Physiotherapy exercises for people with haemophilia
Physiotherapy helps with faster recovery of damage caused to a muscle or joint due to a bleeding episode
A physiotherapy program includes all the exercises that aim to the greatest possible recovery of damage in a joint or a muscle.
The design of a physiotherapy program for the joints depends on 3 factors:
The joint that bled
Knees, ankle joints and elbows bleed more often than other areas of the body.
The type of damage
Damage of the joint may concern the range of motion, the ability of the joint to move, proprioception, or a combination of the above. Proprioception is the ability of the body to react to a change in posture and maintain its balance. Different exercises are designed for each of the above needs.
Time phase of the bleeding
Certain exercises can only be applied if there is no active or recent bleeding, while others are suitable for the recovery phase.
Similarly, physiotherapy programs for muscle are based on:
The muscle that bled
Usually, the muscles in need of rehabilitation are the flexor muscles of wrist and toes, the gastrocnemius muscle (in the calf), the flexor muscles of the hip (iliopsoas muscle), the quadricep femoris muscles and the extensor hip muscles.
The function of the muscle
The effect of the bleeding is different depending on the function of the bleeding muscle. The stabilizing muscles are more resilient, located deep in the body and support the joints. The motor muscles perform the movements and get tired faster. Physiotherapy aims either to strengthen the muscle or to restore the dimension and length to make it functional again.
Apart from the above, a program of physiotherapy is being scaled up to levels of difficulty, in order to achieve the strengthening and restoration of joint or muscle bled. In addition, the type of exercises changes over time to suit the changing needs of the individual.
For these reasons, it is important that the exercise program is designed and implemented by a specially qualified professional of the Haemophilia Center and that the appropriate exercises are individually selected.
Calendar of personalized program for people with haemophilia
One exercise program cannot meet the needs of all people with haemophilia. Remember that each case is unique. The number of exercises and repetitions depends on the age and physical condition of the person, the time elapsed since the injury and, of course, the type of joint or muscle that has been damaged.
The wrong exercise, an exercise performed in the wrong way, an exercise performed at the wrong time (e.g., too soon after bleeding, or at the stage of recovery), or an exercise performed at the wrong frequency or intensity, can hurt even more the injured tissue.
An inappropriate physiotherapy exercise program at best will be unsuccessful while at worst will cause more damage to the injured tissue. Therefore, it must always be designed by a qualified professional, considering the specific needs of the individual.
The calendar of personalized program of physiotherapy exercises is a handy tool, which ensures that all parameters for designing the program are taken into account. It is a dynamic over time record of the exercises performed to repair a joint or muscle after a bleeding episode. As the rehabilitation needs of the joints and muscles change over time, this file shows the tolerance of the joint to the changes of the difficulty levels and the number of repetitions.
This calendar is designed by the physiotherapist in collaboration with the patient and their doctor. Sample page of a calendar regarding rehabilitation exercises of the joint, knee and gastrocnemius muscle:
Check here the rehabilitation exercises for the knee joint, the joint of the elbow and ankle joint:
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References:
1.WFH. Guidelines for the management of haemophilia. 2012.
Available at: http://www1.wfh.org/publications/files/pdf-1472.pdf [Accessed 24 October 2019].
2.Exercises for people with hemophilia by Kathy Mulder. WFH 2006.
Available at: https://elearning.wfh.org/resource/exercises-for-people-with-hemophilia/
