It is important to transfer some responsibility back to the patient. Different components should be included in a sports therapy treatment. To bring these different components together the cogwheel model of motion as shown in Fig. 3 was developed. This model includes five components which stand alone, but also work together hand-in-hand for successful joint interaction. A basic component of this training is body awareness. A good voluntary perception of one’s own body is helpful to protect particularly sensitive structures [62]. A second component is joint mobilization. Restrictions of joint interaction or joint mechanics are common in patients with haemophilia and the release of joint contractures is only possible if these

are due to soft tissues. Mobilization by physiotherapy is an important treatment but must be combined with careful autonomous mobilization http://www.selleckchem.com/products/azd5363.html by the individual patient. This is possible after sufficient education but should be done carefully. Another component of the cogwheel model is the activation of joint metabolism. Specific joint structures such as cartilage are supplied with nutrients by diffusion alone so, on the one hand, joint motion is absolutely necessary, but on the other hand, prevention of high impact on the joints is also mandatory to permit sufficient joint metabolism without high joint stress. Newer studies could show that the tonus

of weight-bearing muscles can be high in patients with ABT888 haemophilia. In 2011 Kurz et al. used electromyography to assess muscle tonus and found a higher tonus in patients with haemophilia, particularly in the knee extensor muscle. Kurz et al. also found that the muscle tonus was dependent on joint status [63]. Patients with haemophilia try to partly compensate a decrease of muscle function by enhanced muscle tonus. Therefore, Clomifene muscle training in patients with haemophilia takes into account that a possible higher muscle tonus is present. This has

to be modulated before and during the training process. Another important component is soft tissue strength and coordination training. After comprehensive teaching, muscular strength and coordination can be trained by the patient at home, e.g. using Thera-Band™ (Thera-Band, Ludwig Artzt GmbH, Dornburg, Germany) exercise bands and a stability trainer. In the Haemophilia and Exercise Project, we survey over 12 years of individual home training of haemophilia patients. The training is controlled by training schedules, with no complications caused by our sports therapy. During this time, we developed and adapted many exercise tools to suit the needs of the haemophilia patient. These tools can be used alone by the patient [64]. One other major point must be taken into account. A key problem for both physiotherapy and sports therapy is pain, with its presence often hindering exercise therapy. We showed for the first time in an experimental study that joint pain is directly and locally dependent on joint status [65].