Protect Your Joints

Admit it, who doesn’t like a scary skeleton? From Halloween costumes to that almost life-size plastic model in health class, there’s definitely something fascinating—and a little freaky—about the framework of our bodies.

While bones are usually the skeleton’s main attraction, they’re not the only star. Take our joints, for example. Without these special hinges, we’d be so stiff that simple actions like bending over or tossing a ball would be impossible.

Though it’s easy to take being able to do these things for granted, good joint health is the key to overall health—and keeping joints in proper shape takes some care and effort.

Everyone is at risk of joint damage from injury and years of use or just from aging. However, people with hemophilia-even young people with hemophilia-need to be especially diligent. Those with severe hemophilia may experience spontaneous bleeding into the joints even without an obvious injury while people with mild or moderate cases may have bleeds after getting hurt.

“The most common places for bleeding are the knee joint, the ankle and the elbow in that order, though bleeding in any of the joints is possible,” says Susan Shannon, RN, MSN, CPNP, coordinator of the Hemophilia Program at Miller Children’s Hospital Long Beach in Long Beach, California. Knees and elbows are at particularly high risk because they are hinges that only move back and forth, unlike the shoulder and hip, for example, which can rotate in many directions and therefore can survive a twist or fall more easily. Not only that, most of the associated muscles are above and below the knee and elbow joints instead of covering and protecting them.

Tips for Joint Health

Even just one bleed can cause joint damage if it’s bad enough, so avoiding a bleed in the first place is important (and getting immediate help if one does occur is critical). The good news is there are things you can do now to help keep your joints healthy for a lifetime.

• Maintain a healthy weight, as carrying around extra pounds puts more stress on your joints.
• Stay active and deal with bleeds quickly to improve your chances of staying healthy. “Once you have one bleed it makes your joint more susceptible to recurrent bleeding,” warns Ms. Shannon. A series of bleeds not only causes long-term joint damage but can lead to muscle atrophy and low bone mineral density over time.
• Consider prophylactic treatment. Whether this is the right move for you depends on your particular health situation and should be discussed with your treatment team.
• Pay attention to your body and seek treatment immediately if you suspect bleeding. Many people feel a bubbling or tingling sensation that can signal the start of a problem. Take care of it promptly, as the sooner it’s caught the quicker it will resolve and the less treatment will be needed.
• Follow your doctor’s orders and remember RICE (rest, ice, compression and elevation) to help in healing. Rest may involve using splints or crutches while ice refers to applying ice packs to the affected area. Compression can be achieved with an ACE wrap or compression bandage while elevation is resting the affected arm or leg above the level of the heart as much as possible.
• Be active. “People with hemophilia traditionally would avoid exercise and physical activity because they were afraid of increased complications or injury,” says Michael Hartman, Ph.D., professor of Exercise Science at Texas Wesleyan University in Fort Worth, Texas. “However, hemophilia does not have to prevent someone from being active if they choose a relatively safe form of exercise.”

A Comprehensive Workout Program

While consulting a physical therapist or trainer who has worked with people with hemophilia should be high on your to-do list, a comprehensive workout program will, in general, include the following:

• Stretching. Stretching is crucial for muscle flexibility and helping your joints to move freely. Each stretch should be done slowly and held for at least 30 seconds. If you feel pain, stop!
• Resistance training. Resistance training can strengthen muscles, help stabilize joints, improve joints’ range of motion and may also help decrease bleeding, says Dr. Hartman. However, this type of workout should be started only under the supervision of a therapist or trainer familiar with hemophilia. Training should include all the major muscle groups and be done two to three times a week for 20 or 30 minutes. Always plan for at least one day of rest afterward.
• Aerobic exercise. Aerobic training can not only boost your cardiovascular fitness and increase your endurance but it’s also a great way to keep your weight in check. At least 30 minutes of moderate intensity exercise most days of the week is ideal. Avoid contact sports such as football, wrestling and boxing – depending on your situation there are a variety of other sports you may be able to try, including swimming, running and rowing.
• Balancing exercises. Balancing exercises are helpful for maintaining good coordination, which can help reduce the chance of falls and injuries. Activities can be as simple as standing on one foot or as elaborate as joining a tai chi or yoga class.
• Proper form is also an important component in any workout. “The proper exercise technique will help increase joint flexibility when the exercise is performed through the entire (correct) range of motion,” says Dr. Hartman. “Proper exercise technique will also help prevent injuries and accidents from occurring.”
• Be mindful of your joints. If you’re doing an exercise to help one joint such as the knee, make sure you aren’t hurting another, like the ankle, in the process.

As always, ask your treatment team before beginning anything new. There is no one-size-fits-all exercise program and your type of exercise, frequency and intensity should be specifically tailored to your situation.