Thanks to advances in treatment and prevention, people with inherited bleeding disorders now experience fewer complications than ever. Still, complete care should regularly monitor for any bleeding issues.
For people with hemophilia, that means focusing on the joints and muscles, the most frequent locations for bleeds. Von Willebrand disease (VWD) can also occasionally cause bleeding in those spots, but more often in the nose and gums or during menstruation.
At Penn Medicine, our hemophilia physical therapists carefully watch for joint or muscle damage and get you the care you need. Their specialized service forms a key part of our comprehensive bleeding disorders treatment.
How Does Bleeding Damage Muscles and Joints?
Bleeding inside muscles can increase pressure to the point that damage occurs. The buildup can lead to a condition called compartment syndrome. Bleeding can also damage the fibers in muscles. As a result, the muscles may not contract, relax, or stretch as they should, leaving them feeling weak and stiff.
In the joints, bleeding can damage bone and protective tissue called cartilage. Certain joints — including elbows, knees, and ankles — also have a feature called a synovial lining. The lining may overcompensate for damage by growing excess tissue. This growth can make the joint look larger and interfere with how it works.
If you do experience internal bleeding in muscles or joints, you should contact your medical team right away. You may need medication to stop the bleeding. Following the RICE procedure — rest, ice, compression, and elevation — may also help.
Physical Therapy Evaluations for Hemophilia and Inherited Bleeding Disorders
Everyone who comes to Penn for hemophilia or another inherited bleeding disorder gets a complete evaluation from hematologists and other team members at each checkup. Our physical therapists play a crucial role during these visits, helping to protect your overall health.
Each physical therapy evaluation is tailored to personal needs. Many people can effectively prevent bleeding with medications and just need confirmation that their regimens are working. Other people experience occasional bleeding despite treatment and need a deeper look. Still others may have damage from when they were younger, before newer, more effective treatments were developed.
During your first visit, we’ll ask about any previous orthopedic injuries or bleeding into muscles and joints. Our team particularly wants to know about any repeated bleeding into the same joint — a complication called a “target joint.” With hemophilia, we’ll also examine the knees, ankles, and elbows — the most common joints affected.
From there, your checkups may include:
- Discussion of recent health history: We’ll ask about any recent bleeding episodes, how active you’ve been, and whether any orthopedic issues have changed your recent routine. We’ll also ask if you have started using equipment such as braces or canes.
- Range of motion: We’ll check any previously affected joints to see how well they move and use a special device to measure your range of motion. We can compare the results to earlier visits.
- Gait analysis: We may ask you to walk a little to see how well you’re moving.
- Assessment of fall risk: People with inherited bleeding disorders have a higher risk of internal bleeding from injuries. Hemophilia A can also weaken bones and make them more likely to break, for reasons that remain unknown. We estimate your chances of falling and help you take steps to lessen your risk.
Treating Muscle or Joint Damage From Hemophilia
Your muscle and joint checkups may reveal the need for further care. Recommendations may include:
- Home therapy plans: Occasionally, you may just need to do stretching and strengthening at home. We can send you home with a plan.
- Outpatient physical therapy: Your checkup may reveal the need for further physical therapy. One of our physical therapists helps you find a convenient location — you can continue with Penn Medicine or choose another provider.
- Equipment recommendations: We can help you secure any supportive equipment you may need, such as canes or walkers.
- Consultation with an orthopedic surgeon: Referral to an orthopedic surgeon at Penn Medicine often provides your best option. The surgeon can thoroughly evaluate your joint and recommend next steps. Sometimes, you may only need physical therapy or a simple procedure. At other times, you may need a joint replacement — bleeding can lead to people needing these operations sooner than the overall population.
Other Services from Bleeding Disorder Physical Therapists
Occasionally, a bleeding disorder can cause bleeding in the brain and lead to a stroke. Our physical therapists help with the recovery that follows.
You may also work with one of our physical therapists if you take part in a clinical trial for a bleeding disorder. You may get an evaluation of your joints before, during, and after the trial to see how the study affects your function and health.
Make an Appointment
Please call 800-789-7366 or make an appointment.