of hemarthrosis include early physiotherapy as an important component. The goal is to control symptoms, prevent recurrence of bleeding and further joint damage, and to quickly restore full joint function and activity.
The typical set of recommendations is referred to as PRICE, which is an acronym for protection, rest, ice, compression, elevation, and rehabilitation. However, recently there has been a trend towards the earliest possible initiation of rehabilitation, introducing a new acronym POLICE (protection, optimum loading, ice, compression, elevation), where rest is replaced by optimal loading, including the use of crutches, support means, etc. Large joints with the presence of blood should initially not be fully weighted, but prolonged rest can negatively affect joint function, especially by reducing the strength of surrounding muscles, changing tissue biomechanics, and dynamic joint control. Therefore, in practice, a balance should be struck between resting and early mobilization.
Exercise positively affects pain, range of motion in the joint, muscle strength, and mobility. Current physiotherapeutic care recommends using exercise as part of the strategy to relieve pain and improve muscle strength. Regimens including functional exercises and hydrotherapy are appropriate.
Conclusion
Physiotherapy represents a crucial component of care for hemophiliacs. With current approaches, such as ultrasound diagnostics in the orthopedic, hematology, or sports medicine outpatient clinic, gait and movement analysis, and the use of modern tools monitoring physical activity, the current state of musculoskeletal health of these patients can be very well determined. Hemophilia is thus a condition typically requiring multidisciplinary care and cooperation.
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Source: Stephensen D., Bladen M., McLaughlin P. Recent advances in musculoskeletal physiotherapy for haemophilia. Ther Adv Hematol 2018; 9 (8): 227–237, doi: 10.1177/2040620718784834.
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