Published on January 27, 2026

How Therapy Can Help Shoulder Pain After a Stroke

Image of a man in plaid shirt grabbing at his shoulder in pain.

Shoulder pain is common after a stroke. It can make daily activities harder and affect recovery. There are several reasons why shoulder pain can happen after a stroke.

Common Causes of Shoulder Pain After a Stroke

  • Shoulder subluxation
  • Frozen shoulder
  • Arm weakness or paralysis
  • Muscle tightness (spasticity)
  • Neglect (not noticing the affected arm)
  • Poor or incorrect arm positioning

Two of the most common causes of shoulder pain after a stroke are shoulder subluxation and frozen shoulder.

What Is Shoulder Subluxation?

Shoulder subluxation happens when the muscles that support the shoulder become weak or paralyzed after a stroke. These muscles, called the rotator cuff, help hold the arm bone in the shoulder socket.

When they are not working well, the upper arm bone can partially slip out of the shoulder joint. This can cause pain and make it harder to move the arm.

It is important to find and treat shoulder subluxation early. If left untreated, it can be hard to fix and may slow down arm recovery after a stroke.

How Therapy Can Help With Shoulder Subluxation

Physical therapy can help reduce pain and prevent the shoulder from slipping further. A therapist may work on:

  • Safe weight bearing through the arm
  • Gentle and safe shoulder movement
  • Improving muscle control
  • Strengthening the shoulder and shoulder blade muscles
  • Teaching proper arm positioning
  • Showing where to place the arm during walking or transfers
  • Using techniques like taping or electrical stimulation, when appropriate, to help support the shoulder

What Is Frozen Shoulder?

Another common cause of shoulder pain after a stroke is frozen shoulder, also called adhesive capsulitis.

Frozen shoulder happens when the shoulder joint becomes stiff. The tissue around the joint tightens and forms scar tissue. This makes it hard and painful to move the shoulder.

Stages of Frozen Shoulder

Frozen shoulder often happens in stages:

  • Freezing stage: Dull or aching pain and stiffness. This stage can last 2 to 9 months.
  • Frozen stage: Less constant pain, but sharp pain with movement and very limited motion. This stage can last from 4 months to over a year.
  • Thawing stage: Shoulder movement slowly returns. This stage can take 2 to 3 years.

How Therapy Can Help With Frozen Shoulder

Movement is very important when treating frozen shoulder. After a stroke, moving the arm can be difficult, which is why working with a therapist is so important.

Physical therapy may include:

  • Shoulder range of motion exercises (active, assisted, and passive)
  • Shoulder and shoulder blade strengthening
  • Pendulum exercises
  • Proper arm positioning
  • Hands-on techniques to help loosen the joint and muscles

Why Therapy Matters

When someone has shoulder pain after a stroke, therapists always check for shoulder subluxation first. They also look at posture and trunk strength, since poor alignment can affect how the arm moves.

A therapist looks at the whole picture, including the trunk, shoulder blade, shoulder, and arm. Treatment focuses on proper positioning, safe movement, and building strength and stability. All of this helps improve comfort and makes everyday activities easier.

Stephanie Sebald, M.S.O.T, O.T.R.L., is an occupational therapist at MyMichigan Health.