Physiotherapy and exercise combined are effective, without causing pain and bleeding, for increasing functionality, joint health, and quality of life (QoL) among patients with hemophilic arthropathy (HA) of the elbow, according to research published in Haemophilia.

The elbow joint is a common site of recurrent hemarthrosis, leading to HA in some patients, which can lead to chronic pain, decreased limb function, and reduced QoL. Orthopedic treatment can, furthermore, lead to an increased risk of bleeding and infection. While a number of exercise recommendations exist, their varying effectiveness, and whether at-home exercises are superior or non-inferior to physiotherapy, is unestablished.

Manual therapy, a type of physiotherapy that aims to increase biomechanical flexibility and joint function, involves the application of controlled force to joints and soft tissue. While this therapy is becoming more frequent in the HA setting, little data exist on its use on the elbow joint.

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For this study, researchers evaluated, in comparison to a home exercise program, the effectiveness of a manual therapy and exercise program on pain, range of motion, muscle strength, joint health, functionality, and QoL among patients with HA of the elbow.

Overall, of the 20 patients assessed for eligibility, 9 were randomly assigned to the manual therapy group and 8 were assigned to the home exercise group. Baseline characteristics between the groups were similar, with an average age of 24 years; 88.3% of patients had hemophilia A while 11.7% had hemophilia B, and 94.2% of patients had severe disease.

In the manual therapy group, bleeding frequency and activity pain decreased, while elbow range of motion and flexor strength increased; these patients also had statistically significant improvements in joint health, functionality, and QoL.

While patients in the home exercise group also had improvements in activity pain, QoL, and some ranges of motion, patients in the manual therapy group had significantly superior results overall in range of motion ─ including elbow flexion, supination, and pronation ─ as well as joint health and functionality.

“Manual therapy…was effective and safe in reducing frequency of haemarthrosis and activity pain and, improving all [ranges of motion] of the elbow, flexor muscle strength, joint health of the elbow, upper limb functionality and quality of life in patients with HA in elbow joint,” the authors wrote. “However, home exercises showed improvements in limited parameters such as flexion and extension [ranges of motion] of the elbow, activity pain level and quality of life.”


Tat AM, Can F, Tat NM, Sasmaz HI, Antmen AB. The effects of manual therapy and exercises on pain, muscle strength, joint health, functionality and quality of life in haemophilic arthropathy of the elbow joint: a randomized controlled pilot study. Haemophilia. Published online February 24, 2021. doi:10.1111/hae.14281