Graciela Bohorquez de Perinni,* Marta Elena Tobón Duque,** Claudia Briceño García.**
*Nurse, with training in Hemophilia **Physiotherapist. Santa Fe de Bogotá Foundation.
Correspondence: [email protected].
Introduction
Most people with hemophilia suffer from musculoskeletal bleeding problems, such as hemarthrosis (bleeding from the joints) and hematomas (bleeding from the muscles).
The joints most frequently involved are the knees, elbows, ankles and less frequently the hips, shoulders and wrists.
Muscle bleeds can occur in any muscle. The gastronemius, calf muscle, is the most common site, and it is also common in the iliopsoas, quadriceps and biceps.
These hemorrhages cause pain, inflammation and limitation of movement, and can lead to muscle atrophy and changes in the normal position of the affected joint.
Once the bleeding is controlled, it is necessary to recover normal joint or muscle function and an appropriate exercise routine is an essential tool.
Physiotherapy aims to maintain and increase joint mobility, improve muscle power, trying to recover the normal function of the joint or affected region. Several phases are considered in the physiotherapy treatment: the preventive part, aimed at people at risk of developing or repeating bleeding. If a person improves their general physical condition, that is, strength and flexibility, the muscles will provide better support to the joints and bleeding will be less likely. The second phase is the treatment carried out when bleeding occurs in a joint, either for the first time or after a previous one.
This brochure produced by the Hemophilia Group of Fundación Santa Fe de Bogotá presents basic concepts about sports activities for patients with hemophilia and an exercise program that can be done at home with the help of the family. It is designed to treat specific problems as well as improve overall physical fitness. To achieve this purpose, the authors recommend performing the exercises with a minimum frequency of three times a week and having a sporting activity once or twice a week, without demanding effort from the body.
Sports Activities
They are exercises that are performed in a group or individually and whose objective is to recreate, produce satisfaction and competition. They highlight those who practice it within their community and maintain the socialization process at different ages of life.
Sports activities are very varied according to the culture of each country; The difference is that people with hemophilia should not do them competitively unless it is as a family or with groups of equally hemophilic individuals. When scheduling these activities, physical conditions, abilities, as well as tastes or preferences must be taken into account.
Any physical activity should be avoided when there is bleeding, but once it stops, activity should be resumed gently.
In general, swimming, table tennis, walking, golf, bowling, cycling, billiards and some dancing are recommended. Avoid contact sports such as boxing, karate, soccer, motorcycling, baseball, basketball, and volleyball, and high-risk sports. In South American countries, soccer is an activity common to all human groups and for this reason isolating the person with hemophilia from this activity could be counterproductive. The use of rubber balls is recommended as opposed to conventional leather ones to offer less resistance to impact. When sharing this sporting activity with the family, parents must take into account not being competitors with their hemophiliac children.
The exercises
Exercises are repetitive and progressive programmed activities that require guidance and assistance, increase muscle power while maintaining or increasing mobility and decreasing deformity.
The lower limbs, upper limbs and trunk can benefit from practicing these exercises, keeping in mind that they should be performed for both sides of the body.
Exercise program
All the exercises described below should be repeated five times and gradually increase until you reach ten or fifteen times.
Exercises to maintain or improve joint ranges of motion
1 Lying on your back, legs straight, slowly bend your thigh and knee, directing it toward your chin. Gently stretch to the starting position. It can be done by resting the heel on the bed, then it can be done by leaving the foot in the air without support. Alternate legs.
2 Lying face down with legs straight, slowly bend one knee as far as you can. Hold for a count of five and gently stretch back to the starting position. Alternate legs.
3 Lying on your back or sitting, do the following movements with your feet: bring your feet up, down, in, out. Bend and straighten your toes.
4 Standing or sitting in a chair, place your arm next to your body, bend and straighten your elbow without moving your shoulder.
5 Standing or sitting in a chair, place your arm next to your body, bend your elbow at a right angle and rotate your forearm until your palm is down and then up. Keep your arm close to your body.
Exercises to strengthen the muscles of the knees, elbows and feet
6 Initially all exercises should be done without weights. Once your strength improves, use an elastic band or a weight.
Lying on your back with a small pillow rolled under your knee, lift the foot of the bed by straightening your knee. Hold for a count of five and lower yourself slowly. An ankle weight may be used.
7 Lying on your back, contract the muscle above the knee and raise your straight leg so that the heel separates from the bed about 10 or 15 cm. Hold the position for a count of three and lower yourself slowly. You can do this by having the opposite leg bent and resting on the bed. Alternate with each leg.
8 Sitting on the edge of a bed or a high chair and with your legs hanging, raise one leg by straightening the knee, count to five and gently lower yourself to the starting position.
9 Once you can stand without support, stand with your feet slightly apart. Leaning on the back of a chair, try to bend your knees without lifting your heels off the floor, stay like this for a count of five and get up slowly.
10 Standing or sitting, place the arm that needs to be exercised in front of you, the opposite hand supports the elbow, bend and stretch until it is completely straight. Hold for a count of five. the upper part of the back.
11 Standing in front of a wall and slightly away from it, rest your hands against the wall, your right leg forward with the knee slightly bent and your feet flat on the floor. Without arching your back, shift your body weight forward until you feel a stretch in the back of your left knee.
Count to ten and rest, repeat with the other leg. It can also be done by placing your arms stretched above your head and your hands resting on the wall. Thus stretching the muscles of the upper back.
Exercises for the shoulder and wrists
12 Sitting or standing with the right arm stretched in front and the palm facing up, with the help of the left hand, bring the wrist and fingers of the right hand downward. Count to five and rest. Do the same with the opposite arm.
13 Standing or sitting, take a rolled towel or a stick with both hands, raise it above and behind your head, count to ten and rest, then bend your elbows passing the stick behind your head.
14 Standing or sitting with your arms stretched downwards, take a rolled towel or a stick with both hands behind your back, bring your arms back trying to bring your elbows together and hold for a count of ten and rest.