Exercise Recommendations for Neck and Shoulder Pain

Core Exercise Components

Gentle stretching and mobilization techniques should focus specifically on increasing external rotation and abduction to prevent frozen shoulder and shoulder-hand syndrome, as recommended by the International Journal of Stroke 1, 2
Active range of motion should be increased gradually while simultaneously restoring alignment and strengthening weak muscles in the shoulder girdle, according to the International Journal of Stroke 1, 2

Overhead pulley exercises should be avoided as they encourage uncontrolled abduction and have the highest incidence of developing hemiplegic shoulder pain, as reported in Stroke 3, 4

Local heat application before exercise is beneficial and has a higher strength of recommendation compared to ultrasound, as stated in a medical guideline 5
Ice, heat, and soft tissue massage can be used as adjunctive modalities to reduce pain/swelling and improve tissue elasticity, according to Stroke 3
Functional electrical stimulation (FES) may improve shoulder lateral rotation and reduce pain, though evidence shows no significant change in overall pain intensity, as reported in Stroke 3
Neuromuscular electrical stimulation (NMES) can be considered as an adjunct, though efficacy data remain limited, as stated in Stroke and a medical guideline 4, 6

Proper shoulder positioning and protection from trauma reduces the frequency of shoulder-hand syndrome, as reported in Stroke 3
Shoulder strapping may be considered during ambulation to protect from traction injury, though evidence for pain prevention is insufficient, according to Stroke 4
For wheelchair users, lap trays and arm troughs may reduce shoulder pain and subluxation, as reported in Stroke 4

Begin with gentle range of motion exercises (active, active-assisted, or passive) to prevent complex regional pain syndrome and maintain joint mobility, as recommended by the International Journal of Stroke 1, 2

Aggressive passive range-of-motion exercises performed improperly can cause more harm than good; exercises should be performed within the patient's visual field in safe, appropriate positions, as stated in Stroke and a medical guideline 4, 6