Shoulder pain in hemiplegia. The role of exercise

One of the causes for shoulder pain associated with hemiplegia is thought to be vigorous range of motion to the involved upper extremity. The objective of this study was to analyze the occurrence of pain in patients treated with one of the three exercise programs commonly used in the rehabilitation of hemiplegia: 1) range of motion by the therapist, 2) skate board and 3) overhead pulley. Of the 48 hemiplegic patients evaluated, 28 were assigned to one of the three exercise groups. Comparing the number of patients who developed pain in each group, there was a significant difference, with 8% of the patients in the range of motion by the therapist group, 12% of the patients in the skate board group and 62% of the patients in the overhead pulley group developing pain (chi 2 = 8.44) (P = 0.014). The three groups did not differ in the side of involvement (P = 0.57), extent of hemiplegia (P = 0.25) or presence of subluxation (P = 0.84). Use of overhead pulley has the highest risk of developing shoulder pain and should be avoided during rehabilitation of stroke patients.