March is Hemophilia Awareness Month, a time when the general public and health care professionals are educated about this bleeding disorder.
Hemophilia is a bleeding condition affecting approximately 20,000 people in the United States, according to the U.S. Centers for Disease Control and Prevention. There are many forms of the condition, with the two most common being Hemophilia A and B. The most common bleeding condition is Von Willibrand’s condition, which affects approximately 33,000 individuals significantly according to the National Hemophilia Foundation.
All bleeding disorders feature a deficiency of the blood’s ability to clot properly. When blood cannot clot properly, a wound will take longer to heal and bleeding considered minor can become majorly significant with the hemophiliac client. The distinction between hemophilia types arises due to which clotting protein is lacking upon thrombocytes, more commonly referred to as platelets.
Risks to Clients with Hemophilia
There are major risks to the hemophiliac client that make this condition clinically significant. The most likely occurrence will be spontaneous bleeding into joint capsule spaces and muscle tissues, which may create alarming injury to a client. A client experiencing this bleeding will witness severe deficits of mobility and muscle strength.
Another alarming risk to the hemophiliac client is internal hemorrhaging, which becomes difficult to control and can lead to seriously debilitating injury to organs. One example of a potentially deadly event will be the subarachnoid hemorrhage, which features excessive bleeding into the subarachnoid space around the brain. This space is referred to as a “potential space,” meaning that this space normally does not exist; however, if injury occurs to create an actual space in this location, this space pools with blood, which can compress upon the brain.
A third risk to the hemophiliac client is the development of anemia due to excessive blood loss. Many years may go by before the body restores its necessary number of properly functioning blood cells. Due to their monthly menstrual cycle, women with hemophilia are very prone to this complication. This may happen to men as well, if seemingly minor bleeds become major.
How Massage Helps
A client of mine referred me to a friend whose son has Hemophilia A. This mother reports that her teenage son plays basketball and that massage aids in alleviating soreness in his legs and joints. The massage therapist needs to be highly skilled, in her view, because any damage to the joint structures can take weeks to resolve; therefore, listening skills are essential when working with her son.
There are numerous hemophilia treatment centers in the U.S. A proper diagnosis of the condition ideally is made at these centers. Upon diagnosis, the medication administered to approximately 75 percent of clients is concentrated FVIII product, also called clotting factor. This drug is generally considered the safest option for hemophiliac clients. Other medications available include prophylaxis treatments, DDAVP (desmopressin acetate) to prevent bleeding and aminocaprioc acid to prevent the dissolving of blood clots.
Considerations & Contraindications
As the severity of the condition increases, so does the risk of spontaneous bleeding for the hemophiliac client. A massage therapist needs to be especially careful with manipulating joints, as bleeding can easily occur at the major joint sites. Modalities which mobilize or stretch limbs may cause unnecessary stress upon joint structures. Friction strokes, which are classically ideal for addressing joints, need to be performed more cautiously.
Second, because bruising is more likely to occur in the hemophiliac client, deep tissue modalities are cautionary. Applying several deep strokes to one particular region can cause more damage to the hemophiliac than to other clients, therefore keep deep tissue applications to a minimum. A therapist working efficiently and slowly can easily have a powerful impact upon a body region with one to two well-performed deep tissue strokes.
Third, consider the impact the massage will have upon the hemophiliac client when taking medications. Good questions to ask all clients on medications include how the medication affects their body, usual side effects, the half-life of each drug and ideal procedure in case a massage needs to be halted due to an adverse reaction. Having the client’s emergency contacts within easy find is always important with any client taking medications as well.
Fourth, for females receiving massage therapy during their monthly menstrual period, circulatory massage may need to be adjusted to not be as stimulating to the circulation of blood. Too much circulation during the period cycle can easily create an excessive menstrual flow for the female client.
Finally, because hematomas can accumulate within muscles of hemophiliac clients, treatment upon these regions will need to be adjusted. A hematoma may appear as either a flat or elevated bruise and feel tender to the touch within a muscular region. Utilizing hydrotherapy treatments within the normal massage session until the hematoma region subsides will be the best course of action.
Jimmy Gialelis, L.M.T., B.C.T.M.B., is owner of Advanced Massage Arts & Education in Tempe, Arizona. He is a National Certification Board for Therapeutic Massage & Bodywork-approved provider of continuing education, and teaches “Working with Pathologies—Arthritis” and many other classes. He wrote “Fibromyalgia: Massage Therapy Considerations” for MASSAGE Magazine’s July 2015 print issue, and “5 Ways Massage Improves Diabetes Care” and “Massage Therapy for Thyroid Health” for massagemag.com.