A retraction of the iliopsoas leads to a hip flexion contracture which distorts posture and gait. Tightness in the iliopsoas causes downward rotation of the pelvis, and this position in turn causes exaggeration of the normal lumbar curvature. Careful stretching exercises should selleck chemical therefore be performed to restore mobility in hip extension. When the pain has disappeared and hip flessum has diminished, a specific muscle strengthening programme is advocated, beginning with isometric contractions and followed by concentric exercises. Care should be taken with

aggressive passive stretches. The decision to conclude the rehabilitation can be based on the patient’s ability to stretch the injured muscle to prebleed levels and the pain-free use of the injured muscle. Limited joint motion and muscle atrophy are key features of haemophilic end-stage arthropathy. If the limitation of movement in the arthropathic joint is as a result of contractures and the end of the joint feels hard and bony, manual physiotherapy techniques may have limited benefit. In the presence of chronic synovitis, the end range limitation of range of selleck chemicals motion (ROM) must be respected. Approaching the closed packed position, where the synovium could become impinged, or when the bony surfaces are coming into contact, should be avoided [54]. As an example, bleeding episodes in the ankle principally Sitaxentan affect the

tibiotalar and/or subtalar joints and may lead to severe degenerative changes. One of the hidden symptoms is decreased ROM of the midtarsal

and tarsometatarsal joints. This deficit could predispose the patient to increased pain, stiffness and disrupted proprioceptive input to the sensorimotor system. Therefore, improving accessory and physiological motion by selective mobilizations/manipulations in the entirety of the ankle and mid- and fore-foot joints is a clinical consideration. Adaptive and corrective splints and orthoses may also be considered for joint instability and deformity. The use of foot insoles and specially adapted shoes has been shown to reduce pain and improve ankle propulsion in patients with end-stage ankle arthropathy [55]. Provided that appropriate clotting factor levels are maintained post surgery, the rehabilitation of people with haemophilia largely mirrors that of their counterparts without haemophilia, but with some specific considerations. Due to the presence of arthrofibrosis and bone deformities in the preoperative stage, stiffness and loss of ROM continue to be a complication after total knee replacement (TKR) in people with haemophilia. The degree of preoperative flexion contracture is the most important variable influencing the postoperative ROM after TKR [56]. To improve outcomes, early postoperative knee mobilization should be performed as soon as possible, both in flexion and in extension.