4. Acute Bleeding means blood escaping from
the circulatory system.
Internally: Where blood oozing from
damaged blood vessels or organ inside the
body.
Externally: Where blood oozing due to
injury or trauma.
5. What is acute joint bleed?
People with hemophilia can bleed into
the joint space after an injury or at times
without obvious cause.
The pressure of blood filling the joint
cavity causes significant pain and can
lead to chronic swelling and deformity.
7. The Knees, Ankles and Elbows are more
commonly affected by acute bleeding than other
joints due to two reasons:
These joints have one degree of freedom of
movement -as simple HINGE JOINTS, they can
only flex and extend.
The hinge joints are not surrounded by other
protective muscles.
8. What are the symptoms of a joint bleed?
Warmth
Palpable swelling
Tingling inside the joint
Discomfort
Pain
Loss of motion
Stiffness
9. What is Acute Muscle bleed ?
The bleeding can start after the
muscle is direct blow, sprained or
sudden stretch in the muscle.
With severe hemophilia, it can also
happen for no clear reason
(spontaneous bleed). Muscle
bleeds can cause a lot of blood loss
inside your body.
11. What are the symptoms of a muscle
bleed?
Aching in the muscle
Trouble - moving arm or leg
The muscle feels warmer than other
areas of skin
Pain in the muscle
Muscle feels tight or swells up
Stiffness
The skin over the muscle changes color
or becomes blue.
12. Acute bleed should be treated as
quickly as possible, preferably within 2
hours.
During acute bleed first appropriate
Factor should be administered.
Patient usually recognizes early
symptoms / “aura” of bleeding.
13. The treatment of disease, injury or
deformity by physical methods such as
Electric Modalities and some type of
proper Exercise rather than by drugs or
surgery...
What is Physical Therapy ?
14. Role of Physiotherapy
Physiotherapy plays a vital role in the
prevention/ minimizing of deformities and
disabilities associated with hemophilia
and facilitates a normal functional lifestyle.
15. Goals of Physiotherapy
Treatment of muscle imbalances
Ensure ↓ of pain and ↑ of function
Stretching to improve flexibility and prevent
muscle shortening
Prevent and correct muscle imbalances
Strengthening of muscles to improve stability
Posture training
Correction of wrong/ harmful movement
patterns and joint biomechanics to prevent
damage
16. Acute bleed
Principle of PRIICE
P - Protection of the affected muscle or joint
R - Replace the missing clotting factor
I - Immobilize using a splint in the neutral
position
I - Ice application
C - Compression with a bandage
E - Elevation of the area which is bleeding
17. Protect: Why?
To reduce pain
Minimize risk of causing another bleed
The joint is at its highest risk of re-injury in
the first 2 weeks
The muscle is at its highest risk of re-injury
in the first 6 weeks
Replacement:
Factor (If available)
18. Immobilize: How?
NWB (Non weight bearing) of the affected limb
Use crutches and splints
Thermal plaster, back-slab (should be light) or
static splint
Splint use in a comfortable position and
comfortable ROM (range of motion)
No sports
Move only within pain-free range
Bed rest in cases of iliopsoas bleeds
19. Ice: Treatment protocol
Ice apply on the affected area
5 mins on, 10 mins off
Place the ice circumferentially around the area
Do not place the ice directly on the skin.
Use a towel or cloth as a barrier between skin
and ice
Use ice before and after exercise
20. Compression:
Slows bleeding
Reduces swelling
Reduces pain
Limits movement of the joint
Use crepe bandages
Not too tight because it may cause more damage
21. When bleeding has stopped…
After controlling acute bleeds
Joints /muscles need to return to pre-bleed state
Pre-bleed state depends on severity of bleeding
and length of rest/ immobilization
Target joints are less likely to return to pre-bleed
state
Rehabilitation
22. During acute stage
Start with gentle static muscle contraction (static
exercises) when pain allows
This can commence while the area is still
bleeding
5-10 contractions twice a day
Progress to 15 contractions at least 3 times per
day when pain decreases and swelling is down
23. ROM
Active stretching exercise
Hold-relax stretching after immobilization phase
Progress to contract-relax stretching
Hold the stretch for 10 -15 seconds
Serial splint can be used for prolonged stretching
24. Stretches
Be careful, because over stretching can lead to
muscle bleed
Active stretch is the best
Passive gentle stretch until full stretch
Serial splint for prolonged stretching (in case of
joint contracture)
25. Strength
Muscles are weaker after immobilization and rest
Isometric muscle contraction from acute stage
Progress slowly to free active exercises:
- Inner range exercises
- Movement with gravity eliminated
- Movement against gravity
26. Proprioception
Is a sense of posture, movement and change in
equilibrium and knowledge of position, weight
and resistance
Very important to restore because it is good for
dynamic balance
One-leg-stand test with eyes open and closed
Walking on uneven surface, hopping, skipping
and stairs climbing
27. Weight bearing status
NWB (non weight bearing) during acute stage with
crutches, splint
Progress to...
PWB (partial weight bearing)
FWB (full Weight Bearing)
28. Once the person resumes ADL
(activities of daily living),
this muscle usually regains its strength
without difficulty…
Swimming Is As Good as Soccer
29. Physiotherapy aims to:
• Educate people with hemophilia and their
families
• Advise patients about the importance of
joint protection
• Advise on treatment for pain and suffering
• Regularly assess and monitor joint status
• Work as part of the multidisciplinary team
to determine treatment modalities
30. Physiotherapy is an important part of hemophilia
care
The healing process will occur with good
rehabilitation techniques and is a slow process
Working in a team with the Medico and
comprehensive care team is advantageous to the
PWH
Proprioception needs to be worked on for every
bleed
Exercises plays most important part in PWHs
life.
Summary
31. Your kind support will help us to achieve the
goal
“ Hemophilia with out disability,
Children free of pain.”
THANK YOU
Contributed by: Dr. Pamela Narayan