ABI POLUS
Abi Polus is Senior Clinical Physiotherapist-Haemophilia at the Ronald Sawers Haemophilia Centre, Alfred Health, Melbourne, Victoria.
It was wonderful to meet colleagues from across the globe at the WFH 2026 World Congress and collaborate with them, discussing similarities and differences in what we see and opportunities to share techniques, strategies and research ideas. I feel very privileged to have been supported to attend and will take what I have learnt and share it with my colleagues and my patients.
(Unsurprisingly), the musculoskeletal sessions were a highlight for me. The sessions described below I found particularly interesting.
Co-chairs ~ Greig Blamey, Canada; David Stephensen, UK
Case #1: Pediatric~ Christian Carulli, Italy
Case #2: Ankle/pseudotumor~ Shubhranshu S. Mohanty, India
An interactive session presenting two clinical cases with three groups discussing and presenting how they would manage them was an excellent way to collaborate with our musculoskeletal colleagues from around the world and see how management of joint issues can be addressed in various ways.
Co-chairs ~ Horacio Caviglia, Argentina; Kumiko Ono, Japan
Treatment of subchondral cysts ~ Horacio Caviglia, Argentina
Radio synovectomies ~ Shubhranshu S. Mohanty, India
Chemical synovectomies ~ Mauricio Silva, USA
Platelet-rich plasma (PRP) ~ Haroon Adam Mann, UK
Post-operative rehabilitation ~ Cindy Bailey, USA
It was also interesting to listen to a session on the pros and cons of orthopaedic minimally invasive procedures. It included procedures such as chemical and radio-synovectomies, PCP (platelet rich plasma injections) and joint injections for cysts (these are not offered in Australian Haemophilia Treatment Centres due to current lack of evidence of efficacy).
Co-chairs ~ Cameron Cramey, Australia; Mauricio Silva, USA
Synovitis & arthropathy ~ Adolfo Llinas, Colombia
Arthroplasty and ulnar nerve compression ~ Christian Carulli, Italy
Rehabilitative aspects ~ Hortensia De la Corte-Rodriguez, Spain
Post-operative rehabilitation in the elbow ~ Greig Blamey, Canada
A session dedicated to the elbow was much welcomed. The orthopaedic surgeons reinforced the complexity of the joint as it has 3 separate articulations (joints within the joint) and therefore unique and diffuse surface areas and much synovium (joint lining). The hand is used as an open chain mechanism, and the proximity and subsequent control at the elbow ensures it needs to be a multi-planar, multi-dimension joint.
The amazingly knowledgeable and engaging physiotherapy consultant from Canada, Greig Blamey, presented in this session and reinforced the idea of realistic goal setting for those requiring and undergoing an elbow replacement, as the surgical protocol is usually limited to minimal lifting (often quoted as under 5kg) and impairments often remain. He reiterated that surgery is usually only for pain reduction and suggested the establishment of daily exercise programs pre-surgery so that it becomes as best it can be pre-surgically, and part of routine and not another thing to learn or worry about post-surgery as it is already part of life. He reminded us that there will be large amounts of scar tissue around a joint, and particularly in a joint with a high mobility profile, i.e., you move and use your elbow a lot day to day. He reminded us that post-operative pain is not pathology, as in, it is NOT a warning sign that you are doing something incorrectly and should cease; rather it is something that should be expected and managed, but it is essential that exercises to regain mobility should continue.
Interestingly, the panel concurred that no specific post-operative elbow protocols exist and in fact rehabilitation is not protocol driven. Treatment guidelines are tissue-healing driven for the individual and involve discussion from the surgeon and the rest of the team. He reported the statistics that time is an enormous factor within exercise management; the longer the joint is held near the end of range (ie extended fully straight) is proportionate to how much end range of movement the joint will have, so prolonged extension will be of more benefit than repeated or pulsed exercises.
Co-chairs ~ Azusa Nagao, Japan; Luigi Piero Solimeno, Italy
MSK health in WGBD – focus on joint health ~ Carla Daffunchio, Argentina
Pelvic floor rehabilitation – a missing piece in comprehensive care ~ Lena M. Volland, USA
Patient perspective ~ Abira Maheen, Pakistan
A session titled ‘An integrated approach to haemostasis, joint health and pelvic floor for WGBD’ included a talk by Dr Lena Volland, a physiotherapist from the USA, linking musculoskeletal issues of women and girls with bleeding disorders (WGBD), which was extremely informative and a highlight for me. It included a talk on the pelvic floor. She discussed chronic pelvic pain with a diagram, which included a revision of the anatomy of the pelvic floor (in both men and women) and reminded us of the proximity of the urethra, bladder, uterus or prostate, bowel and spine/coccyx. This is especially pertinent given that many of these areas are sites of bleeds, but function or dysfunction of pelvic floor and its complications are rarely discussed in people with bleeding disorders.
A review of the literature regarding of joint bleeding in WGBD and haemophilia carriers and musculoskeletal health in WGBD from Carla Daffunchio, a physiotherapist from Buenos Aires and Chair of the WFH musculoskeletal stream, presented current available data and recognised that ‘historically the needs [of WGBD and haemophilia carriers] have been overlooked and that they manifest symptoms including haemarthrosis’ and that ‘less is known about the progression in WGBD’. She highlighted that being aware of the risk factors and the haemophilia joint score (HJHS) and point of care ultrasound (POCUS) assessment may be the tools to show us the clinical reality in this population.
Comparison studies between women with haemophilia, haemophilia carriers, and healthy controls highlighted changes in joint impairment and notably a significant difference in ankle pathology between the affected and control group.
A final speaker in this session was a lived experience from a patient Dr Abira Maheen from Pakistan, who is also a medical professional, and was an extremely well presented, poignant and heartfelt look at how it may feel to live with a bleeding disorder as a female throughout life, physically and emotionally. She presented her thoughts on what patients really want: to be validated, to be heard, to be believed, to be treated holistically and to be included in decision making and left us with the thought that hemostasis > reduces fear, joint care > restores mobility, pelvic rehabilitation > restores dignity and counselling > restores confidence.
Chair ~ CJ Hansen, USA
Move to improve: Managing pain through movement ~ Cameron Cramey, Australia
Pain is more than physical: The emotional and mental load ~ Kathaleen Schnur, USA
The session on managing chronic pain and bleeding disorders included our own wonderful physiotherapist Cameron Cramey from The Royal Adelaide Hospital in South Australia, who gave a fantastic presentation. This included particularly pertinent advice that we currently may have management tools rather than curative strategies. He also considered if pain worsens during an exercise, it may not be that exercise is not for you, but rather that that specific exercise or dosage or position may not be for you. He reflected that a realistic goal may not be for pain to go away completely – but different, smaller more functional goals may be achieved without worsening pain.
The final speaker in this session was Kathleen Schur, a social worker from the USA, on understanding and managing chronic pain: why pain may be ongoing, Multi-disciplinary Team (MDT) management – and when pain cannot be eliminated – strategies on living with pain. She discussed how much pain takes from you and how it can affect your whole life – your job, relationship, family, it involves grief and loss of social interaction, limiting participation and identity, and may be aligned with depression and anxiety. She discussed management in changing the relationship with sensation, e.g., going from ‘I feel pain I must stop’ to ‘I have pain and I can feel it but I am in control of what I am doing’, giving agency and control.
These excellent sessions have made me think about my current practice and challenged me to consider how I can further improve.
Abi Polus was assisted by funding from Haemophilia Foundation Australia to attend the WFH 2026 World Congress.
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