Question
What is joint disease and hemophilia as well as the precautions and contraindication for treating an individual with hemophilia?
Answer
Joint disease is the most common complication of hemophilia in which the synovium and cartilage become damaged. The joint bleed triggers a repetitive cycle of swelling which becomes chronic and results in a deformity. These joints are known as the target joints. The target joints include the knee, ankle, elbow, shoulder, wrist, and hip. The impacted muscles include biceps brachii, forearm flexors, iliopsoas, quadriceps, hamstrings, and gastrocnemius.
The synovium’s role is to remove fluid from the joint. In a patient with hemophilia, this means it absorbs the blood; which is high in iron. Iron triggers the synovium to get thicker. Thicker synovium contains more blood vessels and additional blood vessels contribute to more profuse bleeding. Synovium releases collagenase when it is swollen, which destroys the cartilage that covers the bone. The result is painful bone-on-bone contact.
Precautions for PT include:
- Pain which may not always be felt early in a bleed
- Patient awareness of their body and limitations is very important
- Patient reported fatigue
- Hematomas
- Timing of session with factor replacement
- Severe hemophilia associated with reduced lumbar bone mineral density
Contraindication for PT include:
- Uncontrolled or unmanaged bleed
- Life threatening bleed
- Unstable spine
- Bleed caused by trauma, awaiting imaging to rule out a fracture
- Working muscles that cross two joints, one of which is an active bleed
- 1 Repetition Max
- Ballistic stretching
For more information on physical therapy management and treatment considerations, please see our course: Hemophilia by Dr. Katie O'Shea, PT, DPT, MBA, GCS, CDP
