#040 Exercises for Post-Stroke Shoulder Pain

Aug 26, 2023

#040 Exercises for Post-Stroke Shoulder Pain

In this Doctor Andrea Furlan demonstrates 24 exercises for treatment of hemiplegia and shoulder pain caused by stroke. She shows range of motion, strengthening, stretching and relaxation exercises.

Download the document with a summary of all exercises:
http://bit.ly/Stroke_shoulder_doc

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00:00 Introduction
07:23 Exercise 1
09:30 Exercise 2
12:25 Exercise 3
13:42 Exercise 4
15:17 Exercise 5
16:25 Exercise 6
17:34 Exercise 7
18:12 Exercise 8
18:48 Exercise 9
19:20 Exercise 10
20:37 Exercise 11
22:35 Exercise 12
23:28 Exercise 13
25:02 Exercise 14
26:12 Exercise 15
27:16 Exercise 16
28:17 Exercise 17
29:25 Exercise 18
30:40 Exercise 19
31:58 Exercise 20
32:56 Exercise 21
33:52 Exercise 22
35:23 Exercise 23
36:33 Exercise 24

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=============================================
ALERT: This video is not intended to replace medical
advice. If you think you have a condition that is
causing you pain, please consult with your doctor
to get a diagnosis and a treatment plan for you.
The intent of this video is only for educational
purposes.
=============================================

Content

1.28 -> stroke is very common according to the world stroke organization one in four adults will have a

7.52 -> stroke in their lifetime there are over 13 million new strokes every year globally fortunately the

14.32 -> majority of people will survive however many people will remain with some sort of disability

20.48 -> rehabilitation post stroke is very important and it involves a team of doctors like me physiatrists

26.64 -> and a team of physiotherapists occupational therapists speech and language pathologists

31.36 -> psychologists and social workers one of the common consequences of stroke that i see in my pain

36.96 -> clinic is shoulder pain today i will demonstrate 24 exercises that people who had a stroke can do

45.2 -> at home to improve muscle weakness stiffness and shoulder pain so let's talk about stroke shoulder

53.28 -> today

62.08 -> first let me talk to you about the 10 principles of exercises for stroke number one movement is the

70.08 -> best thing to boost your recovery your confidence and your well-being there is no medication device

77.68 -> surgery or cure for stroke exercises to the best modality that we have to help the brain to recover

84.96 -> from a stroke number two moving also reduces your risk of having another stroke it reduces the

92.96 -> clogging up of your arteries it lowers your blood pressure it stabilizes the blood sugars reduces

100.4 -> cholesterol and if you make changes in your diet exercise will also help you to reduce your weight

107.28 -> number three you must practice some sort of exercise every day seven days a week for at

114.32 -> least one hour every day to see some benefits for a stroke there is a window of opportunity within

121.28 -> two years after the stroke that your brain is reorganizing and making new connections we call

127.28 -> this neuroplasticity it doesn't mean that you cannot do exercises after two years you can and

134.64 -> you should but the improvements after two years will be slower and it will take longer for you to

140.88 -> notice the benefits but don't give up there can be brain reorganization after two years number four

150.4 -> for each exercise you need to do a mental practice before you start the exercise remember you're not

158.32 -> just exercising the arm or the hinge or the elbow you're making neuronal connections in your brain

166.16 -> mental exercises mental practices involves rehearsing the task mentally

172.88 -> in your head do a mental visualization of all the movements you would do for the next exercise

179.92 -> and after you have seen them in your mind then you start doing the exercise

186.4 -> number five keep an eye on the movements that you are doing

190.96 -> when you are doing these movements keep looking at your affected hinge the images of your arm moving

197.92 -> will help the brain to make those connections your brain will receive information from your eyes your

204.48 -> joints and your muscles all this will tell the brain to make a new connection a new synopsis

212.8 -> number six bilateral arm training the same activity is done with both arms simultaneously

220.8 -> this is important for three reasons first the good arm will be your physical therapist

227.44 -> and the second thing is that the left brain communicates with the right brain so if the

233.52 -> good arm is moving there will be a message in your brain going from side to side telling the affected

239.52 -> side to move it's almost like a mirror therapy the affected side of the brain will see how

246.48 -> the healthy side of the brain is working and it will imitate what is happening on the other side

253.36 -> number seven task specific training is better than just repetitive activity so if you can find some

260.88 -> activity that is meaningful to you and you can do regularly that is better than just repeating these

266.8 -> movements without a task in mind i'll give some examples when i show you the exercises

273.68 -> number eight start slow and goals low don't try to achieve too much when you are starting the

281.04 -> most important thing is that each day you can do a little bit more than the day before so i recommend

287.36 -> you to keep a notebook and take notes of your progress how many repetitions you can do today for

293.76 -> exercise number one for example and then maybe you take notes four repetitions today maybe then your

300.08 -> goal for tomorrow is to do five repetitions of that exercise and then start increasing gradually

307.6 -> number nine about 80 of individuals with paralysis of the arm will experience some shoulder pain pain

315.52 -> can be caused by a subluxation rigid muscles frozen shoulder immobility or repeated trauma

324.08 -> exercises help to reduce pain in the affected arm shoulder pain is usually caused by a weakness in

330.64 -> the muscles around the shoulder and sometimes the muscles get rigid we call this a specificity

336.88 -> and it's hard to move keep in mind that these exercises should not cause pain if you do any

344.24 -> of these exercises and your shoulder hurts it's a sign from your body that you are overdoing it

351.36 -> and number 10 talk to your physical therapist or your occupational therapist

356.64 -> or your rehabilitation physician they can give you some specific advices for your case

362.8 -> each person is different and it depends on the type of stroke and how much your arm is affected

370.32 -> i'll show you some exercise to improve range of motion to strengthen the muscles

375.2 -> to stretch the muscles and to relax but this video is only for educational purposes

381.44 -> it's not intended to give you individual advice if you need advice please talk to your doctor

386.8 -> and if there is any emergency please go to the nearest emergency department

392.8 -> here is a list of what you need to do these exercises a chair a table or a desk

400.64 -> a cane or some sort of a long stick a piece of fabric if you don't have a good grip to

406.72 -> hold the cane a towel a hard pillow an elastic binge a carpet or a mat to lie on the ground

416.88 -> if you go to the description of this video below you will find a summary of dispositions and

422.32 -> exercises that you can download and print to do at home just find a button down that says show more

431.12 -> i have also included time stamps on this video so you can scroll up and down and

437.36 -> find the exercises you are looking for in the timeline this is a range of motion exercise

445.76 -> and one hand is going to help the other hinge so with the unaffected hinge

452.24 -> you're going to grab the other hinge and you're going to do movements

460.24 -> the good hinge helping the affected hinge try to keep your elbows straight

466.96 -> if you can come just to the level of your nose that's okay and keep going down and up to here

477.76 -> however if you can go above your head without causing any pain any discomfort keep going

485.68 -> the further you go back is better without causing any pain or discomfort in your affected

494 -> shoulder ideally you should be able to go all the way up behind your head and come back

503.6 -> the important thing is that your affected arm will start working with the good warm arm it's not just

511.92 -> a good arm doing the movement and grabbing your other arm but both working together see if there

518.72 -> is any movement and try to look at your hinge so look at your hinge when it's passing in front of

525.28 -> your face keep looking at it remember you are training your brain to make new connections

535.28 -> and you may do many repetitions of this exercise until you start getting fatigued

541.92 -> so if this is about four repetitions that's all you can do that's fine the important thing is that

549.44 -> then tomorrow you may try to increase to five

553.04 -> and then six and seven ideally you should be doing all this range of motion about 20 times

564.08 -> and you need to repeat this every day seven days a week so this exercise is very similar

571.28 -> to the previous one but we are going to do indeed diagonal and so you're going to grab

577.92 -> the same thing both of your hands together and you're going to go from the right hip

585.92 -> to the left side of your head so diagonally this is very important both elbows stretch

597.12 -> and you're doing this diagonally your head should be relaxed on the ground and when your

605.04 -> hinge passes in front of your face make sure that you look at your hinge you are seeing it

612 -> and feeling it elbows straight and you do this as many as you can and you get fatigued

621.44 -> ideally 20 and then you do for the other side so grab your hands together here elbows are straight

629.6 -> and now you're going to do to the other side

633.28 -> and look at the hinge when it passes in front of your face and go go go go all the way stretching

645.28 -> and doing range of motion of the shoulder so one hand is helping the other one the good hand

653.2 -> is being the physiotherapist for the badge hinge for the bad shoulder so keep doing this movement

665.2 -> so there is a modified version of this exercise if you have an elastic band like this

672.32 -> and if your affected hinge can grab the elastic bend then you can use this

679.76 -> so both hands here together and what you're going to do is you're going to keep

685.04 -> one hand close to the hip and the other one will go in the diagonal

691.68 -> and all the way down and come here to the diagonal all the way touching the floor there

701.84 -> do for the other side as well so this one keeps here on the side of your hip and this one goes

709.68 -> all the way and touch the forehead so this is straight elbow this is strengthening the muscles

719.36 -> but also its range of motion for the shoulder we are opening the shoulder

724.72 -> opening the axilla which is very important because people who have stroke they usually

731.36 -> have the muscles pulling the shoulder towards the trunk so it's important to open the arm like this

742.96 -> if you do have a cane then you can do some exercises for the shoulder

748.24 -> using the cane so if you have a good grip of the the hinge here you're going to hold let's

758 -> say that this is the affected hinge and with this one you're going to grip hold here and

764.24 -> what you're going to do is with the good arm it's going to help the affected arm to move all the way

775.04 -> up and again if this causes pain you should not be doing it and you can go from here

785.36 -> and some people can only come to the level of the nose and come back here

794.72 -> and come back and again do this as many repetitions and cheer your muscles get fatigued

802.56 -> and in the beginning it's going to be a few repetitions you'll not be able to do too many

807.68 -> but as you practice this every day you're going to get stronger

811.92 -> and then each day you can increase the repetitions and you can do 20 of those

820.48 -> so this exercise is similar to the previous one

823.6 -> but now we are going to do side to side and what happens is

827.84 -> when the person doesn't have a good grip on the affected hinge you can use a piece of fabric

835.6 -> to attach the hand this is a scarf that i have and you can just go around and hold the hinge here

847.52 -> to help the hinge not to escape here from the grip okay so the exercise is similar to the one

856 -> we did before but now we're going to go side to side so you see the good hinge

863.28 -> is now pulling the affected hinge and pushing the affected hinge here so go all the way to the floor

874.64 -> up look at your hinge when it's moving your eyes should be following your hinge

883.04 -> and you do this movement using the right arm to guide your affected arm

890.64 -> and again do as many repetitions as you can and you can use i think this is better you can use

898.56 -> like four or five and then start increasing every day don't forget the elbow has to be straight

907.12 -> and your eyes should be following your affected change

915.04 -> so this exercise is for the elbow flexion and extension it's important that you grab

923.84 -> a towel and you put under your elbow here and the other important thing is that your shoulder elbow

932 -> and hinge is aligned so don't bring your hand towards your belly because this is a movement

940.96 -> that people with stroke usually they keep the hinge the the shoulder closed like this and the

948.88 -> hinge on the belly we need to do the opposite we need to open the arm so for this exercise so

957.36 -> you put the towel under the arm here and then you're going to binge and stretch the elbow

969.04 -> and do this as many repetitions you can ideally doing twenty every day in the affected side

984.16 -> so this is an exercise for weight bearing on the shoulder very important because weight

990.8 -> bearing on the shoulder will help to strengthen the muscles of stabilization of the shoulder

998.88 -> so we have a heart pillow under our chest

1002.88 -> and then we're going to it's important to align the elbow with the shoulder here

1009.68 -> and we're going to do the first stage is very basic just doing like a catch cow just raising the

1020.48 -> chest up and down you're putting weight on both shoulders right and left just go down and up

1036.08 -> down up okay and then you can progress when this becomes easy and you can do 20 repetitions of this

1044.88 -> very easily you progress and the next stage will be you're going to go side to side so

1052.72 -> you're going to put more weight on the left and more weight on the right

1058.4 -> more weight on the left more weight on the right

1064.72 -> and do this 20 times on each side

1070.96 -> and you can rest if you get tired and go back so you feel the weight of your chest going through

1079.76 -> the left shoulder left elbow and when this becomes easy that you're going side to side

1087.28 -> you will start lifting the left the unaffected arm and putting more weight on the affected edge side

1100.32 -> so you do this and come back so you see i'm lifting the good arm of the floor here and putting

1110.32 -> almost all of the weight of my chest on the affected side and then you do this 20 repetitions

1120.16 -> and when this becomes easy to you you will going to start lifting completely the good arm

1128.24 -> and putting all of the weight of your chest is going through the affected arm and then you rest

1139.6 -> then your left

1143.36 -> and rest

1147.44 -> lift rest and do this 20 times

1158.72 -> and don't forget the last exercise when you're lying down should be the stretching and relaxing

1167.52 -> exercise so the important thing to stretch the shoulder is again is opening the axilla

1176.16 -> so what we're going to do is we're going to start going up opening the axilla

1182.96 -> and find a position that is comfortable for you if you can hold your hands here above your head

1193.36 -> and stay in this position for a couple of minutes and the important thing here is to relax

1201.92 -> try to relax especially this muscles here the pecs the pectoralis all the muscles of the axilla

1209.68 -> because when the person has a stroke they have a tendency there is rigidity pulling the arm to this

1216.32 -> position so we need to do the opposite we need to open and stay here for a couple of minutes

1223.6 -> relaxing and stretching these muscles so now this exercises you need a chair

1238.8 -> and um these are very simple exercises again the good hand is going to help the affected hinge so

1247.2 -> grab them together interlacing your fingers in your hand and elbows is straight touch one

1256.8 -> knee and you're going to raise your arms looking at your hand all the way up

1264.96 -> to about the level of your head the level of your nose and come down

1272.72 -> so go up you don't need to go too high if you want to go too high higher you can

1280.4 -> but don't forget to your eyes always following the hinge okay that's very important

1287.6 -> because your eyes are sending information to the brain that the affected hinge is moving

1295.04 -> and do this 20 repetitions because there is one thing called neglect when a person has a stroke

1304.56 -> the brain kind of forgets that the that part of the body exists so you need to tell the brain

1313.92 -> yes look at my hand it's moving so the brain will wake up and make connections and you can do also

1323.6 -> on the other side so relax it's important to relax your shoulders and go on the opposite side

1332.16 -> okay so do for both sides so now i'm going from right knee to the left side of my head

1341.28 -> and you see all the way i'm looking at my hands it's really important that you look at your hands

1351.84 -> okay while you are in this position you can also do some exercise for your elbows

1358.32 -> relaxing your shoulders so now we're going grab both hands hold both hands interlacing the fingers

1367.76 -> and you're going now to binge the elbows bring the hands close your chest

1374.88 -> and down close to your chest and down so the good hand is helping the affected hinge

1383.2 -> and look at the affected hinge and tell your brain you see it's moving so it can move

1390.56 -> there is ability to move wake up you're going to recover you're going to create some synapses

1398.24 -> in your brain when you're doing those movements you have to do them every day seven days a week

1405.84 -> so now we're doing some exercises for a stretching of the muscles around the

1410.56 -> shoulders and again we can use the cane and if you don't have a good grasp of your hinge

1418.08 -> just wrap a fabric around your hinge and the handle so keep your elbows straight

1428.24 -> and we're going to stretch the pectoralis and biceps and do for the other side

1439.44 -> so this the pectoralis is this muscle here and biceps is just one so you should be feeling

1446.24 -> stretching of the muscles when you do this and the good hinge is like a guide for the affected hinge

1455.92 -> and you do this so if this is the affected hinge then i recommend you to do more on this side

1465.12 -> but you can also do on the good side in here so you see opening the axilla

1472.88 -> some people have difficulty even to wash the axilla because it's so tight the arm is so rigid

1481.84 -> and it's so close to the chest that the person has even difficulty to clean and to wash the axilla so

1490.08 -> we are doing this we are doing stretching of the biceps and biceps and pectoralis muscles

1499.36 -> so the other stretching that is important is to stretch the trapezius muscles

1504.48 -> trapezoids are just big muscles here and they usually hurt there is usually myofascial pain

1511.92 -> of the upper trapezius area that can radiate pain to the shoulder so find a anchor on the side of

1519.28 -> the chair here and you're going to pull slowly to the other side relax and when you breathe out

1529.6 -> so breathe out one two three four five six seven eight nine ten you are pulling slowly

1537.68 -> just slightly pulling you don't need to pull too much take another deep breath one two three four

1545.28 -> five six seven eight nine ten and another deep breath one two three four five six seven eight

1555.28 -> nine ten it's always good to do with the other side but if this arm is weak you're not be you

1562.24 -> you won't be able to do this so just do with the affected side another muscle that usually hurts

1572.4 -> around the shoulder is called levator scapula it's a muscle around here in the shoulder blades

1579.12 -> so you find an anchor here in the chair and we are going to pull in the 45 degrees towards

1586.88 -> your opposite knee so just put a good hinge on the back of your head and take a deep breath

1595.84 -> and when you breathe out you count loud to 10 and pull slightly down towards the other knee okay one

1605.6 -> two three four five six seven eight nine ten take another deep breath one two three four five six

1615.92 -> seven eight nine ten and another deep breath one two three four five six seven eight nine ten

1628.8 -> come back slowly so then you don't get dizzy

1633.52 -> so now for this stretching we need to stretch the pectoralis muscles here you're going to sit on a

1640.64 -> chair but the back is here because you're going to grab your hands both of your hands behind

1647.44 -> your body and you're going to pull backwards so you see i'm stretching the pectoralis muscles

1655.52 -> in front of my chest and i'm pulling both of my hands backwards here so poop and come back

1667.52 -> and you can do this again pull so you're opening your chest stretching the pectoralis muscles

1676.24 -> hold and come back and relax this is important because pectoralis muscles

1684.4 -> are usually very shortened and tight in people who have a stroke that affects the shoulder

1691.2 -> and come back so for this exercise you need a desk or a table ideally the height of the

1699.92 -> table should be at your elbow level so then you're not shrugging your shoulders too much

1706.64 -> and you're comfortably sitting here and the first exercise we're going to do here

1712 -> on this desk or table is the exercise to rotate the elbows you're going to grab

1721.2 -> both hands together interlacing the fingers so the good hand is going to help the

1728.16 -> bad hinge so you're going to do this rotation movement this is important for the elbows mainly

1740.64 -> okay and do this 20 times for each side if you get fatigued you can stop and increase the

1753.36 -> repetitions the next day and you should be doing this every day

1762.08 -> so we cannot forget the rest too because the wrist can also get rigid so

1769.12 -> when you are in this position here you can also move the good hinge helping to move the

1776 -> bad one the affected hinge and going in one direction and the other one so the good hinge

1786 -> should be helping the affected hinge to open the fingers because they usually

1792.16 -> that's the position that usually the patient will hold so then the good hinge will open the fingers

1799.6 -> interlacing them and let's do the movement of the rest so both of the elbows are on the table here

1808.24 -> and you're just moving the wrist to from one side to the other one and you can also do side

1814.56 -> to side or up and down so this is up and down this is side to side and make sure that the

1823.04 -> good hinge is always helping the fingers to open because the tendency is to close and be like this

1836 -> so for this exercise you're going to imagine that there is a imaginary object that you need to grasp

1844.72 -> so you're going to stretch stretch stretch with your fingers open and bring the object to you

1854.48 -> so this is the stretching of the arm open open open and close can do with both hands

1865.44 -> so the good hands can imitate each other so if you want you can do with both and always looking

1873.52 -> at the affected hinge you need to train your brain that your affected hinge can move so arm

1883.2 -> goes in front stretch stretch and reach far open the fingers and when you're bringing

1891.2 -> the imaginary object you close your hinge do there's many repetitions as you can if you

1897.92 -> get fatigued you stop and then you take notes how many you could do today and your goal is tomorrow

1905.68 -> to repeat do more repetitions that you could do today up to the level that you can do 20 of this

1913.28 -> every day so now for this exercise you're going to put your elbow on the table and you're going to

1923.2 -> go all the way this side of the table and open ideally with your elbow stretch if you can

1934 -> maintain your elbow straight that's ideal and the other hinge is on your side

1941.28 -> keep your eyes on your affected hinge so your brain is learning that this arm is able to move

1952.48 -> right if you can't hold this because it's too tiring for you to keep the

1958.88 -> elbow straight you can just do this so you're opening and closing here

1972.96 -> so this exercise now is similar to the previous one that we ditched but now we are going to do

1978.64 -> with both hands together elbows are straight so it's important that you interlace the fingers

1985.52 -> so the hand will be opening here

1988.8 -> elbows are straight and we are going to move the trunk so you see i'm now moving my whole body

1997.68 -> to one side and now to the other side the previous exercise was just moving the shoulder

2006 -> now i'm moving my whole body and i'm looking at my hands and on the other side so do this

2017.44 -> as many repetitions you can and you get fatigued and ideally 20 on each side okay

2028.64 -> so now another movement that we need to do from the shoulder is to help the shoulder to rotate

2034.88 -> one of the important movements that a person with stroke

2039.52 -> loses when they have a stroke is the ability to do external rotation and although they can do this if

2048.4 -> you know this is one of the exercises they could be doing elbows close to the chest and opening up

2054.64 -> it's hard because sometimes it hurts so the easiest way of doing this is the good hinge will

2061.84 -> help the affected side so put your elbows on the table relax the arm ideally with the elbow

2070.88 -> straight but if not possible this is okay so the good hinge will rotate the shoulder out

2079.52 -> and inside you see my hand moving i'm not doing anything with my hand i'm just this is doing all

2085.6 -> the movement so there i grab my arm here and it goes inside and out so this is moving the

2097.36 -> humerus this the ball inside of the socket inside and outside this is excellent to prevent frozen

2104.32 -> shoulder so out and inside outside and inside okay do this 20 times for your affected arm okay

2120.88 -> so now the last two exercises here in the chair and desk is stretching exercise so we're going

2128.56 -> to stretch our rhomboids the muscles on the back of your thoracic spine and to do this

2136.16 -> both hands together interlacing the fingers

2139.44 -> always looking at your hand and we're going to go forward forward and

2148.32 -> so you have to feel stretching on the back of your shoulder and stretch and when you are there

2155.92 -> just stay there relax

2159.92 -> and come back and again you can do this as many repetitions you can

2168.08 -> go in front you're stretching all the muscles on the back of your shoulders and when you get here

2175.44 -> make sure you relax and look at your hinge you are relaxed

2184.08 -> and come back do these many repetitions

2190.4 -> so the last exercise is stretching of the latissimus of the dorsal here

2198.24 -> and to do this i recommend that you get your

2202.16 -> cane and you hold both hands here if you can't have a good grasp just wrap a fabric around

2210.72 -> your hand so you hold both here and with the desk in front of you you're going to put your

2218.8 -> elbows on the desk here and you're going to lower your head and you have to feel your latissimus

2228.72 -> stretching and opening there you can even rest your head on the table and try to pull the pain

2240.08 -> behind your head and you're stretching all the muscles here the latissimus the

2245.44 -> triceps i hope you enjoyed these exercises for this stroke shoulder if you continue having

2262.16 -> shoulder pain after stroke talk to your doctor you may need other treatments like

2267.04 -> medications or other modalities i have another video that i talk about neuropathic pain and

2273.36 -> the type of medications that we use to treat post-stroke pain it's also important that you

2279.44 -> treat any anxiety depression or mood disorder associated with stroke see this other video

2285.92 -> where i talk about mind-body therapies for pain remember that the treatment of chronic pain is

2293.44 -> better when you use multiple tools i like to remember my patients that they need a toolbox

2299.52 -> to self-manage their pain the type of tools include movement modalities manual therapy

2306.96 -> mind-body therapies and medications these are the five m's of self-management toolbox

2315.52 -> well it is better not to have a stroke than to treat it we all know that an ounce of prevention

2322.4 -> is worth a pound of cure how can we prevent a stroke high blood pressure continues to

2328.96 -> be the strongest factor leading to stroke make sure you treat and monitor your blood pressure

2335.44 -> obesity diabetes high cholesterol smoking and low physical activity are all

2342.16 -> important factors leading to stroke and these are things that can be modified

2347.6 -> i have another video that i talk about strategies to quit smoking press the share button below to

2355.52 -> send this video to anyone with stroke and shoulder pain and in the comments below please write down

2362.88 -> if you had a stroke and if you're doing exercises and what's working for you also there is a link

2369.92 -> to any products that i mentioned in this video if you want to purchase them if you like this video

2375.6 -> give a thumbs up here turn on the notifications and don't forget to subscribe to this channel

2382 -> you can also find me on twitter facebook and instagram thank you for watching bye

Source: https://www.youtube.com/watch?v=6Fp7awyJC6s