Orthopaedics and Physiotherapy at the EHC Congress

The lecture on orthopaedic insoles described the examination of foot loading both statically and dynamically. I think it was good that the topic of insoles was emphasised here, because proper foot correction adjusts the overall body posture. By correcting stance and thus gait, as the human mode of movement, improvements occur in the positioning of all joints, thereby improving movement patterns. All of this results in reduced pain and slower degenerative processes on joint surfaces.

Unfortunately, the only lecture on physiotherapy was very general. The presenter spoke about the beginnings of rehabilitation, about the field as such, and about physiotherapists' education. She did mention the fact that rehabilitation is very important for people with hemophilia, but without specific proposals for how rehabilitation should look and what solutions it offers for individual conditions.

For physicians who are supposed to motivate patients toward rehabilitation, the presentation was unspecific and did not include reasons why it is important for the musculoskeletal system. Convincing physicians that other healthcare is also necessary is always difficult. If the field of physiotherapy does not highlight the importance of movement, it will continue to be overlooked.

In cases of bleeding into joints and muscles, changes occur not only in joint positioning but also in the feedback information travelling from the periphery to the brain and vice versa. The central nervous system responds by resetting the perception of the joint, which then remains limited in its range of motion. Very simply put, this leads to uneven loading of joint surfaces. Non-ideal joint loading accelerates degenerative processes in the joints -- early onset of haemophilic arthropathy -- and also further negatively affects the brain's perception of joint and muscle position, potentially leading to further injuries or microtraumas. This can be influenced precisely through rehabilitation. A specific approach for each stage of bleeding affects not only the joints and soft tissues themselves, but primarily the controlling organ of the musculoskeletal system -- the brain.

An interesting theory was that spontaneous bleeding may not be without a cause. A short video showed that the reason for so-called spontaneous bleeding can be any unconscious movement, for example during sleep.

I am glad that I was able to participate and I hope that more space will be devoted to physiotherapy in the future. In the era of excellent pharmaceutical treatment, greater emphasis should also be placed on movement therapy.

Mgr. Marie Katzerová, physiotherapist

Further links and articles about the EHC Congress: **Hemophilia A versus Hemophilia B -- Differences and DetailsSuccess? It Seems SoHaematological Elite Gathers in PraguePhoto Gallerywww.ehc2012.eu**