Haemophilia is a genetic disorder in which blood clotting is impaired. The blood from wounds does not clot at all or does so only slowly. Sufferers often experience spontaneous haemorrhages without any visible wound. Haemophilia occurs mostly in men. Affected persons are referred to colloquially as bleeders.

Bleeding that is severe or caused by an accident can only be controlled by the administration of coagulating factors. If this treatment is not given in time, the haemophiliac can bleed to death (even if the injury is not serious).

The risk of internal bleeding ( such as renal bleeding with occlusion of the urinary tracts by blood clots) is also higher for haemophilia patients.

Female carriers of the genetic defect can have a tendency towards heavier bleeding that manifests itself in increased menstrual bleeding, susceptibility to bruises (haematomas) and excessive bleeding during routine operations such as tooth extraction or giving birth. In rare cases ( such as joint haemorrhages), such bleeding can approach the level seen in male haemophiliacs.

In the most common sub-forms of haemophilia, cut, tear and scrape wounds do not lead to greater blood loss than in healthy patients, since scab formation functions initially thanks to the intact blood platelets (thrombocytes). But the delayed blood clotting causes the surface scabs to break open and, depending on the severity of the haemophilia, the bleeding can be stopped only slowly or not at all. This means that subcutaneous or intramuscular haematomas can develop even without outside interference.

A common location for bleeding is the joints. The first bleeding in a joint (also called the initial haemorrhage) is often caused by an accident/trauma. The larger joints are particularly susceptible. The synovial membrane releases enzymes that remove the blood in the joint. After large-volume haemorrhages, more synovial fluid is provided, and the area experiences a higher concentration of blood vessels, increasing the chance of subsequent haemorrhages or inflammation. A cycle of inflammations and haemorrhages ensues, and so-called haemarthrosis develops: uncontrolled movements in particular, but also torsion and overflexion (even at night), ankle twists, stumbles and so on can cause further joint haemorrhages (usually ankle, knee, elbow, shoulder or, more rarely, hip haemorrhages), all usually associated with severe pain.

Spontaneous muscle haemorrhages occur less frequently and are usually caused by trauma. Depending on the position and size of the muscle, such haemorrhages can, however, require extremely lengthy recuperation periods and cause irreversible muscle damage leading to permanent disability.

The consequences of frequent bleeding events are especially noticeable in older patients, since effective preventive therapies have only been available for about 30 years:

• Joint stiffness, sometimes extreme, early osteoarthritis (occasionally requiring surgical intervention or orthopaedic aids) and
• deformities of the musculature and bone construction for which continuing physiotherapy can improve or at least maintain joint mobility for a certain degree of load.

• kybun cannot replace the necessary medications, but does help to actively shape your everyday routine without overtaxing the joints and muscles, making it an ideal therapeutic complement for ‘bleeders’.
• The soft, elastic sole dampens the impact from hard surfaces, protecting the joints. This is perceived to be particularly pleasant by those with joint problems (such as inflammation or deterioration) and motivates patients to exercise more.
• Since the foot can move freely in all directions on the soft, elastic sole, foot mobility, power, and stability is improved. It is the best way to prevent deterioration of the ankle joints and the joints above them, such as the knees, hips, and back.
• Because ‘bleeders’ frequently suffer joint haemorrhages due to minor cuts or scrapes, strong feet that provide the body with a solid foundation are the best prevention for these hazardous injuries.
• The activated musculature stimulates circulation, which promotes the healing of existing injuries and prevents future ones.
  It is important for ‘bleeders’ that the joints and muscles are supplied with fresh oxygen from the blood so that these structures can remain healthy in the long term.

It is very important that haemophiliacs avoid overexertion, which can lead to injuries.
Please observe the following tips:

• kybun training should always be adapted to the user’s condition each day. It is important for the affected individual to discover how much kybun training is helpful and when it is time for a break in order to avoid increased pain afterwards. On some days, it may well be that only short and gentle kybun shoe training is required (or even skipping a day), while walking longer distances in the kybun shoe may be possible on other days.
  Regular walking in the kybun shoe allows the body to adjust over time (developing stronger muscular and connective tissue and more stable joints), and complaints will decline.

  More helpful tips:

• If you feel pain in the kybun shoe or on the kybun mat, or if your existing pain gets worse, this may be due to various reasons (e.g. an unfamiliar, more upright posture, tense muscles, movements that are unfamiliar for the body).
• We advise you to perform the kybun exercises regularly every now and again. They loosen the muscles and straighten the body. This relieves strain on the joints. As a result, pain should decrease after a few hours or days.
  Choose the kybun exercises that are good for you! Some customers prefer easier movements while others find the more intensive exercises helpful; this is highly individual.
• Choose a kybun shoe with a lower rebound effect. It provides you with greater midfoot stability. Ask your kybun dealer to show you the various models.
• If you feel unstable wearing the kybun shoe or are looking for an additional training device to use at home, the kybun mat is the ideal alternative. You can strengthen the foot, leg and back musculature at home on the soft, elastic springy mat. You can hold on to a fixed object if you feel unstable. The kybun mat is also available in a choice of different thicknesses (the thicker, the more intensive the training). Ask your local kybun dealer for advice.
• If you get very fatigued in spite of the kybun exercises, or if you feel pain or in case of lateral/medial rolling of the ankle joint on the kybun sole, we advise you to take a short kybun shoe/kybun mat break until the symptoms go away.
• Be sure to maintain an upright posture, avoid taking excessively long steps and keep your gaze forward (do not look at the floor). You should walk straight on the kybun shoe sole and correct any lateral/medial rolling of the ankle joint!
• If uncertainty or complaints arise even after you have implemented these tips, please contact a local kybun dealer you trust for advice.