Blood Flow Restriction in Improving Muscle Strength of Patients With Hemophilic Ankle Arthropathy

A self-registration will be used to evaluate the frequency of bleeding, and thus the safety of the technique. This selfregistration will be given to each patient at the beginning of the study and they must fill in the number of hemarthrosis and their main characteristics: date, origin (traumatic or spontaneous) and location (knee, ankle or elbow). The selfregistration will be delivered to the evaluator in each of the study evaluations (post-treatment and follow-up).

With a pressure algometer (model Wagner FPN100) the investigators will measure the pressure pain threshold, at the joint level and at a distance (in another part of the body). This device measures in Newton / cm2 the pressure at which the subject perceives pain under pressure. A pressure will be made on the chosen point, which the investigators will increase at an approximate speed of 50kPa / s until the patient warns us that the sensation begins to be painful.

With a pressure dynamometer (microFET®2 Digital Handheld model) the investigators will measure the strength of the tibialis and gastrocnemius. This device measures in Newton the force that the patient exerts in the requested muscular action. The higher the value, the greater the muscle strength. The investigators will carry out the measurements bilaterally. The patient will be asked 4 maximum isometric contractions of 5 seconds, with a rest of 30 seconds between them, against the dynamometer located in the hand of the evaluator

Using surface electromyography (model SHIMMMER2, Shimmer, Ireland), the investigators will evaluate the electrical activity of the musculature and its level of activation. The placement of the electrodes will be marked on the standing subjects, and they will be placed following the European recommendations for the use of the SEMG. A bipolar SEMG system will be used with circular electrodes 10 mm in diameter, 20 mm apart, placed longitudinally, in the direction of the fibers of the studied muscle, and with a remote reference electrode.

With the Hemophilia Joint Health Score scale, specific for its use in patients with hemophilia, the joint status of patients with hemophilic arthropathy will be evaluated. It evaluates 8 items: inflammation and duration of this, pain, muscle atrophy and strength, crackles, and loss of flexion and extension. It has a score of 0 (no joint damage) to 20 points (maximum joint damage) per joint (elbows, knees and ankles). A gait rating is added to the 120 points (range 0-4 points), the maximum rating on this scale being 124 points

With the Single Leg Stance Test, static postural control and balance will be evaluated. To perform this test, the subject must place both hands on the hips and flex the knee of the non-tested leg, leaving the opposite foot as the only support. The time will be timed (in seconds) from the moment the participant flexes his leg until he places it on the ground again or his hands come off his hips, with a maximum of 60 seconds. This test will be performed with visual support (eyes open) and without it (eyes closed). The longer the time, the better stability. The participants in this study will perform the test twice with each leg, with the best score recorded in the data analysis.