Early intervention and new treatment possibilities allow the physical therapist and the patient to address the ROM before the early fibrosis settles in. With the patient receiving physical therapy on the days the patient is on prophylaxis, treatment is very much like any nonhemophilic patient treatment of the same injury or surgery. With clotting-factor treatment, the hemophilic patients’ clotting levels become equal to those of a nonhemophilic patient. In physical therapy, the hemophilic patient carries out the same therapeutic program as any other patient who undergoes total knee, total hip or total shoulder replacement, or kneemeniscus arthroscopy. Therapy programs include the previously discussed regime of passive and active ROM, graduated pool therapy, functional patterns of proprioceptive neuromuscular facilitation (PNF) and skill functional progression.
A new treatment modality of light elastic kinesiology tape has added several dimensions to the previous treatment options. Light elastic tape has become a common technique used in physical therapy to assist in reduction of swelling and blood from joints and soft tissue areas, as well as assist in muscle facilitation or inhibition. Kinesiology tape cut in an edema technique pattern assists in clearing the joint or soft tissue of swelling more quickly. Light elastic kinesiology tape cut in a muscle technique pattern and placed on the patient correctly enhances proper muscle function. This approach in turn increases a patient’s overall joint and limb control, leading to fewer bleeds and better overall development of musculature.
The obvious huge difference in treatment is that the hemophilic patient benefits from the experience of the HTC physical therapist, who is always looking for and communicating with the patient about any signs of bleeding. No matter how small they may seem, bleeds must be treated immediately and aggressively to assure a smooth rehabilitation process. The hands of the therapist — in palpation of the joint for changes in heat, texture and skin tension — can detect small differences that are information tools to suggest changes that may be happening subtly inside the joint postoperatively. By seeing patients daily, the physical therapist is able to immediately bring these changes to the attention of the physicians and nurses for any needed medical intervention.