Hemophilia | Top 10 Exercises to Prevent Bleeding Disorder

Does anyone around you or known to you suffer from Hemophilia? If yes, then advise him/her to do exercises. Hemophilia is a genetic blood disorder that affects the ability of the body to make blood clots to prevent excessive bleeding. Due to the lack of clotting, hemophilia patients may experience spontaneous bleeding episodes in different parts of the body. Earlier these patients were advised to refrain from exercising due to a perceived risk of bleeding. But due to inactivity obesity, and bone density loss became prominent in such patients which gave rise to cardiovascular disease, chronic joint inflammation, and increased the risk of diabetes, further causing bleeding in the joints and risk of fractures. To prevent these complications of hemophilia, physical activity is found to be essential for health maintenance and general fitness. Exercises can be encouraged for coordination, muscle strengthening, and maintaining body weight which in turn promotes neuromuscular health, and self-esteem. Patients should consult a well-trained and qualified physiotherapist before engaging in physical activities. In this blog, we have discussed a few exercises and their benefits for patients with significant muscle and bone weakness or problems due to hemophilia.

 

Physiotherapy Exercises:

After the incidence of bleeding, it is best to return to any physical activity in a gradual manner. The physiotherapist decides whether a particular planned exercise or activity is appropriate, whether the patient requires a protective gear that might need to be used, etc. Weight-bearing exercises which are comfortable for the patient are recommended such as non-contact sports like swimming. It promotes the development and maintenance of bone density. Whereas, high-contact and collision sports, like rugby or football, are to be avoided.

 

Benefits of Exercises:

It is essential to remain active to strengthen joints and muscles, maintain a healthy weight, and provide an outlet for stress or tension. Other benefits of exercises include:

• Improves joint stability and function.
• Reduces the risk of injury.
• Strong muscles which support the joints, and help prevent bleeding and joint damage.
• Improves flexibility of muscles.
• Improves coordination.
• Feeling of being fit and energetic.
• Helps reduce fatigue.
• Decreases the stress on the joints.
• Improve balance.
• And finally, help to prevent bleeding and joint damage.

 

Exercises:

Regular exercises help boost self-esteem, and confidence relieves stress, relax the mind, and promotes social interaction and acceptance. A few simple exercises have been discussed below which can be performed by the hemophilia patients.

Knee range of motion Exercise:

• The patient lies on the back, with legs straight.
• Then bends the hip and knee and slides the heel towards the body.
• Again straighten the knee by sliding the heel away from the body.
• This exercise is repeated several times.

Knee strengthening Exercise:

• The patient lies on the back, with legs straight and a towel rolled under the knee.
• Then try to tighten the muscles (front) of the thigh.
• Hold this contraction for a few seconds.
• Repeat this exercise several times.

Knee Proprioception exercise:

• The patient is kept in a standing position.
• Stands on the affected leg.
• Try to maintain balance.
• Hold this position for 30 seconds.

Ankle range of motion exercise:

• The patient lies on the back.
• Keep the affected leg straight, and move the foot up and down, in and out.
• Draw the shapes or letters of the alphabet with the foot.

Ankle strengthening exercise:

• The patient sits on a chair.
• The knee is bent and the foot flat is kept on the floor.
• Lift the toes off the floor by pushing the heels onto the floor.
• Hold for several seconds and relax.

Ankle Proprioception exercises:

• Patient in a standing position.
• Stand on the affected leg.
• Try to maintain balance.
• Hold this position for 30 seconds.

Elbow range of motion exercise:

• The patient is in a sitting position
• Slowly bend the elbow and then straighten it, repeat several times.

Forearm exercise:

• The patient is in a sitting position
• Slowly bend and straighten the elbow.
• Turn the palm of the hand up and down
• Repeat a few times.

Elbow Extension exercises:

• Place the unaffected hand under the affected arm.
• Press the affected arm down into the unaffected hand.
• Hold for a few seconds,
• Repeat several times.

Elbow proprioception:

• Place the hands on the floor.
• Raise one leg behind while maintaining balance on both arms.
• Maintain balance for a few seconds then lower the leg.
• Repeat the same exercise with the opposite leg.

Moderate muscle exercises can be performed with the help of elastic bands or elastic resistance and conventional training machines. Even hydrotherapy exercises are safe and effective for patients with severe hemophilia, receiving preventive treatment.

Sports Activities: Sports that can be played safely under the proper guidance are walking, cycling, swimming, table tennis, dancing, badminton, bowling, golf, etc. But care should be taken to avoid contact sports like boxing, soccer/football, basketball, wrestling, motorcycling, hockey, skateboarding, etc.

Physical activity is not only beneficial physically i.e. a strong body not only helps to protect the body and prevent bleeding but also improves emotional and spiritual well-being.

 

Physiotherapy after Liposuction | A way to Maintain your Body Contour.

Do you suffer from swelling, skin irregularities, and lumps after undergoing Liposuction surgery and want to manage these problems? If yes, then you should consult your physiotherapist.  Physiotherapy is one of the best options to flatten and smoothen out these isolated areas.  Physiotherapy techniques are painless and non-invasive and help to maintain a healthy body so that the patient can enjoy the results of liposuction surgery. In this blog, we have discussed liposuction and how physiotherapy helps to maintain the results achieved after liposuction.

 

What is Liposuction?

Liposuction is a cosmetic procedure that removes excess fat deposits from one or more specific areas of the body. For this procedure, a tube called a cannula is passed through the targeted areas, to suction fat out of the body. The vigorous motion of the cannula can damage the connective tissues when large amounts of fat are removed. Some common areas for liposuction include breasts, abdomen, buttocks, hips, thighs, and arms. Recovery can be painful and can take some time, and by giving time for proper healing, the patient can enjoy the results of this procedure. General activity can be resumed within 1-2 days, but special care needs to be taken while resuming exercise routines.

 

Physiotherapy Treatment

For best results, a well-trained and experienced physiotherapist should be consulted to create a personalized treatment plan and ensure that the patient gets the body that he/she has always desired.

 

Compression Garments:

Physiotherapists recommend bandages and compression garments to collapse the tunnels that are made with the tool used while suctioning out the fat.  A compression garment helps to decrease the swelling, maintains pressure on the area, stops bleeding, and helps the skin lay flat. These garments also help prevent infection, therefore both the garment and the wounds should be kept clean. Loose-fitting clothing should be worn to avoid pressure on the surgical area.

 

Rest and Lightweight Exercises:

A comfortable environment, including a cozy mattress, pillows, and bedding can help rest and heal more effectively. Rest is recommended for 24 hours after liposuction, light exercise, such as short walks, gentle movements, and light physical activity one to two days after the procedure can improve blood circulation and speed up the healing process, but strenuous activities and exercises should be avoided. It is important to start moving at a gentle pace as soon as the patient can. Walking can help prevent blood clots from forming in the legs, which can be fatal.

 

Manually Massaging Skin:

Physiotherapy technique like lymphatic drainage massage (MLD), is often recommended to decrease recovery time and reduce post-surgical swelling and scarring. While using this technique the physiotherapist uses a sequence of massage strokes to stimulate the flow of fluids through the lymphatic system which helps relieve swelling and lessens the risk of infection and complications caused by liposuction. Another example of a physiotherapy technique that can be used after liposuction surgery is Myofascial release (MFR), it is a hands-on soft tissue technique that facilitates a stretch into the restricted fascia. It is performed below and above the scar area and helps eliminate the pain.

 

Weight Loss:

Weight loss is advised to reduce the risk of developing loose or uneven skin after liposuction, Weight should be kept stable once liposuction is performed, Exercises should be done 5- 6 days a week for at least 30 minutes.

 

Strengthening Exercises:

Resistance exercises can be done in the 2nd week after surgery. Strengthening exercises are done to tighten the muscles, allowing them to hold the skin in place of fat. exercise programs help the body heal and regain its ideal mobility. The patient should pay attention to the way the bodies react during and after exercise. If pain, discomfort, or drainage occurs due to resistance exercise, the physiotherapist should immediately be informed.

 

Aerobic Exercise

Light aerobic exercise, like walking, is recommended within two days of liposuction.  Every person responds to surgery differently thus the person should listen to his/her body and consider the limitations when returning to exercise. Exercise routines should be returned to slowly with a lower intensity level initially. Mostly wait for 3 weeks post-opt to return to higher impact aerobic activities such as running and aerobics.

 

Cardiovascular Exercise:

Moderate intensity cardiovascular exercise can help maintain fitness and also help lose weight.  Minimum 30 minutes of moderate exercise 4-5 days a week should be done. Exercises include using an elliptical machine, biking, walking, swimming, running, and rowing are excellent options.

 

Skin Tightening Exercises:

Skin tightening exercises like tummy tuck, arm lift, and thigh lift, can help tighten the skin. Individuals need to make positive lifestyle changes to maintain the changes achieved through liposuction.  Doing regular exercises is the key to long-term positive results.

 

Laser Therapy:

Laser therapy generates heat and can smooth out lumps or uneven skin. Erchonia lasers target and eliminate fat in areas that are difficult to reduce with regular diet and exercise. Zerona laser is proven to stimulate the body at a cellular level and is the first and only low-level laser to be given FDA clearance for use before and during liposuction treatments. It is a painless treatment applied before liposuction to liquefy the fat, making it easier to remove during the surgery. In addition to improving surgery outcomes, it also helps to reduce post-operative pain and bruising and decreases the overall recovery time. Though not used in pregnant women, laser treatment is not recommended due to its effects on fetuses are not well understood.

 

Shockwave Therapy:

Shockwave therapy is used after liposuction. It is an easy, non-invasive, local therapy, without side effects, with short periods of application.  Shock wave therapy delivers pulses of energy to the body and causes the fibrous cords to break down to smoothen the skin, and collagen and elastin are triggered to regenerate and strengthen the skin from within. Blood circulation and lymphatic flow in the treatment area are also improved.

 

Therapeutic Ultrasound:

Therapeutic Ultrasound can also be used to decrease inflammation in sore muscles, reduce swelling, and speed up the recovery process. It cleans up debris in an injured area which decreases the recovery time.

The patient should drink plenty of water at least 8 glasses of water daily to keep functioning. And also keep stress levels low to prevent weight gain.

This article was first published at CB Physiotherapy

 

Guillain-Barré Syndrome | Restoring Muscle Strength and Joint Functions by Physiotherapy

Guillain-Barré Syndrome also known as G B Syndrome is a rare medical condition that triggers the immune system of the body to attack its own nervous system, specifically the peripheral nerves that are responsible for sensation and motor control. This in turn affects the way brain signals are sent across the body and thus causes weakness, tingling, changes in sensations, and paralysis. Though there is no known cure for Guillain-Barré Syndrome. But, some treatments lessen the severity of the disease. Physiotherapy is one such treatment that plays a large role throughout the entire progression of Guillain-Barré syndrome. Physiotherapy does not affect the nerve healing process, it rehabilitates the muscles and works towards functional restoration and increasing stamina. This blog has been written to discuss exercises that help patients suffering from G.B Syndrome, to remain active and maintain strength.

 

G B Syndrome:

It is thought that GB syndrome occurs due to an autoimmune response after exposure to acute infections like a chest infection or diarrhea. It attacks the peripheral nerves and damages the myelin, an insulating layer of the nerve which is important in nerve impulse conduction. The patient has symptoms like feeling of altered sensation in the feet and hands, tingling and numbness in the fingers and toes, and progressive weakening of the limbs, legs, chest, hands, and arms spreading towards the trunk and face.  This rapid progression of deterioration leads to the paralysis of muscle, sensory disturbances, respiratory difficulties, and problems with swallowing and speech. Most people reach the stage of greatest weakness after two weeks of the onset of the disease and might require hospitalization and ventilation. GB syndrome patients usually have a residual weakness after 3 years, reduced stamina, and exhaustion after a period of increased activity during the recovery phase.

 

Physiotherapy Exercises

Physiotherapy treatment for patients with G-B Syndrome should be started immediately and continued until maximum recovery. Physiotherapy rehabilitation aims to maintain joint ranges of movement, increase muscle strength, restore mobility and balance, and re-train the normal movement patterns that are necessary for normal function and independence.

The treatment required depends on the extent of the disease progression and the areas of the body which are involved.

 

Respiratory Exercises:

In severe cases, respiratory physiotherapy may be required. Patients who need more care, mechanical ventilation and suctioning are provided. If the muscles of the chest and respiratory system are compromised and weakness or paralysis occurs in the chest, individuals will experience respiratory issues. Then physiotherapy will promote lung hygiene and respiration through positioning, breathing exercises, secretion clearance, and manual chest physiotherapy techniques

 

Exercises:

During the rehabilitation process, the patient suffering from G-B Syndrome is taught to use the energy constructively. This can be achieved by using the body correctly, avoiding unnecessary routines, and compensating for difficult activities by doing them another way. Passive limb movements to maintain joint ranges of movement and muscle flexibility while immobilization is recommended. Later, as the patient begins to recover physiotherapy is vital in assisting the restoration of muscle strength, limb control, balance, and coordination.

 

Range of motion exercises:

1: Ankle joint ROM exercises:

The patient is made to sit on the floor with legs straight. Wrap a towel around the feet. And hold both ends of the towel in your hand. For ankle dorsiflexion gently point the toes toward the body, and slowly return to starting position, for ankle plantar flexion, point the toes away from the body, eversion of the foot is, by moving the foot outwards, inversion of the foot is by moving the foot inwards, and ankle circumduction of the foot, is by moving the foot in a circular motion.

2: Knee joint ROM exercises:

The patient is positioned supine lying for heel slides, bend the hip and knee by sliding the heel up toward the buttocks while keeping the heel on the bed. Slide the heel back down to the starting position and relax. Use a plastic bag under the heel to slide it easily.

3: Hip joint ROM exercises:

The patient is positioned supine lying for hip flexion, move the leg by sliding with knees straight, for leg slides ( hip abduction ) slide the leg out to the side, for adduction( Hip Adduction ) slide the leg back to the starting position, for hip extension, the patient is in standing position and push the leg towards the back.

4: Shoulder joint ROM exercises:

The patient is in a sitting position for shoulder flexion, raise the arm forward over up to the head, for shoulder extension bring the arm back to the side and return it to the starting position, for shoulder abduction raise the arm by the side and then up over the head as far as possible, for Shoulder adduction return the arm to the side, for shoulder rotation roll the shoulders in a smooth circle clockwise and anticlockwise.

5: Elbow joint ROM exercises:

Elbow flexion is done with the palm facing forward, just bending the elbow, and for the elbow, the extension return the arm to the starting position.

6: Wrist joint ROM exercises :

Wrist flexion is done by bending the hand back towards the wrist so that the fingers point towards celling, for wrist extension bend the hand down so that the fingers points towards the floor, for wrist side to side movements move the hand from side to side, for wrist rotation roll the hand in circles clockwise and anticlockwise.

7: Hand and Fingers exercises:

Fingers bands make a tight fist and then relax it, for fingers spread open the hand and stretch the fingers as far apart as possible bring the fingers together again, for the finger to thumb touch, touch each fingertip with the pad of the thumb, for the thumb to palm stretch move the thumb across the palm.

8: Neck ROM exercises:

The patient is sitting or standing with the face forward shoulder should be straight and relaxed. For neck flexion gently bow down the head and try to touch the chin to the chest, for neck extension tilt the head back while looking towards celling, for neck side flexion tilt the head to the side and raise the shoulder, for neck rotations turn the head to look over the shoulder.

 

Strengthening Exercises:

1: Static quadriceps:

Static quadriceps are done by tightening the muscles on the top of the thigh, by pushing the back of the knee down into the towel. Hold for 5 -10 secs and then relax.

2: Cat and Camel exercises:

The patient begins the exercise from 4 points kneeling, tucking in the chin, and rounding the back upward. Reverse by letting back one segment at a time, and keep the neck in neutral at the end. Hold 30 secs and repeat 3 times per session.

3: Bridging:

The patient is asked to lie on the back with knees bent and feet flat, and slowly lift the hips off. Hold for 5 - 10 secs and return. Make sure that the head and neck remain straight during the lift.

4: Knee to chest:

The patient is made to lie on the back with knees bent towards the chest. Wrap the arms around the legs to hold the hands in the position. Gently tuck the chin to the chest and hold the position for 30 secs, repeat 2 to 3 times.

5: Knee roll:

The patient is made to lie flat with knees bent and feet flat on the ground. Roll the knees side and stretch diagonally across the trunk. Bring back to the middle, and repeat the exercise over another side.

6: Chair stand:

The patent is asked to perform sit-to-stand exercises from the chair and repeat them 5 -10 times.

7: Gait Training:

A gait training program is given and gradually the distance of walking is increased.

 

Positioning:

Due to bed rest and prolonged sitting, pressure sores can develop. Physiotherapists ensure that proper bed positioning and continuous change in posture ensure that the risk is minimized. Physiotherapists also recommend the proper assistive devices such as orthoses and wheelchairs, if required.

 

Life Modification and Homecare:

The physiotherapist modifies the lifestyle of the patient to prevent the contractures, DVT, and bedsores, and also support the weak extremities. Multiple rests between treatment sessions should be taken to reduce the level of stress by applying gentle massage to the affected area, maintaining a healthy weight, and doing regular physical activity. Individuals with Guillain-Barré Syndrome can also face emotionally painful periods as it is extremely difficult for patients to adjust to a state of sudden paralysis and dependence on others. The physiotherapy treatment plan can help through support and education as part of a holistic approach, and also advise patients about the help and support that can be provided through the use of other associated health professionals.

The physiotherapist recognizes the body's signals and warnings when the patient's limit of exercise for that session is reached. These signals may include tingling, numbness, or other sensory abnormalities, by pushing oneself through the limit can cause pain, weakness, spasm, and temporarily fatigued muscles. The patient must learn his/her limit, the need to rest as required, and to interpret the body's signals and symptoms.