The role of physical therapy in hemophilia is still unknown to many health professionals. In this disease, where the protagonist has always been the hematologist, physical therapy also plays a role. Musculoskeletal problems that cause repeated spills can be alleviated from our field. A proper rehabilitation therapy can restore the patient greater independence and functional ability and, consequently, increase their quality of life.

Hemophilia is a bleeding disorder, hereditary, monogenic, recessive sex-linked. Its cause is deficiency of factor VII or blood clotting factor IX. This deficiency is the cause of cerebral hemorrhage that may be more severe, and / or musculoskeletal, with greater consequences. It is in these musculoskeletal injuries, rehabilitation treatment which can bring great solutions. Biggs and Mcfarlane already in 1962 published a series of works which proposed a new approach to treatment, emphasizing the value of the orthopedic field. Hemophilia, like all diseases, receives better treatment from a multidisciplinary perspective and the physiotherapist is essential in this team, always accompanied by appropriate hematological treatment.
The most common musculoskeletal injuries in hemophilia are the hemarthrosis, synovitis and muscle bruising. The patient ends up suffering a hemophilic arthropathy and consequently, all functional disorders and disability that entails. The hemarthrosis (blood intra-articular) are common in elbows, ankles and knees. The etiology may be trauma or spontaneous (unexplained), and severity is usually related to the intensity of the trauma. This deposit of blood causes an intra-articular synovial hypertrophy, which often lead to a new bleeding. This causes bleeding episode most of the time hemophilic synovitis. Recurrent intra-articular hemorrhage and hemosiderin iron deposits in the joint, which produces an inflammation of the synovium with the same physiological changes. As a result, an alteration in the nutrition of cartilage and the possibility are causing further bleeding. Another common injury is the muscle hematomas. The bleeding continues until suffering intramuscular pressure equals the pressure vessel intravascular injury. If the amount of blood exceeds the ability of phagocytes to absorb, is encapsulated and forms a cyst. This can evolve into a hemophilic pseudotumor, which can invade and damage nearby tissues or evolve and form an abscess.

The aims of hemophilia physical therapy in patients are broad. Relieve pain and sensory disturbances, helping the reabsorption hemorrhagic and inflammatory process, get a proper physical condition, improve their quality of life and prevent and treat injuries and after you might have. The techniques used are also diverse and range from exercise -sports for patients without lesions, all kinesitherapy techniques, thermotherapy, electrotherapy, magnetic therapy, laser therapy, hydrotherapy and ultrasound that we use every day in our professional activity. Each of these techniques pursues a specific objective, from the removal of the hematoma to improve mobility. It is noteworthy that each joint has its peculiarities when making a treatment, and the existence of orthoses, also specific to each joint.

Hemophilia is a common pathology in the rehabilitation services, but we must not forget that it exists. Like many other diseases go unnoticed in the broad spectrum of diseases that we usually deal with, but why not be left untreated. Hemophilia physical therapy are done by professional and ethical obligation to continue training for life. Investigate what you know, study what has been forgotten and never forget that there is always a treat, even if the treatment of consolation.

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