Why post-stroke shoulder pain happens — and why you shouldn’t ignore it
Hey Fam,
Post-stroke shoulder pain (PSSP) affects a lot of people — and it often happens in the early stages, sometimes between 2 weeks to 3 months after the stroke.
If it’s not addressed early, the fear of pain and the tendency to avoid movement can start to set in — and that avoidance can limit long-term recovery of the arm, even when power is returning.
What is PSSP / HSP?
It basically means shoulder pain on the side affected by the stroke. It may start gradually, often without a single injury or fall triggering it.
In the 2024 Tan et al. article, the authors note it as a “common debilitating condition” that interferes with motor retraining, daily living, and long-term arm function.
Why does it happen?
There aren’t just one or two causes — in fact, the evidence identifies multiple broad reasons:
Reduced motor power & control
Tone related issues (spasticity, muscle tightness)
Soft tissue changes (tendinopathy, impingement)
Nerve or neurological changes
Because of this complexity, a multi-component rehabilitation strategy is recommended — rather than just a “stretch this one muscle”.
Do watch this video for a full breakdown:
Self-assessment you can do now
Here’s a quick check you can do (with help if needed):
Feel (or ask someone to feel) the gap between the acromion and humeral head (subluxation measure – finger breadths)
Consider your own shoulder’s range of motion: what movements are still pain-free? What movements trigger pain or discomfort?
What’s next
In the paid version of this issue, I’ll walk you through:
A full breakdown of why you might be feeling this shoulder pain (with clear cause categories)
My step-by-step exercise plan (what to do and what to avoid)
Trusted tools and supports I recommend (including a sling I often recommend)
👉 Unlock the full version here — https://open.substack.com/pub/basicallyphysio/p/a-practical-recovery-blueprint-for?r=53qcr5&utm_campaign=post&utm_medium=web&showWelcomeOnShare=true
Thanks for reading. You’re not alone in this — and catching this early gives you a stronger chance of better recovery.
With care,
BP