30 SECONDS OF THERAPY: Hemiplegic Post-Stroke Shoulder

Mar 26

5 min read

START:

1.Acute Phase (Weeks 1-2) Goal: Pain management, swelling reduction, joint protection, maintaining mobility, muscle activation.

A. Pain/ Swelling: Ice (15 min every 2 hrs, first 10 days), NSAIDs (as prescribed),

B. Protect: Support Shoulder sling or lap tray to prevent subluxation.

C. Mobility: PROM in pain-free range (flexion: 0-45°, ER: 0-10°),, and scapular mobilization.

D. Activation: NMES (35 Hz, 250 μs pulse duration) applied to supraspinatus and posterior deltoid for 30 minutes, 5x/week to reduce shoulder subluxation.

2. Early Mobilization (Weeks 2-6) Goal: Prevent stiffness, increase activation, and restore movement.

A. Mobility: AAROM (Flexion: 0-90°, ER: 0-30° pain-free), pendulums (2-3x/day),

B.. Restore: scapular retractions (15 reps, 5-sec hold), isometric strengthening (flexion, extension, abduction, adduction: 10 reps, 5-10 sec hold).

3. Functional Rehab (Weeks 6-12+) Goal: Restore stability, function, and return to activity.

A. Strength Prone Ys/Ts (12 reps, 2-3 sets), resisted Theraband exercises (internal & external rotation at 0° and 45° abduction, progressing to overhead movements).

B. Dynamic Control: Wall slides (10-15 reps, 2-3x/day), quadruped rock backs (10 reps, 2x/day), BOSU push-ups (modified to full range), functional reaching drills (cup stacking, overhead ball toss).

Example: Quadruped rocking with scapular depression and protraction improves weight-bearing stability in the shoulder girdle.

STOP:

1.Excessive Immobilization (Beyond 3-4 Weeks)Continuous sling use past four weeks leads to adhesive capsulitis—gradual introduction of AAROM reduces stiffness.

A. Neglecting Stabilizers Scapular clocks (week 5-6) and wall slides with external rotation (week 6-7) restore scapulohumeral rhythm and prevent compensatory motion.

B. Neglecting Thoracic Mobility Limited thoracic extension impairs overhead reach—foam roller thoracic extensions (10 sec holds, 10 reps) and open book stretch improve flexibility.

WHY:

1. Prevent Subluxation & Maintain Stability

A. Early activation of stabilizing muscles reduces glenohumeral instability and enhances joint control. Which prevents shoulder subluxation long term. Seated forearm weight-bearing promotes scapular and rotator cuff co-contraction. Protection is important to allow inflammation in the brain to subside for the first 6 weeks, but the muscles need control activation to encourage nerve regeneration and neuroplasticity.

2. Enhance Functional Movement & Optimize Recovery

A. Active mobility prevents stiffness, while task-specific training restores coordination and strength. Manual scapular mobilization with PNF patterns improves reaching, while sit-to-stand transitions with arm weight-bearing enhance proprioception.

B. Stabilizers Protect and facilitate function. Weak serratus anterior muscles can cause scapular winging and create damage to other internal structures including labral tears, impingement, rotator cuff damage.

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Hemiplegic Post-Stroke Shoulder