Manual therapy may help improve joint health and functional independence in people with severe hemophilia and hemophilic arthropathy, according to research published in Haemophilia.

Recurrent hemarthrosis occurs in people with severe hemophilia and often affects the ankle joints. Hemophilic arthropathy most commonly develops in young adults in their 20s and can cause functional problems. Treatment with physiotherapy, such as swimming and walking, has been found to be highly effective for hemophilic arthropathy.

The study authors investigated the effects of manual therapy combined with home exercise on hemophilic arthropathy in the knees and ankles. The authors measured effect through functional level, Hemophilia Joint Health Score (HJHS), Functional Independence Score in Hemophilia (FISH), and kinesiophobia.

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The study included 17 individuals between the ages of 18 and 30 years with severe hemophilia and hemophilic arthropathy of the lower limb joints. Nine people assigned to the control group were instructed to participate in home exercises, including resistance, passive stretching, and strength exercises, for 30 minutes 3 days a week for 5 weeks. Eight people were assigned to the manual therapy group, which involved at-home exercises plus manual therapy for 1 hour 3 days a week for 5 weeks.

Both groups experienced functional improvements. The manual therapy group had greater improvements in both knee and ankle joints compared with the control group. The manual therapy group also reported improvements in knee extension, resting ankle pain, range of motion of plantar flexion, and strength of plantar flexors; these improvements were not seen in the control group.

The authors concluded that both at-home exercise and manual therapy reduces activity pain and improves strength and functional level in patients with hemophilic arthropathy. Manual therapy was found to be superior to the control group at reducing pain based on visual analogue scale (VAS), although both groups experienced a decrease in pain. There was no significant difference in FISH noted between the 2 groups.

The results may be limited by the small sample size and limited follow-up time. Both interventions were found to be safe for people with hemophilia.


Tat NM, Can F, Sasmaz HI, Tat AM, Antmen AB. The effects of manual therapy on musculoskeletal system, functional level, joint health and kinesiophobia in young adults with severe haemophilia: a randomized pilot study. Haemophilia. Published online January 10, 2021. doi:10.1111/hae.14031