The components that will be discussed are flexibility, strength, sensoriomotor retraining (sometimes referred to as proprioception), balance and overall function. The role of each component will be explored, reviewed and linked to the management of musculoskeletal health for patients with haemophilia. Prior to embarking

on any kind of exercise programme, no matter what components selleck products of exercise are involved, it is recommended that all patients with haemophilia be evaluated by the multi-disciplinary health care team. This coordinated approach ensures that all medical and musculoskeletal issues will be identified and addressed as needed to enhance the efficacy of the exercise regimen. PD-1/PD-L1 inhibitor Commonly referred to as stretching, exercises with this focus are recommended to improve performance [2,3], as a warm-up prior to sports or activity to reduce or prevent injury [3–6], to decrease muscle soreness [4] and to gain range of motion (ROM) [7–10]. The benefits, however, of stretching to improve performance and reduce injury have come into question as reported by several review articles [11–14]. There are a variety of stretching techniques practised including static stretching, ballistic or dynamic stretching and proprioceptive neuromuscular facilitation (PNF) techniques. Static stretching is commonly referred to as slow stretching or passive stretching. Dynamic or ballistic

stretching involves bouncing motions or swinging a limb with momentum to stretch a muscle group. PNF stretching, such as the contract-relax technique, uses a combination

of isometric contractions and static stretches of the agonist and/or antagonist muscle, following the theory of autogenic and reciprocal inhibition. Stretching exercises result in elongation of soft tissues and muscles [15,16] that can have a lasting effect 24 h later, with the greatest increases being maintained in the first 15 min [17]. Viscoelasticity of skeletal muscle is affected, and selleck chemical stress-relaxation occurs with a gradual reduction in tension as a stretch is held at a constant length over time [18,19]. In addition, a slow, sustained stretch stimulates the Golgi tendon unit, resulting in muscle relaxation [20] and reduces the spinal stretch reflex [21]. Stretching has been shown by many studies to increase ROM [7–10]. Some investigators, however, have proposed that stretching is responsible for decreasing strength directly after it is performed [22–24] while others have concluded that it either does not have an influence [25–27] or that it in fact increases strength [23,28–32]. Ballistic stretching causes facilitation of the stretch reflex [21,33] and could, in fact, injure the muscle fibres [34]. There are a multitude of articles relating to the non-bleeding disorder population on recommended practices for stretching exercise.