Understanding Post-Stroke Pain and Joint Stiffness: How Improper Rehabilitation Can Hinder Recovery

Stroke-related complications can manifest in various ways, with hemiplegia being one of the most common long-term consequences. This case study explores the journey of a 66-year-old male who experienced left-sided paralysis following a hemorrhagic stroke one year prior. While he had been consistently managing his condition at home with medication and self-directed rehabilitation exercises, recent developments—such as severe limb pain and joint stiffness—raised concerns about possible stroke recurrence. Upon evaluation at Shandong Provincial Third Hospital in May 2021, it was determined that these new symptoms were not due to another brain bleed but rather improper rehabilitation techniques. With targeted medical intervention and corrected therapy protocols, the patient showed significant improvement within a week.

Case Overview

Patient Profile: Male, 66 years oldDiagnosis: Hemiplegia secondary to intracerebral hemorrhageHospital: Shandong Provincial Third HospitalDate of Admission: May 2021Treatment Plan: Pharmacological management (Baclofen tablets, Acetaminophen and Dihydrocodeine tablets) combined with guided physical therapyTreatment Duration: 7-day inpatient stay followed by 1-month outpatient follow-upOutcome: Stable condition with notable symptom relief and improved mobility

Initial Assessment: Recognizing the Signs

The patient arrived at the neurology clinic using a wheelchair, visibly distressed. His family reported a history of left hemiplegia resulting from a brain hemorrhage approximately one year earlier. Since discharge, he had adhered to prescribed medications and engaged in daily rehabilitation activities such as stair climbing and walking practice. However, over the past three days, he began experiencing intense muscle pain, increasing joint rigidity, and a marked decline in strength—leading the family to suspect a recurrent stroke.

Neurological examination revealed left-sided muscle strength graded at level 3 on the Medical Research Council scale, elevated muscle tone (spasticity), and positive Babinski signs—indicative of upper motor neuron damage. The preliminary diagnosis was spastic hemiplegia. To rule out acute cerebral rebleeding, a cranial MRI was recommended. The family consented promptly, understanding the importance of accurate diagnostics before proceeding with treatment.

Diagnostic Workup and Treatment Approach

Following hospitalization, comprehensive blood tests were conducted, including complete blood count, liver and kidney function panels, electrolytes, lipid profile, glucose levels, and cardiac enzymes. Results showed elevated blood sugar and cholesterol levels—known risk factors for cerebrovascular disease—but no signs of infection or organ dysfunction. Electrocardiogram and chest CT scans were unremarkable, and crucially, the brain MRI confirmed no new hemorrhages or ischemic lesions.

Identifying the Root Cause: Overexertion in Rehabilitation

A detailed review of the patient's home exercise regimen revealed excessive training frequency and duration, primarily focused on repetitive weight-bearing tasks like ascending and descending stairs. These activities, while well-intentioned, were performed without proper guidance or attention to form, leading to overuse injuries and increased neuromuscular spasticity.

The clinical team concluded that the pain and stiffness stemmed from improper rehabilitation practices—not neurological deterioration. A tailored treatment plan was initiated:

• Baclofen: A muscle relaxant used to reduce spasticity by acting on the central nervous system.
• Acetaminophen/Dihydrocodeine: For moderate-to-severe pain relief.
• Physical Therapies: Regular therapeutic massage, acupuncture, and passive range-of-motion exercises to alleviate muscle tension and improve circulation.

Progress and Clinical Outcomes

Within 72 hours of starting treatment, the patient reported reduced pain and improved joint flexibility. By day three, he was able to ambulate short distances with the aid of a cane—an encouraging sign of regained stability and coordination.

A structured rehabilitation program was introduced under professional supervision:

• Five short sessions per day, each lasting around 30 minutes.
• Exercises included step training, sit-to-stand transitions, and straight-line gait practice.
• Intensity was calibrated so that muscles would not experience post-exercise soreness—ensuring sustainable progress without strain.

By the end of the 7-day inpatient stay, the patient's symptoms had largely resolved. Muscle strength improved to grade 4, indicating functional recovery. At the one-month follow-up call, he remained free of discomfort and continued his revised rehab routine independently at home.

Key Recommendations for Stroke Survivors and Caregivers

This case highlights an often-overlooked aspect of post-stroke care: the potential harm caused by overly aggressive or unsupervised rehabilitation. While motivation is essential for recovery, balance is equally critical. Here are key takeaways for patients and families:

Adopt a Gradual Rehabilitation Strategy

Recovery after a stroke is a marathon, not a sprint. Sudden increases in exercise intensity can lead to musculoskeletal strain, joint contractures, and worsening spasticity. Always progress slowly, guided by a licensed physiotherapist.

Monitor for Warning Signs

If any of the following occur during rehabilitation, seek medical advice immediately:

• New or worsening limb pain
• Swelling or redness in joints
• Reduced range of motion
• Muscle spasms or cramping

Maintain Optimal Health Metrics

Secondary prevention is vital. Post-stroke patients should maintain strict control over modifiable risk factors:

• Follow a low-sodium, low-fat diet
• Regularly monitor blood pressure, glucose, and lipid levels
• Engage in consistent, physician-approved physical activity

Clinical Insights: The Importance of Supervised Recovery

Hemiplegia, characterized by unilateral muscle weakness or paralysis, commonly follows central nervous system injuries such as ischemic stroke, intracranial hemorrhage, or encephalitis. It results from irreversible neuronal loss in motor pathways, necessitating long-term functional adaptation.

In the early stages of recovery, many patients feel anxious about regaining independence and may push themselves too hard during therapy. Unfortunately, this enthusiasm can backfire. Unsupervised, high-intensity workouts—especially those involving repetitive motions—can trigger inflammation, microtrauma, and abnormal muscle tone, ultimately delaying healing.

As seen in this case, proper education and professional oversight make all the difference. Family members play a crucial role in observing changes in movement patterns and ensuring adherence to safe rehabilitation principles.

To optimize outcomes, stroke survivors should attend regular follow-ups with both neurologists and rehabilitation specialists. Personalized therapy plans, periodic reassessments, and timely interventions are the foundation of effective post-stroke care.