Hemophilia: A Quick Overview

By: Jordyn Vanelli, SPT



What is Hemophilia?

  • A blood clotting disorder where there is missing or defective levels of clotting proteins known as “factors.” These clotting factors help generate fibrin, which is like a mesh that helps hold a blood clot together. Therefore, when strands of fibrin are not generated properly, a weak and fragile blood clot forms.[1]


What are the different types of Hemophilia?

  • Hemophilia A (Factor VIII Deficiency), Hemophilia B (Factor IX Deficiency), and Hemophilia “C” (Factor XI Deficiency). Other rare factor deficiencies include factors I, II, V, VII, X, XII, and XIII


What are the most common complications treated by physical therapists?

  • Joint Bleeds – usually seen in the knees, elbows or ankles and characterized by rapid loss of ROM, pain or unusual sensations, palpable swelling, and warmth when touched


  • Muscle Bleeds – characterized by muscle achiness, severe pain with stretching or contracting the muscle, tenderness upon palpation, and swelling[2]



How is Hemophilia diagnosed?

  • Hemophilia can only be truly diagnosed through blood testing that screens for factor levels in the blood. Factor level counts or “factor assays” will determine the type of Hemophilia as well as the severity. [3]


How is the severity of Hemophilia classified?

  • Based on the results of the factor assay, hemophilia can be classified as mild, moderate, or severe. If there is a 6%-49% presence of the clotting factor in the blood, it is classified as mild. Moderate hemophilia has a presence of 1%-5% of the normal value for the clotting factor and severe has <1%. [1]


How can Hemophilia be managed?

  • By utilizing a comprehensive care approach, staying physically active with an emphasis on weight bearing activities and playing non-contact sports, and through Prophylactic Factor Replacement Therapy based on the severity of the case.[1]



Additional information on the recommended management of hemophilia can be found at:




  1. Hemophilia A. National Hemophilia Foundation. https://www.hemophilia.org/bleeding-disorders/types-of-bleeding-disorders/hemophilia-a. Published April 2014. Accessed July 20, 2016.
  2. What Are the Signs and Symptoms of Hemophilia? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/hemophilia/signs. Accessed July 21, 2016
  3. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/hemophilia/diagnosis.html. Published 2011. Accessed July 21, 2016
  4. Srivastava A, Brewer AK, Mauser-Bunschoten EP, et al. Guidelines for the management of hemophilia. Haemophilia. 2012;19(1). doi:10.1111/j.1365-2516.2012.02909.x.

Two Methods to Recover from Workouts

By Gwendolyn Dougherty, SPT


Since I was about 5, I have been participating in organized sports. Basketball, soccer, softball, Irish dance – it was a crazy schedule. You learn to become really organized with your gear and your time. My way of staying organized was to develop routines…which ultimately turned into superstitions. I packed my bag the same way, at the same time, ordered the same sub, listened to the same music, in the same order, got dressed at the same time. Every. Single. Game. My pre-game routine was set, and it lead to many successful games. My post-game routine…not so much.


The recovery part of a workout is just as important as the warm-up and actual workout. It helps refuel and “reset” our bodies so we can get ready to go out and either play again that day, like many AAU and travel players, or be able to walk up the stairs once we get home (and let me tell you those suckers are my mortal enemy). For those of us who aren’t practicing or playing 6 days a week, who have taken more of a “weekend warrior” role, recovery is even more important.


The first aspect to anyone’s recovery should be a focus on refueling his or her body. This recovery involves the re-synthesis of glycogen stores; a key compound our bodies use for energy.1 To maximize the resynthesis, studies have suggested that 30-45 min post-exercise, 50-75 g of carbohydrates (CHO) should be consumed and for the next few hours, carbohydrate consumption should range between 1.2-1.5g CHO/kg body weight/hour.1,2,3,4,5  Most people, however, don’t want to sit down and eat a huge pasta dinner after they workout, so what can they do? This is where companies such as Gatorade and Endurox have come in to play. They offer recovery drinks to help maximize CHO consumptions post-exercise. Recently, there has been a push to move away from these drinks and move to a more natural product – milk – chocolate milk to be exact! Numerous studies have shown that when chocolate milk is consumed after a workout, athletes were able to perform just as well, or better, in a second workout either a few hours later or the next day!1,2,6,7,8 Milk contains a carbohydrate called sucrose and it is this simple sugar that has been found to result in great liver glycogen resynthesis than other carbohydrates.9 So maybe mom was right when she told you to drink your milk…just don’t tell her that.




Another important aspect to recovery is stretching. Stretching is sort of like how most people are with a car. You can feel it working, but you’re not sure how. Many people believe stretching helps to increase range of motion, prevent injuries, prevent DOMS, and improve performance.10,11,12,13 There has been little evidence that stretching helps with anything other than decreasing muscle stiffness.14,15,16 This doesn’t mean stretching is useless. Decreasing muscle stiffness helps our muscles function more properly. Remember those stairs I mentioned earlier? While it still might hurt to go up and down them, stretching after exercise helps your body be able to go through the ranges of motion necessary to be able to tackle those stairs.




So remember, if you’re like me and not rich enough to afford escalators in your home, go through a recovery process once your workout is complete. Find a routine you like and stick to it. Refuel your body with the right foods and add in some gentle stretching. Your body will thank you.



  1. American College of Sports Medicine, American Dietetic Association, and Dietitians of Canada. Nutrition and Athletic Performance. Joint Position Statement of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine. Med. Sci. Sports Exerc. 32(12): 2130-2145, 2000.

  2. Karp J, Johnston J, Tecklenburg S, Mickleborough T, Fly A, Stager J. The Efficacy of Chocolate Milk as a Recovery Aid. Medicine & Science in Sports & Exercise. 2004;36(Supplement):S126. doi:10.1097/00005768-200405001-00600.
  3. Costill, D.L. Carbohydrate for athletic training and performance. Bol. Assoc. Med. P. R. 83(8):350-353, 1991.

  4. Evans, W.J., Hughes, V.A. Dietary carbohydrates and endurance exercise. Am. J. Clin. Nutr. 41(Suppl 5):1146-1154, 1985.

  5. Friedman, J.E., Neufer, P.D., Dohm, G.L. Regulation of glycogen resynthesis following exercise. Dietary considerations. Sports Med. 11(4):232- 243, 1991.

  6. Spaccarotella, K., Andzel, W. The Effects of Low Fat Chocolate Milk on Postexercise Recovery in Collegiate Athletes. Journal of Strength and Conditioning Research. 2011;25(12):3456-3460. doi:10.1519/jsc.0b013e3182163071.
  7. Pritchett, K., Bishop, P., Pritchett, R., Green, M., Katica, C., Carter, S. Acute Effects Of Chocolate Milk And A Commercial Recovery Beverage On Post-exercise On Muscle Damage And Endurance Cycling Performance. Medicine & Science in Sports & Exercise. 2009;41(Supplement 1):508. doi:10.1249/01.mss.0000356099.84103.42.

  8. Ferguson-Stegall, L., McCleave, E., Doerner, P. et al. Effects of Chocolate Milk Supplementation on Recovery from Cycling Exercise and Subsequent Time Trial Performance. Medicine & Science in Sports & Exercise. 2010;42:760. doi:10.1249/01.mss.0000386204.90806.51.

  9. Casey, A., Mann, R., Banister, K., Fox, J., Morris, P.G., Macdonald, I.A., Greenhaff, P.L. Effect of carbohydrate ingestion on glycogen resynthesis in human liver and skeletal muscle, measured by (13)C MRS. Am. J. Physiol. Endocrinol. Metab. 278(1):E65-E75, 2000.
  10. Viale F, Nana-Ibrahim S, Martin R. Effect of Active Recovery on Acute Strength Deficits Induced by Passive Stretching. J Strength Cond Res. 2007;21(4):1233. doi:10.1519/r-21476.1.

  11. Herbert R., Gabriel, M. Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic review. BMJ. 2002;325 (7362):468-468. doi:10.1136/bmj.325.7362.468.

  12. McHugh, M., Cosgrave, C. To stretch or not to stretch: the role of stretching in injury prevention and performance. Scandinavian Journal of Medicine & Science in Sports. 2009. doi:10.1111/j.1600-0838.2009.01058.x.

  13. Lewis, J. A Systematic Literature Review of the Relationship Between Stretching and Athletic Injury Prevention. Orthopaedic Nursing. 2014;33 (6):312-320. doi:10.1097/nor.0000000000000097.

  14. Torres, R., Pinho, F., Duarte, J., Cabr,i J. Effect of single bout versus repeated bouts of stretching on muscle recovery following eccentric exercise. Journal of Science and Medicine in Sport. 2013;16(6):583-588. doi:10.1016/j.jsams.2013.01.002.

  15. Herbert, R.D., de Noronha, M., Kamper, S.J. Stretching to prevent or reduce muscle soreness after exercise. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD004577. DOI: 10.1002/14651858.CD004577.pub3.
  16. Wilk K, Macrina L, Fleisig G et al. Correlation of Glenohumeral Internal Rotation Deficit and Total Rotational Motion to Shoulder Injuries in Professional Baseball Pitchers. The American Journal of Sports Medicine. 2010;39(2):329-335. doi:10.1177/0363546510384223.



Reducing Low Back Pain In Your Golf Game

By Tim Abel, PT, DPT, OCS


1: Reduce your backswing. In the modern golf swing, when we take our backswing, our hips and shoulders rotate away from the target.  When our hips naturally stop rotating, our shoulders and trunk rotate even further to coil up the body and get ready to unleash that energy toward the golf ball.  This extra trunk rotation can be a vulnerable position for the lumbar spine and often contributes to pain.


2: Walk smart: If you like to walk the course for exercise that’s great, but don’t do it at the expense of your low back.  If you like to carry your clubs, make sure you have a bag with two shoulder straps.  If you like to use a cart, make sure you push it in front of you, don’t pull it behind you.  This will preserve strength in your core muscles to help last the entire round.


3. Don’t’ spend a lot of time on the practice green: The typical putting stroke requires you to bend forward a considerable amount. If you are practicing your putting for a long time, you have already begun to fatigue these important muscles that support good spine posture, and they might not be able to do their job during the actual round of golf.


4. Watch your posture when you are not golfing: If you are a seated professional, keep an eye on your posture during the day when at your desk. Sitting places 2.5 times your body weight on the low back, so it’s important to avoid slouching during the work day.


5. Train your body to succeed at golf: While golf isn’t considered an intense activity by a lot of people, you need specific strength and flexibility to reduce the stress on your spine. You also need good muscular endurance to maintain a consistent swing for up to 5 hours.  Seek professional advice and training from a physical therapist that has golf specific knowledge.




golf photo