Scott Russell is the Haemophilia Physiotherapist at the Royal Brisbane and Women’s Hospital
For many people with haemophilia joint bleeds are an unfortunate consequence of the condition. Whether they are spontaneous, due to an injury or increased activity, a bleeding joint can have significant short-term (and possibly long-term) effects. Timely treatment in the form of factor replacement, rest, ice, and compression is important to reduce the bleeding and minimise these consequences. This article also explains the appropriate type and length of rest that should be employed following a joint bleed.
I have pain in my joint. Is it a bleed?
If you are developing pain in a joint, the first thing to determine is whether it is a bleed or not. This can be difficult, especially if the joint has arthritis. Some common bleeding signs are a tingling sensation, swelling, warmth, pain with weight bearing and reduced movement in the joint. Other conditions such as arthritis may have some of these signs but usually to a smaller extent. For example an arthritic joint may feel ‘stiff’, but you can still move the joint as per normal and it often doesn’t respond to factor replacement. There are also many other non-haemophilia muscle and joint conditions that can cause pain.
It’s a joint bleed! I have started my factor replacement, ice and compression. How should I rest the joint?
In the early stages it is important to rest the joint. This is done by restricting movement (e.g., by not bending and straightening the joint) and by avoiding weight bearing. For ankles and knees this means you should use crutches (or another suitable mobility aid). For elbows it means avoiding lifting and leaning on your arms. By doing this you minimise the risk of further bleeding and damage to the cartilage.
How long should I avoid weight-bearing?
Ideally, weight-bearing should be avoided whilst there is blood in the joint. This can vary depending on the severity of the bleed, but a good guide is to avoid weight-bearing for at least 2-3 days once adequate factor replacement has commenced. This is normally enough time for the bleeding to stop and pain to subside. If there has been no improvement over this time, then this period may be extended.
If you need assistance with equipment or advice regarding a painful joint, please don’t hesitate your Haemophilia Treatment Centre.
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