Biomechanical viscoelastic properties in leg muscles of people with hemophilia: a case control study
- 1Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
- 2Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
Abstract
Background: People with hemophilia (PwH) are prone to joint bleeds, resulting in hemophilic arthropathy, potentially altering muscle tissue. Although functional and morphologic impairments are documented, little is known about biomechanical muscle properties in PwH.
Objectives: This study investigates muscle stiffness in relaxed and contracted states in the lower limbs of adult PwH and its relationship to muscle strength and joint health.
Methods: In this cross-sectional case-control study, 40 PwH and 20 healthy controls were assessed. Using myotonometry, stiffness of 8 lower limb muscles was measured under relaxed (Srel) and maximum voluntarily contracted conditions (Scon). Stiffness increase rate (SIR) was calculated. Joint health was assessed via the Hemophilia Joint Health Score and sonography (Hemophilia Early Arthropathy Detection with Ultrasound), and muscle strength was measured using a mobile isometric force gauge. PwH were stratified by lower limb joint impairment (PwHminor vs PwHmajor).
Results: PwHmajor exhibited significantly increased Srel in anterior thigh and calf muscles compared with controls and PwHminor (all P ≤ .05, r = 0.397-1.010). Under contraction, PwHmajor showed reduced Scon in the tibialis anterior (P ≤ .05, r = 0.511-0.683) and biceps femoris (P = .04, r = 0.390). The SIR was significantly lower in PwHmajor across most muscles (all P ≤ .05, r = 0.380-0.573), indicating impaired muscle contractility. Furthermore, muscle strength correlated negatively with Srel (rs = –0.220 to –0.430) and positively with both Scon and SIR (rs = 0.273-0.449). Hemophilia Joint Health Score correlated with myotonometric parameters (rs = 0.248-0.683), linking joint damage to altered muscle properties.
Conclusion: Advanced hemophilic arthropathy is associated with increased passive stiffness and reduced active muscle response, particularly in stabilizing muscle groups. Myotonometry may serve as a potential supplementary tool for the exploratory assessment of biomechanical muscle status in PwH.
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BibTeX
@article{bruhl2026biomechanical,
title = {{Biomechanical viscoelastic properties in leg muscles of people with hemophilia: a case control study}},
author = {Marius Brühl and Fabian Tomschi and Andreas Christian Strauss and Joschua Wiese and Pia Möllers and Alexander Schmidt and Thomas Hilberg},
journal = {Research and Practice in Thrombosis and Haemostasis},
year = {2026},
month = oct,
doi = {10.1016/j.rpth.2026.107000},
url = {https://doi.org/10.1016/j.rpth.2026.107000},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Biomechanical viscoelastic properties in leg muscles of people with hemophilia: a case control study
AU - Marius Brühl
AU - Fabian Tomschi
AU - Andreas Christian Strauss
AU - Joschua Wiese
AU - Pia Möllers
AU - Alexander Schmidt
AU - Thomas Hilberg
PY - 2026
DA - 2026/10/01
JO - Research and Practice in Thrombosis and Haemostasis
DO - 10.1016/j.rpth.2026.107000
UR - https://doi.org/10.1016/j.rpth.2026.107000
AB - Background: People with hemophilia (PwH) are prone to joint bleeds, resulting in hemophilic arthropathy, potentially altering muscle tissue. Although functional and morphologic impairments are documented, little is known about biomechanical muscle properties in PwH. Objectives: This study investigates muscle stiffness in relaxed and contracted states in the lower limbs of adult PwH and its relationship to muscle strength and joint health. Methods: In this cross-sectional case-control study, 40 PwH and 20 healthy controls were assessed. Using myotonometry, stiffness of 8 lower limb muscles was measured under relaxed (Srel) and maximum voluntarily contracted conditions (Scon). Stiffness increase rate (SIR) was calculated. Joint health was assessed via the Hemophilia Joint Health Score and sonography (Hemophilia Early Arthropathy Detection with Ultrasound), and muscle strength was measured using a mobile isometric force gauge. PwH were stratified by lower limb joint impairment (PwHminor vs PwHmajor). Results: PwHmajor exhibited significantly increased Srel in anterior thigh and calf muscles compared with controls and PwHminor (all P ≤ .05, r = 0.397-1.010). Under contraction, PwHmajor showed reduced Scon in the tibialis anterior (P ≤ .05, r = 0.511-0.683) and biceps femoris (P = .04, r = 0.390). The SIR was significantly lower in PwHmajor across most muscles (all P ≤ .05, r = 0.380-0.573), indicating impaired muscle contractility. Furthermore, muscle strength correlated negatively with Srel (rs = –0.220 to –0.430) and positively with both Scon and SIR (rs = 0.273-0.449). Hemophilia Joint Health Score correlated with myotonometric parameters (rs = 0.248-0.683), linking joint damage to altered muscle properties. Conclusion: Advanced hemophilic arthropathy is associated with increased passive stiffness and reduced active muscle response, particularly in stabilizing muscle groups. Myotonometry may serve as a potential supplementary tool for the exploratory assessment of biomechanical muscle status in PwH.
SN - 2475-0379
ER -