The Importance of Exercise for Hemophilia Patients

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The Importance of Exercise for Hemophilia
Patients

• Tania Murray, PT

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Orthopedic complications with hemophilia

• Joint Bleeds
• Muscle Bleeds (may become pseudo tumors)
• Contractures (inability to move a joint due to
  fibrosis changes around the joint)
• Gait Deviations (limp)
• Bony Changes (deformity)
• Postural Changes/Biomechanical Alignment
• Muscle Atrophy (wasting)
• Osteoporosis (bone weakening)
• Degenerative Arthritis

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Joint Bleeds

• Left Figure Bony Changes due to joint bleeds
• Right figure shows actual bleed in an elbow
  jointblood within the joint space which may
  calcify

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Orthopedic Complications

• Top slide--- muscle atrophy
• Bottom slide----Osteoporosis

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Target Joints

• Hinge joint
• Knee
• Ankle
• Elbow
• Cant handle rotary (twisting) forces
• Naturally have more synovium

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Less Common Orthopedic Complications

• Subchondral cysts (usually found in hinge
  joints)
• Hemophilic pseudo tumor
• Osteonecrosis

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Subchondral Cysts

• These dark synovial masses will erode the
  cartilage and produce subchondral cysts (arrows).

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Hemophilic Pseudo tumor

• Excessive bleeding into the bone/muscle may
  produce psuedo tumors
• X-ray of this 37 year old shows the formation of
  a pseudo tumor on the lateral aspect of the femur.

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Osteonecrosis

• Death of bone tissue
• Evident in the talar dome of the ankle in this 20
  year old with hemophilia

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Healthy Joints

• Have full pain free motion
• Surrounded by STRONG muscles
• Do not show evidence of bony changes
• HEALTHY JOINTS BLEED LESS!!!

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Exercise promotes healthy Joints

• Maximizes Range of Motion
• Improves Muscle Strength
• Promotes Good Balance and Coordination
• Allows for Gait with Minimal Deviation
• Prevents Synovial Changes

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Range of Motion

• How much mobility a joint has
• Active how much the patient can move the joint
• Passive- how much an external force can move the
  joint
• Bracing
• Stretching
• Full Range of motion at a joint allows for normal
  usage of the joint and less wear and tear on
  that joint

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Lack of Range of Motion

• Can be caused by bony changes as well as tight
  muscles
• Contractures will result from this lack of motion
• Gait deviations (Limp) may result from this lack
  of motion
• Muscle atrophy (wasting) usually occurs with
  prolonged gait deviations

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Stretching

• Upper Left ---Calf Stretching
• Lower Left---Hamstring Stretching
• Upper Right--- Bicep Stretching using Weight

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Muscle Strength

• Strong muscles stabilize joints
• Stable joints have less torsion, friction and
  shear
• Torsion (twisting), friction (rubbing) and shear
  (parallel forces applied in opposite directions)
  lead to joint breakdown
• Joint breakdown leads to increased bleed
  occurrence

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• Good Balance and Coordination
• Decreases risk of falls
• Less sprains and strains

• Gait Without Deviation
• Gait deviations put abnormal strain on other
  parts of the body
• This strain can cause micro trauma to the joints
• This micro trauma can lead to new bleeds

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Other benefits of exercise

• Improved Pain Tolerance
• Promotes a Sense of Emotional Well Being
• Allows for Normal Growth and Development
• Expedites Rehabilitation

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Improved Pain Tolerance

• Endorphins and enkephalins release by the brain
  during exercise improve ones tolerance to pain
• Mobility causes muscle relaxation and promotes
  circulation both of which decrease pain

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Emotional considerations

• Sense of well being
• Promoting peer interaction
• Decreased fear of bleeds
• Stress management

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Allow for normal growth and development

• Proper posture and biomechanical alignment
• Preventing muscle atrophy
• Preventing Osteoporosis
• Preventing deformity
• Aesthetics
• Maximizes patients level of functional
  independence

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Expedited Rehabilitation

• Stronger more flexible joints heal faster
• Faster healing time means less stress on other
  areas of the body due to compensation
• Quicker return to normal activities

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