Sickle cell anemia is an inherited blood disorder caused by abnormal hemoglobin, the protein in red blood cells that binds to oxygen to transport it around the body. The abnormal hemoglobin deforms the red blood cells, causing them to become trapped inside small blood vessels. This can cause bone and joint problems, pain, acute chest syndrome, and stroke. There are several treatments to help manage the disease. Physiotherapy can also be used to improve patients’ quality of life.
What is physiotherapy?
Physiotherapy involves using movement, exercise, and manual therapy to help people affected by injury or disease. For sickle cell anemia, physiotherapy may be in the form of aerobic exercises, breathing exercises, and massages, or through devices such as transcutaneous electrical nerve stimulation (TENS). (TENS) involves delivering a small electrical current that may disrupt pain sensors and relax muscles. However, there is still insufficient evidence to determine how effective this treatment is for reducing pain levels.
Physiotherapy should be tailored to the individual, reflecting patients’ limitations and the areas from which they could benefit most.
Physiotherapy and pain management
Patients with sickle cell anemia can experience chronic pain, as well as sudden and debilitating pain. Physiotherapy can be used, often alongside medication, to help manage pain. For example, light exercise can improve blood flow and help manage the symptoms of the disease.
Massage therapy carried out by a physiotherapist can help improve blood flow and relax the patient. This can reduce stress and pain, and therefore may improve quality of life.
A randomized controlled trial published in the Journal of Pediatric Psychology found that massage therapy given over a 30-day period reduced levels of pain, depression, and anxiety in sickle cell anemia patients compared to patients not receiving the intervention.
Physiotherapy and acute chest syndrome
Acute chest syndrome is a common complication in sickle cell anemia. It can be fatal if left untreated. Physiotherapy may help reduce the risk of acute chest syndrome and can help reduce the pain associated with it. For example, breathing exercises can help reduce the chance of lung infections and improve oxygen supply throughout the body. An incentive spirometer can also be used to make it easier to breathe deeply.
Physiotherapy and musculoskeletal problems
Sickle cell anemia can cause a range of problems involving the bones, joints, and muscles. For example, blockages in blood vessels in the hips can lead to the bone tissue dying (a condition known as avascular necrosis of the femoral head). This can cause the bone to collapse, resulting in hip deformities that can cause pain or limit movement.
Physiotherapy exercises can help maintain or improve a patient’s range of motion, improve muscle strength, and reduce pain.
A pilot study assessed the effect of aquatic and land physiotherapy in sickle cell anemia. Ten patients with hip or back problems related to sickle cell anemia were randomly assigned a 12-week exercise program either in water or on land. The results published in the Brazilian Journal of Hematology and Hemotherapy showed that all patients, regardless or exercise type, saw a significant improvement in their range of motion and muscle strength as well as a reduction in their Oswestry Disability Index score, which assesses lower back pain.
Physiotherapy and stroke recovery
Ischemic strokes, caused by blockages in the blood vessels supplying the brain, can occur due to sickle cell anemia. Strokes can cause a range of problems, including movement difficulties such as muscle weakness, muscle stiffness, or muscle spasms. Physiotherapy can be essential in rehabilitating patients who have had a stroke and may help them regain function. It may involve a tailored exercise program to regain muscle strength and increase the range of movement. The physiotherapist may recommend supports for the ankles or hands to aid movement.
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