# ORTHOPAEDIC MANUAL PHYSICAL THERAPY FOR POST-STROKE SHOULDER PAIN: TWO CASE REPORTS INCLUDING CLINICAL ASSESSMENTS AND PARTICIPANTS’ EXPERIENCES

## TL;DR

This paper explores using orthopedic manual physical therapy to reduce shoulder pain after stroke, showing promising results in two patients.

## Contribution

The study introduces orthopedic manual physical therapy as a novel treatment for post-stroke shoulder pain and reports its effectiveness in two cases.

## Key findings

- Both participants experienced decreased pain intensity and increased range of motion after the therapy.
- One participant showed improved grip strength and upper extremity function that lasted after follow-up.
- Participants reported satisfaction with the therapy and its long-term effects.

## Abstract

To descriptively evaluate Orthopaedic Manual Physical Therapy – a novel intervention for post-stroke shoulder pain – by use of clinical assessments and the participants’ experiences.

Two case reports.

Two individuals with mild to moderate upper extremity impairments and persistent post-stroke shoulder pain, underwent Orthopaedic Manual Physical Therapy for 12 weeks. The intervention comprised a thorough clinical examination, joint mobilization, stretching, and exercises targeting the affected structures and incorrect movement patterns. Participants were clinically assessed pre- and post-intervention and followed up 4–5 months later. They also answered interviews about their experiences of the intervention and perceived effects.

After Orthopaedic Manual Physical Therapy, both participants showed decreased pain intensity during movements and increased range of motion. One of the participants also experienced decreased resistance to passive movements, improved motor function, grip strength, and upper extremity daily activities after the intervention and at follow-up. Interviews revealed that the participants tolerated the therapy well and were satisfied with the intervention and long-lasting results.

Orthopaedic Manual Physical Therapy may be a useful method to reduce post-stroke shoulder pain in persons with mild to moderate upper extremity paresis after stroke. To confirm the results, further studies are warranted.

Although shoulder pain could be a disabling condition in persons with arm paresis after stroke, the effectiveness of existing interventions is limited. Orthopaedic Manual Physical Therapy is a promising intervention for persons with orthopedic shoulder related injuries. In Orthopaedic Manual Physical Therapy, a thorough examination leads to a clinical diagnosis. The intervention is individualized, specifically targeting the person’s affected structures and incorrect movement patterns. In this study, we evaluated 12 weeks of Orthopaedic Manual Physical Therapy in 2 persons with shoulder pain after stroke. After the intervention, we observed decreased pain intensity and increased arm mobility in both participants. One of the participants also showed improvements in grip strength and upper extremity daily activities. The participants expressed that they tolerated the intervention well and were satisfied with the intervention and long-lasting results. Thus, Orthopaedic Manual Physical Therapy might be a useful intervention for persons with post-stroke shoulder pain, but larger studies are warranted.