What are the risks from some types of physical activity, exercise and sports?
When recommending or discouraging certain physical activities, exercises or sports for a child or teenager with hemophilia, the HTC care team considers the risk and likelihood of these four different types of injury that can occur:
- Joint bleed – This is usually because of “pinch or twist” types of injury to the joint and the lining of the joint called the synovia or synovial membrane. A joint bleed can happen especially if the activity involves putting full weight and stress on a joint or forceful movements such as throwing and kicking.
- Muscle bleed – This can happen if a muscle is strained or stretched too much. A muscle bleed can be caused by a single serious trauma or small but repetitive trauma.
- Early joint (osteoclast) damage — This can develop if someone already has a target joint or inflammation of a joint like arthritis.
- Body collision or contact injuries – This can range from minor and serious bruising (hematoma) to life-threatening bleeds that involve the head, neck, chest, or abdomen.
It’s probably impossible for a child with hemophilia to avoid ever having a bleed at all. But it’s still extremely important to prevent serious types of injury, and repeated bleeds into the same joint. Although most sports carry some risk, there are certain factors that increase the risk of getting a bleed or serious injury.
• Body contact – Sports such as hockey involve a lot more physical contact than something like team tennis because players fight for the puck and bump into each other and against the rink boards. The chances for an injury to occur are therefore higher.
• Speed – There is a bigger risk of injury with motorized sports that involve a lot of speed such as snowmobiling and dirt biking.
• Force of impact – Sports such as football and boxing are extremely risky even for people who do not have hemophilia because of the high force of physical impact.
• Height – Sports that involve big heights such as downhill skiing, snowboarding and hang-gliding come with more risk of serious injury.
• Hard-to-predict conditions – Waves in water skiing, and icy surfaces when downhill skiing, are examples of how unpredictable conditions can affect how risky some sports can be.
A child who has a target joint, arthritis or — most significantly — inhibitors in the bloodstream that fight against clotting factor as soon as it is infused and make it less effective, needs to be especially careful about selecting physical activities and sports that won’t harm his joints. This is more of a challenge for families. Individuals who have any of these complications require more careful assessment and should discuss what is safe and what’s not with the comprehensive care team.
What benefits are you seeking?
• Is the activity something your family can do together? For example, hiking and cycling are just a couple of the safe activities that the whole family can enjoy. What’s more, you can closely supervise and manage injuries if they occur.
- • Does your child already have a target joint? Are there realistic ways to protect the joint by using a brace for joint support, special footwear or by changing the exercise, activity or sport so that it’s safer? Any previous injury or chronic joint damage from prior bleeds will be more likely to get injured and start bleeding again.