Effectiveness of Myofascial therapy and conventional physiotherapy with intermittent prophylaxis on Joint Health in Haemophilic Arthropathy- A Randomized Control Trial

Haemophilia is an X-linked recessive hereditary bleeding disorder which occurs due to deficiency of coagulation factors VIII and IX in the body. Their incidence ranges from 8 to 20 and 1 to 8 for every 100000 male patients, respectively depending on the geographical area. The best treatment to prevent the recurrent haemarthrosis and haemophilic arthropathy is the standard infusion of FVIII or FIX concentrates in the form of continuous prophylactic treatment.  However, the initial few bleeds and cause further joint damage due to iron deposition leading to inflammation, proliferation of synovium and neovascularization leading to a vicious cycle of bleed begetting bleeds.  This will in turn lead to muscle atrophy and instability of joint further aggravating the situation.   Along with prophylactic factor support, physiotherapeutic exercises are helpful in hemophilic joint arthropathies and prevent this ongoing damage.

Myofascial therapy is a type of manual therapy which aids in reducing the fibrous adhesions between different layers of the fascial tissue.  It includes mobilization of soft tissues including the fascial complex using various direct and indirect techniques. These techniques include the application of a low load long duration mechanical force specifically guided to manipulate the myofascial complex. The purpose of myofascial therapy is to reduce pain, improve tissue mobility and function. Conventional physiotherapy exercises are effective in decreasing the frequency of joint bleeds. However, when combined with manual therapy techniques such as Myofascial therapy, it can give an added advantage in improving joint health.

Although there is a high prevalence of haemophilic joint arthropathies these are often under treated. There is paucity of literature focusing on treatment specific for arthropathies. Thus, our study aims to find out the effectiveness of Myofascial therapy and prophylactic factor support along with conventional physiotherapy treatment on Joint Health in Haemophilic Arthropathy.