SPORTS INJURIES
Sprained ankles are the most common sport injury seen in PWH and can be severe with multiple tendon and ligament damage. Following this type of injury there will usually be a joint haemarthrosis, which will require factor replacement, but it is also necessary for the physiotherapist to diagnose other potentially damaged structures and give appropriate treatment.
There is also the risk of bleeds affecting joints and muscles. Choosing a suitable sport for them is therefore difficult. Contact sports (cricket, football, wrestling, boxing etc) have a greater risk than non-contact sports such as swimming, cycling or golf. Other factors like the level at which a sport is played, and whether there is adequate preparation and training, should also be considered when deciding whether a sport is suitable or not. Advice from a trained physiotherapist will help take a decision.
There are both intrinsic and extrinsic risks that can lead to injury connected with sports:
Intrinsic risks

These relate to factors within the body. Body type, shape, overall weight and muscle type mean that some people are more suited to some sports than others. Some people are better able to do endurance activities than speed activities. Choosing a sport without considering these aspects may lead to injury.

Tight muscles can predispose to injury. For example, if the calf muscles remain tight following a bleed, this can reduce the amount of dorsiflexion available at the ankle (the movement of the foot towards the head). This can lead to compensatory movements in the foot that can alter the alignment of the lower limb when walking or running and can lead to pain in the ankle, knee or hip.

Joints that may have been subject to bleeds in the past may have degenerative changes that cause damage to the articular cartilage, which loses its shock-absorbing capacity. These joints are less resistant to trauma, particularly during high-impact weight bearing activities.
Extrinsic risks

These relate to factors outside the body, including foot wear and clothing, equipment, the environment, training programmes and physical contact.

Footwear: For all sports particularly those involving walking and running, well-fitting shoes with a good grip and adequate shock absorption are essential. Ill-fitting shoes with high backs, shoes that are worn out can cause problems and should be avoided.

Protective clothing: Depending on the sport, protective clothing may be essential in reducing the injury. For example, a helmet is advisable when riding a bike.

Equipment: The correct equipment is also important. For example, a tennis racquet needs to be the correct size and weight for the user.

Environment: The surface on which the sport is played also needs to be considered. Running on grass may be less jarring on the lower limbs than running on a hard surface such as a road. If the sport involves road running, the direction needs to be changed regularly as the camber of the road can place an even strain on the limbs.

Training: Adequate training is important for all activities and this includes warm-up and cool-down after activities. It is important to stretch the muscles before sport and ensure that there is sufficient flexibility and range of movement to perform the sport safely. Training can also ensure that the skills, techniques and co-ordination required for the sport can be learnt and practised in a controlled environment

Physical contact: Sports that involve physical contact with others can lead to injuries. Playing competitively in team games may involve a greater risk. It is important to ensure that timing of prophylaxis is adequate to provide some protection against bleeds, but this should not be used indiscriminately in order to partake in particularly risky activities.
The key management of injuries is prevention. However if injuries occur despite consideration of the intrinsic and extrinsic risk factors then treatment is required.
How do sport injuries get treated?
Acute injuries
It is likely that any acute injury will be associated with increased bleeding and therefore factor replacement should be given as soon as possible and should be continued until the injury has resolved. If there is severe pain, swelling, numbness, appropriate medical advice should be sought as soon as possible. Failure to treat adequately initially can lead to a slow recovery and the risk of permanent damage. Acute injuries should settle quickly. If symptoms persist advice from the nearest hameophilia centre should be taken.

The management of acute injuries is recognized by the acronym RICE, which stands for rest, ice, compression and elevation. (For details please see under section MUSCLE)
Chronic injuries
If minor aches and pains or repeated bleeds are associated with sporting activities, it is advisable to seek the opinion of a physiotherapist with experience of hemophilia. These injuries may be due to inappropriate activity, over-training, poor technique or intrinsic factors that may need to be addressed with appropriate exercise programmes. In some situations alternative sporting activities may have to be considered.
It should be understood that risks are involved in some activities of sport. However, if the appropriate precautions are taken, then sport can be a rewarding experience and fun.