SWAYAM

A Physio Volunteers Group

IMPORTANCE OF
PHYSIOTHERAPY IN
HAEMOPHILIA

•Dr. Maulik Patel (B.P.T.,MIAP)

 How do clotting factors work ?

Clotting factors in
blood -

vWork one after the

other
vAt the end of the
chain, bleeding stops.
vIf one clotting factor
is missing or does not
work, clots will not
 Types

Haemophilia A
•

• most common type

• caused by lack of clotting factor VIII.

Haemophilia B
•

• caused by lack of clotting factor IX.

Haemophilia C
•

• caused by lack of clotting factor XI.

•
 Severity
Mild :-
•

•
Level is 5-50%.
• Only occasional bleeding usually related
to significant trauma or surgery.
Moderate :-
•

•
Level is 1-5%.
• Spontaneous bleeding is uncommon but
occurs after minor trauma or surgery.
Severe:-
•

•
Level is < 1%.
• Spontaneous joint and soft tissue
bleeding several time several month.
 Bleeding
Sites
Head
N
eck Shoulde
Arm r
Elbow
Hip

Thigh
Thigh
K
nee

Ankle Calf
Joints
• • Muscles
• Knee • Iliopsoas
• Ankle • Fore-arm
• Elbow muscles
• Calf
• Thigh muscles
•
Which bleeds are serious
or life-threatening?
 Is haemophilia lifelong?
•

• Yes
• The level of clotting
factor in his blood
usually stays the
same throughout his
life.
 How can bleeds be
treated with first aid?

REST
•

ICE
•

COMPRESSION
•

ELEVATION
•
Maintenance of healthy joints and muscles
•

• crucial to the quality of life of a PWH.

Clotting factor replacement

•

• may stop or even prevent bleeds but does

not restore joint or muscle function.

•

• Only regular
movements and exercise
can do that
 Aims of Physiotherapy

Diagnosis and treatment of the musculoskeletal

•

system;
•

Advise and education regarding physical activities;

•

Collaboration with other team members;

•
MUSCLE BLEEDS
•

•Early
• Tingling sensation

• Feeling of warmth

•Late

• Difficulty in movement

• Pain with movement

• Tightness or swelling, possibly even when

muscle is at rest
• Numbness or tingling feeling (may be

described as feeling "asleep")

• Area is warm to touch

•
 What are the long-term
effects of muscle bleeds?
After repeated bleeds,
•

muscles can become weak,

scarred, and shorter than
normal (sometimes
permanently).
•

Joints above and below the

•

muscle cannot move properly.

•
If nerves are damaged during
•

muscle bleeds, the muscle

may become weak or even
paralysed.
•

Permanent damage to joints,

•

muscles, and nerves

•

Affects the way a person sits,

•

stands, and walks.

•
Patient adopts a poor posture
•

• Hip & knee flexed

•

Parasthesia
•

• – front of the thigh

In acute stage
•

• Rest
• Ice
• Elevation
• Factor replacement
•
 In subacute stage
•

• antagonist muscles, i.e. abdominals

and greater gluteal muscles
• Gradually extend the affected hip as
pain and sensory changes allow
• Once the patient can lie
supine with the affected
leg resting almost flat on
the bed, or prone with
assistance of only one
pillow, it is time to
stretch the Iliopsoas
muscle further into its
length.
•
 • In the recovery stage
• start exercising in the standing position
• weight transfers in various stance positions,
• strengthening the lower limbs
•
JOINT BLEEDS
 Which joint bleeds are
most common?
Common joints involved
•

• Knees
• Ankles
• Elbows
•

Joints of the hands are not usually

•

affected except after injury.

•
 Signs and Symptoms
• Early
• An "aura" or feeling that something is wrong with the joint
• A feeling of bubbling, tingling or warmth in the joint
• Late
• Stiffness of joint
• Pain
• Swelling
• Inability or refusal of patient to straighten joint or to bear
weight
• Limited movement
•
 Synovitis

Accumulation Irritates Synovial

of blood synovial lining
membrane swells

Develop
More more
Bleeding blood
vessels
 Hemophilic Arthritis
This damages the smooth cartilage
•

that covers the ends of the bones.

•

Joint becomes stiff, painful to move,

•

and unstable.
•

muscles around the joint weaken.

•

With time, most of the cartilage

•

breaks down and some bone wears

away. Sometimes the joint cannot
move at all.
•

The whole process is called

•

hemophilic arthritis.
•
•Flexion contracture
•Dorsal subluxation of tibia

•Valgus deformity

•Outward rotation of tibia

•Patella subluxated laterally

 Physiotherapy
•

•Traction

• Intermittently –

manually
• Continue – through

weight
•

Mobilization
•

• Ventral sifting of tibia

• Patella mobilization

•
Weakness in extensor muscles
•

• Quadriceps, hamstrings, hip abductors

•
Only active stretching
•

• Hamstrings,

• femoral head of

quadriceps
• calf
•To relieve pain
•Promote tissue repair

•Assist in the restoration of function

• Modalities used
• Ultrasound
• TENS
• Pulse SWD
•
Ultrasound therapy
Pulsed short-wave diathermy (PSWD)