Safe Sports in Haemophilia? Axel Seuser Centre for Prevention, - - PowerPoint PPT Presentation

Safe Sports in Haemophilia?

Axel Seuser

Centre for Prevention, Rehabilitation and Orthopaedics, Bonn Institute for Motion Analysis (IBQ), Bonn Institute for Prevention and Aftercare (IPN), Cologne

REVIEW ARTICLE Haemophilia (2013), 1–12

The benefits of exercise for patients with haemophilia and recommendations for safe and effective physical activity

• C. NEGRIER,* A. SEUSER,† A. FORSYTH,‡ S. LOBET,§ A. LLINAS,¶ M. ROSAS** and
• L. HEIJNEN††

*Unite d’Hemostase Clinique, Centre Regional de Traitement de l’Hemophilie, Lyon, France; †Kaiser-Karl-Klinik, Bonn, Germany; ‡Christiana Care Health System Hemophilia Program, Newark, DE, USA; §Haemostasis and Thrombosis Unit,Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Brussels, Belgium; ¶Department of Orthopedics andTraumatology, Fundacion Santa Fe de Bogota, University Hospital and Universidad de los Andes, School of Medicine, Bogota, Colombia; **National Hemophilia Center, Banco Metropolitano de Sangre DC, Caracas, Venezuela; and ††Van CreveldKliniek, UMC, Utrecht and Rehabilitation Centre De Trappenberg, Huizen, The Netherlands

Literature:

ORIGINAL ARTICLE Haemophilia (2015), S. 1 - 7

How fit are children and adolescents with haemophilia in Germany? Results of a prospective study assessing the sport-specific motor performance by means of modern test procedures of sports science.

SEUSER A1, BOEHM P2, TRUNZ E2, OCHS S2, HALIMEH S3, KLAMROTH R4

1Practise for Prevention, Rehabilitation and Orthopedics, Bonn, Germany, 2Institute for Prevention and Aftercare, Cologne, Germany, 3Coagulation Center Rhein-Rhur, Germany 4Vivantes Klinikum Berlin, Center for Haemophilia and Haemostaseology, Berlin, Germany

Literature:

• September 2002 – Mai 2012
• 23 CCC in Germany
• 306 Patients from 8 – 25 y. (1/3 of the hemophilic age

group in Germany) + 300 siblings and parents

• Age 13,2 ± 4,2 y
• Hight

159,2 ± 18,7 cm

• Weight

52,8 ± 20,3 kg

• 266 Hämophilia A, 40 Hämophilia B
• 177 < 1%, 58 1-5%, 71 > 5%,
• 29 inhibitors

Own Investigations:

Blankenheim 02 / 03  Frankfurt 03 / 05 Berlin 03 / 04 / 08  München 03  Leipzig 03 / 05  Hannover 03  Heidelberg 03 / 05 / 07/ 09  Rotenburg 04  Rostock 04 / 05 / 07 / 09  Ulm 04  Bremen 04 Potsdam 04  Hamburg 04 / 06 / 08  Magdeburg 04 / 07  Düsseldorf 05 / 07  Münster 05  Visselhövede 05 / 07 / 09 Köln 06 / 06    Freiburg 06 / 08 Magdeburg 06   München 06 Duisburg 07/ 09  Frankfurt/Oder 06 / 08   Homburg / Saar 07 / 09    Jena 08  Bonn 08 Dresden 09 

Fit for life – Activities

Haematologic Basis?

Clinical Examination?

Find silent symptoms and treat them Find silent symptoms and treat them Early detection of inflammation Early detection of inflammation Ultraound: search for synovitis Ultraound: search for synovitis Treat pain and inflammation Treat pain and inflammation Loss of muscle contraction pattern in EMG? Loss of muscle contraction pattern in EMG? 3D Motion Analysis 3D Motion Analysis

(n = 102)

31 30,4% 5 4,9% 9 8,8% 4 3,9% 47 46,1% 2 2,0% 3 2,9% 1 1,0%

anteriomedial anteriolateral Aussenband Innenband Malleolen Achillessehne

• M. tibiales posterior

Peroneussehne

Thermographiereport

Milan Schleiermacher; Chiemsee_110604 Kamera: VarioScan high resolution 3201 ST (Jenoptic Laser, Jena) 8-12 µm, ±0,03 K, 360x240 Pixel

OSG dorsal

M- Wert Min Max Bereich St.Abw. rechts- links

R Ventrolaterale Kapsel OSG 30,16 28,97 30,61 1,65 0,38 0,13 L

Ventrolaterale Kapsel OSG

30,03 28,2 30,83 2,63 0,62 R Tibialis posterior Innenknöchel

OSG

30,31 29,72 31,18 1,46 0,41

• 1,96

L

Tibialis posterior Innenknöchel OSG

32,27 31,31 33 1,69 0,41 R Achillessehne 29,76 28,22 30,25 2,03 0,36 0,05 L

Achillessehne

29,71 28,52 30,17 1,65 0,36 Bemerkungen

Thermographiereport

Milan Schleiermacher; Chiemsee_110604 Kamera: VarioScan high resolution 3201 ST (Jenoptic Laser, Jena) 8-12 µm, ±0,03 K, 360x240 Pixel

OSG ventral

M- Wert Min Max Bereich St.Abw. rechts- links

R Peronealsehne Außenknöchel OSG 30,62 30,39 30,88 0,49 0,11

• 1,04

L

Peronealsehne Außenknöchel OSG

31,66 31,26 31,98 0,73 0,16 R Ventrolaterale Kapsel OSG 30,6 30,18 30,88 0,7 0,17

• 1,23

L

Ventrolaterale Kapsel OSG

31,83 31,59 32,09 0,5 0,13 R Ventromediale Kapsel OSG 30,01 29,88 30,17 0,29 0,06

• 1,07

L

Ventromediale Kapsel OSG

31,08 30,84 31,38 0,54 0,14 R Tibialis posterior Innenknöchel

OSG

30,25 29,98 30,67 0,7 0,14

• 1,15

L

Tibialis posterior Innenknöchel OSG

31,4 30,62 31,92 1,3 0,42 Bemerkungen

31,83°C 30,6°C

Δ 1,23°C

30,31°C 32,27°C

Δ 1,96°C right left right left

Silent Symptoms ankle

Painful tender point at ligament: negative secondary changes in arthro-neuro-muscular system leads to malfunction. (Nigg and Herzog 2007)

Percentage of joints with signs of hemarthropathy (HEAD-US Score)

Muscle coordination patterns and strength are intimately associated with cartilage disease! (Nigg & Herzog 2007) Diminished strength (Herzog et al., 1998) , weakening

• f muscles (Slemenda, et al., 1997 & 1998; Hurley, 1999) Reflex inhibition of

maximum muscle contraction (Hurley & Newman, 1993) , change of contraction patterns from normal. ((Herzog & Federico 2003)

The natural course of muscle function of the lower extremity in children and young adults with hemophilia. A two year superficial kinetic EMG study in San José, Costa Rica

Axel Seuser, Martha Navarrete-Duran, Maria del Pilar Chaverri Saenz, Günther Auerswald

Personal Preperations?

Professionell Sports Advice! Work with a coach! Diminish own fitness deficits and meet demands of Sport! Streching! Warm up! Start slow! Stop early! Train regularly!

Safest Sport.....?

Low acceleration Low joint loading Low risk of injury Match own fitness with demands of sport No contact sports

International injury statistics

0% 20% 40% 60% 80% 100%

Rugby/ American Football (1;3) Squash (3;3,7) Rodeln (1;3) Wasserski (1;3) Bodybuilding (1;2) Ringen (2;3) Basketball (12;3,2) Gewichtheben (3;3,7) Handball (9;3,6) Inline-Skaten (3;3) Kampfsport (2;4) Volleyball (9;3,6) Fechten (1;3) Snowboarding (2;2,5) Ski-Alpin (10;3,3) Hockey (5;3,2) Fußball (14;3,3) Judo (7;3,4) Radsport (9;3,4) Eishockey (2;2) Tanzen (2;2,5) Leichtathletik (9;3,3) Badminton (6;3,7) Klettern (3;3) Joggen (5;2,6) Krafttraining-Gerät (1;2) Reiten (6;3,5) Kegeln (1;3) Aerobic (2;3,5) Eislaufen (4;3,5) Segeln (3;2,7) Tennis (10;3,4) Bergwandern/Alp. (2;3,5) Rudern (1;3) Tischtennis (2;3,5) Hanteltraining (2;2) Gerätturnen (10;3,4) Schwimmen (6;3,2) Ergometer (1;2) Golf (1;3) Skilanglauf (1;2) Walken (1;2) Wasserball (1;2)

Boehm P. Dissertation

3,37 2,45 3,02 3,51 1,98 2,68 3,47 1,73 2,36 2,59 2,64

1 2 3 4 5 F Co SF SE SB S MUE MLE OM A OR

Results of Fitness-Tests (n= 306)

Curriculum:

• 9. Grade Basketball

Safe School Sport?

1 ankle involved No involved joint

100% Safety?

No safety 100% Safe

Thank you!