{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T23:04:18Z","timestamp":1789513458405,"version":"build-2803163510"},"reference-count":174,"publisher":"Georg Thieme Verlag KG","issue":"07","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Thromb Hemost"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>People with hemophilia (PwH) face persistent joint damage risk despite prophylactic factor replacement therapies. Although muscles are recognized as biomechanical stabilizers, their broader protective mechanisms remain poorly understood. This review provides an integrative theoretical framework that examines how muscles protect joints in PwH through three interconnected dimensions: (1) mechanical\u2014via joint stabilization and force absorption; (2) neuromuscular control; and (3) biochemical regulation through exercise-induced myokines (exerkines). Muscle contractions provide joint stabilization and attenuate mechanical impacts via eccentric actions and muscle\u2013tendon buffering, thereby reducing joint loading during daily activities. Neuromuscular control maintains joint stability through coordinated muscle activation, though excessive co-contraction in arthropathy can paradoxically increase joint stress. Critically, the endocrine function of skeletal muscle, producing anti-inflammatory and cartilage-protective exerkines including interleukin-6, irisin, and lubricin (among others), represents an underexplored yet crucial protective mechanism. Physical inactivity and intramuscular fat accumulation impair these protective functions, accelerating joint degeneration. This integrative theoretical perspective offers a comprehensive framework for understanding how muscles protect joints in hemophilia. Understanding these integrated mechanisms is essential for developing targeted rehabilitation strategies and guiding future research to optimize joint health in PwH.<\/jats:p>","DOI":"10.1055\/a-2788-1715","type":"journal-article","created":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T00:35:08Z","timestamp":1768437308000},"page":"816-826","source":"Crossref","is-referenced-by-count":0,"title":["How Do Muscles Protect Joints in Hemophilia? Integrating Mechanical, Neural, and Endocrine Mechanisms"],"prefix":"10.1055","volume":"52","author":[{"given":"Carlos","family":"Cruz-Montecinos","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joaqu\u00edn","family":"Calatayud","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Exercise Intervention for Health Research Group (EXINH-RG), University of Valencia, Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo","family":"N\u00fa\u00f1ez-Cort\u00e9s","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel C.","family":"Ogrezeanu","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Exercise Intervention for Health Research Group (EXINH-RG), University of Valencia, Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Tur-Boned","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Exercise Intervention for Health Research Group (EXINH-RG), University of Valencia, Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangxin","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ver\u00f3nica","family":"Soto-Arellano","sequence":"additional","affiliation":[{"name":"Hospital Puerto Montt, Eduardo Sch\u00fctz Schroeder, Puerto Montt, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars L.","family":"Andersen","sequence":"additional","affiliation":[{"name":"National Research Centre for the Working Environment, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huub","family":"Maas","sequence":"additional","affiliation":[{"name":"Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1134\/S1063771016050134","article-title":"Skeletal muscle contraction in protecting joints and bones by absorbing mechanical impacts","volume":"62","author":"O Rudenko","year":"2016","journal-title":"Acoust Phys"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.mehy.2014.04.020","article-title":"Muscle as a molecular machine for protecting joints and bones by absorbing mechanical impacts","volume":"83","author":"A Sarvazyan","year":"2014","journal-title":"Med Hypotheses"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1111\/j.0954-6820.1986.tb08943.x","article-title":"Role of muscles in protecting athletes from injury","volume":"711","author":"E L Radin","year":"1986","journal-title":"Acta Med Scand Suppl"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/S0889-857X(05)70068-5","article-title":"The role of muscle weakness in the pathogenesis of osteoarthritis","volume":"25","author":"M V Hurley","year":"1999","journal-title":"Rheum Dis Clin North Am"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1177\/036354658801600205","article-title":"Muscular coactivation. 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