I am considering a rougher sport like rugby or Australian Rules, despite the risks. What do I need to know to manage these risks, and what injuries do I need to really watch out for?
Sport and physical activity have great benefits for young people with bleeding disorders – but contact or collision sports such as rugby and AFL are considered ‘high risk’ because they are more likely to result in bleeding episodes.
It is very important if you are considering a high risk sport to discuss it with your Haemophilia Treatment Centre (HTC) and talk to them about the risks, even if you know they do not recommend a certain sport. We all know about joint bleeds, but it is important to know what else to watch out for. Remember - having prophylaxis before sport may decrease the severity but won’t stop you from having a bleed if you get injured!
- Head injuries: Concussions and knocks to the head are common in contact sports such as rugby and AFL and the effect of head knocks in people with bleeding disorders is the main reason they are not recommended. Any hits to the head or signs of concussion need to be taken very seriously due to the risk of a bleed in your brain. Young people with bleeding disorders can have significant brain injuries if they suffer a blow to the head and develop a bleed in their brain.
- Tongue or throat bleeds: These need to be treated straight away and monitored, as they can lead to swelling around your airway and affect your breathing
- Eye injuries: Bleeding in your eye could damage your eyesight
- Spinal injuries: Watch out for back pain, weakness, tingling and numbness or weakness of your legs or arms and seek medical management if they occur
- Testes injuries: Blow to the groin
- Abdominal bleeds: Signs can include pain in the stomach, vomiting or coughing up blood or blood in your bowel motions or urine
- Muscle bleeds: Particularly watch out for those in your calf or forearm. If too much pressure builds up inside these muscles from bleeding and swelling it can cut off blood flow and permanently damage a muscle and its nerves. Take care with thigh and groin bleeds. They need to be managed appropriately - if they are large, they can cause muscles to become very tight and take a long time to settle. If they are not rehabilitated properly, they may keep bleeding and damage surrounding tissue.
- Joint bleeds: Be aware of any pain, swelling or warmth in a joint during or shortly after exercise, especially in knee, ankle and elbow joints. If you suspect you have a joint bleed, contact your treating team immediately and treat the bleed promptly with RICE (Rest, Ice, Compression, Elevation) and factor replacement therapy as prescribed by your doctor.
- Joint bleed or arthropathy (arthritis)?: It is also important to work out the difference between a joint bleed and/or a painful and sometimes slightly swollen joint due to more permanent damage, called arthropathy. If you have haemophilia, this damage is called haemophilic arthropathy and can be diagnosed by your treating team. It is a type of arthritis caused by repeated bleeds into the same joint or where the joint bleeds have not been managed adequately. With new haemophilia treatments, arthropathy is becoming less severe and occurring less often – but even in young people, once the joint damage has occurred, it is permanent. No amount of factor will fix arthropathy or relieve its pain, so it is important to know what it is you are feeling.
Australian and New Zealand Physiotherapy Haemophilia Group:
Original answer (2012): Auburn McIntyre, Women's and Children's Hospital, Adelaide; Emma Paterson, Royal Brisbane & Women’s Hospital; Wendy Poulsen, Lady Cilento Children's Hospital, Brisbane
Revised answer (2022): Cameron Cramey, Royal Adelaide Hospital; Elise Mosey, Queensland Children's Hospital
Answered by: Physio