Common Complications After Stroke

Why the complications can matter as much as the stroke

The stroke itself is over within hours. What happens to the body in the weeks that follow is a different story, and much of it is preventable. A painful shoulder can stop arm rehab for months. A pressure sore on the hip can keep someone in bed long after their legs were ready to stand. A chest infection can undo a fortnight of progress in three days.

This page is an overview of the common complications of stroke, roughly in the order families meet them, with what to watch for and where physiotherapy actually helps. Each complication needs medical review when it appears; we work alongside the doctor, not instead of them. For the broader recovery picture, start with our guide to stroke recovery.

Shoulder pain on the weak side

This is one of the most common problems we see, and one of the most avoidable. When the shoulder muscles are weak or floppy, the weight of the arm pulls the joint slightly out of its socket (subluxation). Then someone lifts the patient by pulling under that armpit, or the arm dangles off the side of the wheelchair, and the soft tissues get strained. Pain follows, and a painful shoulder is very hard to rehabilitate.

Prevention is mostly handling: support the arm on a pillow or armrest whenever sitting, never pull on the weak arm during transfers, and position it carefully in bed. Our page on positioning a stroke patient in bed shows the setups we use. Once pain has developed, treatment includes gentle movement within comfort, strapping or taping in some cases, and careful work on the shoulder blade muscles.

Spasticity and contractures

Weeks to months after a stroke, many people develop spasticity: the muscles become stiff and resist being stretched, especially if moved quickly. The fingers curl into the palm, the elbow bends, the foot points down and turns in. Spasticity isn't always bad (some stiffness in the leg can actually help a person stand). The problem comes when it's left alone and muscles shorten permanently, which is a contracture. A hand that can no longer be opened enough to wash the palm is a real loss of daily life.

Physiotherapy here means regular, slow stretching, positioning that keeps joints in a lengthened position, standing and weight-bearing to load the legs, and splints when needed. Doctors sometimes add medicines or injections for stubborn spasticity; that decision is theirs. The passive and assisted range of motion exercises we teach families are among the most useful daily habits in early recovery.

Clots in the legs

A person who isn't moving much, with a weak leg that doesn't pump blood back to the heart, is at higher risk of a deep vein thrombosis (DVT). The danger is that a clot can travel to the lungs. Hospitals usually take steps to reduce this risk; at home, the job is early movement and vigilance.

Watch for one calf becoming swollen, warm, red or painful, especially if it's different from the other leg. That needs a doctor the same day. Sudden breathlessness or chest pain needs an ambulance. Getting up and moving as soon as the medical team allows, and ankle movements in bed, are part of how physio reduces this risk.

Pressure sores

Skin over bony points (the tailbone, hips, heels, shoulder blades and the back of the head) breaks down when it's pressed on for too long without relief. People who can't feel properly or can't shift their own weight are most at risk. Sores can start as a red patch that doesn't fade when pressed and become deep wounds surprisingly quickly.

Turning schedules, a suitable mattress, keeping skin clean and dry, and not dragging the person up the bed are the basics. Physiotherapy helps by teaching rolling and bridging so the patient can relieve pressure themselves, and by getting them sitting out of bed as early as is safe. For people who need hands-on daily care, our home nursing for bedridden patients covers skin care and turning in more detail.

Falls

Falls are common after stroke, and they tend to happen at the worst moments: at night going to the toilet, turning around in a narrow bathroom, or reaching for something on the weak side. Weakness, poor balance, reduced sensation in the foot, low blood pressure on standing and impulsiveness (which some right-brain strokes cause) all contribute.

We assess the home as well as the person: the bed height, the 10 cm step into the bathroom, the loose rug near the door, how far the commode is from the bed. Balance and walking work follows. The guides on walking and balance after a stroke and balance training explain the approach.

Swallowing problems and chest infection

Weakness in the throat and face muscles can let food, drink or saliva slip into the airway. That can cause pneumonia, sometimes without obvious coughing at the time. It's one of the more serious complications in the early weeks, and it's covered fully in our page on swallowing and chest infection risks.

Mood, fatigue and seizures

Low mood, anxiety and depression are common after a stroke, and they're not a weakness of character. They change how much energy someone has for rehab and how they respond to setbacks. Tell the doctor if low mood lasts more than a couple of weeks or if the person talks about not wanting to go on. Fatigue often travels with mood problems; we discuss both in fatigue and mental health after stroke.

A smaller number of people have seizures after a stroke, sometimes months later. Any first seizure needs urgent medical attention. If a seizure lasts more than a few minutes, or the person doesn't wake up properly afterwards, call 112 or 108.

Altered sensation can also lead to injuries and odd pain, explained in our guide to numbness and tingling.

Complications after stroke that physio can prevent, and those it can't

Physio has a strong role in some of these complications and a supporting role in others. Being honest about that helps families put their energy in the right place:

• Largely preventable with good handling and early movement: shoulder pain from poor handling, contractures, many pressure sores, many falls
• Risk reduced, but medical care leads: leg clots, chest infections
• Physio supports, doctor manages: spasticity that needs medicines, depression, seizures, central pain

With physiotherapy for stroke paralysis, we set up these preventive routines from the first visit and teach the family to carry them on between sessions. Where daily nursing support is also needed, stroke patient care at home can run alongside.

Frequently asked questions