Joint and Myofascial Manual Therapy Techniques in Haemophilic Ankle Arthropathy: A Randomized Pilot Study

Background: Haemophilic ankle arthropathy is characterized by chronic pain, loss of strength and proprioception, decreased range of motion (ROM) and impaired functionality. Objective: To evaluate the safety and efficacy of a manual therapy protocol based on joint and myofascial techniques in patients with haemophilic ankle arthropathy. Methods: A randomized, single-blind pilot study. Twenty-four patients with haemophilia were randomized to the experimental (manual therapy) and control (no intervention) groups. The intervention lasted for 3 weeks, with one 50-min weekly session. Techniques used: active-passive joint mobilization, articulatory technique, joint decompression and high-speed and short-stroke manipulation, and sustained myofascial induction techniques. The study variables were safety of the intervention (number of hemarthroses), joint pain intensity (visual analogue scale), pressure pain threshold (pressure algometer), range of ankle motion (Leg Motion) and joint condition (Haemophilia Joint Health Score). Results: None of the patients developed ankle hemarthrosis during the intervention. After the intervention there were intergroup differences in the variables pain intensity (MD = -0.45; p < 0.001), ROM (MD = 0.19; p = 0.003), joint condition (MD = 0.04; p = 0.03) and pressure pain threshold in the internal malleolus (MD = 1.36; p = 0.01). For the interaction time*group after the follow-up period, there were statistically significant differences in pain intensity (F = 6.94; p = 0.01) and dorsal flexion (F = 3.36; p = 0.04) of the ankle. Conclusions: Manual therapy based on joint and myofascial techniques is safe in haemophilia patients. A protocol implementing joint and myofascial techniques having the dosage and safety parameters established in this study can improve the intensity of pain and dorsal flexion of the ankle in these patients.