How to Solve Stroke Pain with Physio

If you or someone you love has recently had a stroke, you are almost certainly juggling two feelings at once: relief that they survived, and worry about what comes next. That worry is understandable. Recovery from a stroke is rarely a straight line, and the amount of therapy someone actually receives on the NHS can vary considerably from area to area.

What happens to the body after a stroke?

A stroke happens when the blood supply to part of the brain is interrupted, either by a clot (an ischaemic stroke) or a bleed (a haemorrhagic stroke). Brain cells starved of oxygen begin to die within minutes, which is why the FAST message — Face, Arm, Speech, Time to call 999 — is so important.

Once the immediate medical emergency has been managed, the challenge shifts to recovery. Depending on which part of the brain was affected, a stroke can leave people with weakness or numbness on one side of the body, problems with balance and walking, difficulty with speech or swallowing, changes to vision or memory, and profound fatigue. According to the Stroke Association, nearly two-thirds of the UK's 1.4 million survivors live with a resulting disability.

The good news, and it is genuinely good news, is that the brain does not stop learning after a stroke. Through a process called neuroplasticity, undamaged areas can, with practice, take on functions that were previously handled elsewhere. This is the foundation of everything a stroke physiotherapist does.

The stroke pathway in West London — and where private physio fits

Understanding the NHS stroke pathway helps you know where you are, and where a private clinic like ours can add value. For most patients in Hanwell, Ealing and the surrounding W5, W7 and W13 postcodes, the journey looks something like this:

1. Hyperacute stroke unit — the first 72 hours. In West London, the hyperacute stroke unit is at Charing Cross Hospital (Imperial College Healthcare NHS Trust), on Fulham Palace Road, W6.
2. Acute stroke unit — ongoing hospital care, medical stabilisation, and the very earliest rehabilitation.
3. Early Supported Discharge (ESD) — where suitable, therapy at home for up to around six weeks, delivered at the same intensity as hospital rehabilitation.
4. Community rehabilitation team — longer-term NHS support, typically at reducing intensity.
5. Six-month review — a formal check-in that should happen but, as we discuss below, often does not.

Private physiotherapy is not a substitute for any of these steps. Where it can help is in filling the gaps: topping up therapy intensity toward the levels the guidelines now recommend, continuing rehabilitation after NHS discharge, and delivering sessions in your own home when travel is difficult. To learn more about our clinic-based service, see our physiotherapy treatments page and our West London location page.

What do the current UK guidelines say about stroke rehabilitation?

Two major national documents set the standard for stroke rehabilitation in the UK today. Both were published in 2023, and both represent a step change from the guidance that preceded them.

NICE Guideline NG236 (October 2023)

The National Institute for Health and Care Excellence updated its stroke rehabilitation guideline in October 2023. Its headline recommendation (1.2.16) is that adults after a stroke should be offered "needs-based rehabilitation … for at least 3 hours a day, on at least 5 days of the week, and cover a range of multidisciplinary therapy including physiotherapy, occupational therapy and speech and language therapy." This is roughly a fourfold increase on the previous 2013 standard of 45 minutes of each therapy per day, and it formally endorses telerehabilitation as a legitimate way to deliver some of that care.

National Clinical Guideline for Stroke (2023)

Published by the Intercollegiate Stroke Working Party and endorsed by the Royal College of Physicians, SIGN and the Royal College of Physicians of Ireland, the 2023 National Clinical Guideline for Stroke made two shifts that matter enormously to families:

• It states clearly that "the term 'no rehabilitation potential' is not appropriate and should not be used" and that anyone who has had a stroke should be considered to have the potential to benefit from rehabilitation, at any point in their recovery.
• It recommends task-specific, repetitive, intensive practice as the principal approach to motor recovery — that is, practising the actual movements you want to get back to, over and over, at the edge of what you can currently manage.

Evidence-based physiotherapy techniques for stroke recovery

A well-run stroke rehabilitation programme is not a single technique but a personalised blend of approaches. Here are the ones with the strongest evidence base — the ones a Chartered Physiotherapist working in neurological rehabilitation is most likely to draw on.

Task-specific repetitive training

The principal approach recommended by the 2023 National Clinical Guideline. Rather than exercising in the abstract, you practise the specific things you want to get back to — standing from a chair, reaching for a cup, walking to the front door — in a graded, repeated way. Progress is measured in what you can now do that you could not do last week.

Constraint-induced movement therapy (CIMT)

For people who have some movement in a weaker arm but tend not to use it, CIMT restrains the stronger arm for periods of the day to encourage use of the weaker one. A 2015 Cochrane review of 42 studies involving 1,453 participants found CIMT was associated with meaningful gains in arm motor function, though the carry-over to everyday activities was more modest and highly individual.

Gait and balance retraining

Walking again is one of the most common goals stroke survivors bring to us. Rehabilitation may include treadmill work, over-ground practice, balance drills, and, where appropriate, orthoses or walking aids. The emphasis is on quality and safety, not just distance.

Functional electrical stimulation (FES) and electrotherapy

NICE supports the use of FES for drop foot of central neurological origin, and the 2023 NG236 guideline recommends considering neuromuscular electrical stimulation for focal spasticity and shoulder pain after stroke. The evidence base is supportive rather than dramatic — it is best thought of as a useful adjunct rather than a standalone treatment. You can read more on our electrotherapy page.

Mirror therapy and virtual reality

Emerging evidence suggests mirror therapy and virtual-reality-based programmes may help upper-limb recovery, particularly when combined with conventional rehabilitation. We treat these as promising adjuncts rather than proven replacements for hands-on physiotherapy.

Telerehabilitation

Endorsed by both NICE NG236 and the National Clinical Guideline, remote sessions have become a normal part of stroke rehabilitation since 2020. They can work well for people who cannot easily travel and for topping up between in-person sessions.

For a broader look at how neurological rehabilitation is delivered privately, our related guide on common questions about neurological physiotherapy treatment is a helpful next read.

How long does stroke rehabilitation take?

Direct answer: The most rapid gains typically happen in the first weeks and months after a stroke, with meaningful improvement often continuing for 12 to 18 months, and sometimes years, thanks to neuroplasticity. Full recovery cannot be predicted or guaranteed — every stroke is different — but improvement is possible far later than many people are told.

The recovery curve tends to be steepest in the first three to six months after a stroke, which is why early, intensive rehabilitation matters so much. But it is a mistake to think of six months as a hard ceiling. The NHS, the Stroke Association and the 2023 National Clinical Guideline are all clear that improvement can continue well beyond that point, provided the practice continues.

Practically, this means that if progress has slowed with NHS input and you or a loved one has been discharged, this is not necessarily the end of the road. Many of the survivors we see at CK Physio come to us six, twelve or eighteen months post-stroke, and continue to make measurable gains.

Can stroke rehabilitation be done at home?

Direct answer: Yes. Home-based physiotherapy is a well-established option for stroke survivors, particularly after hospital discharge or when travel is difficult. It is endorsed within the current UK stroke pathway (Early Supported Discharge is delivered at home), and private home-visit physiotherapy can extend that model further into recovery.

For many of our West London patients, a home visit is the difference between doing rehabilitation and not doing it at all. Practising in your own kitchen, on your own stairs, using your own furniture, is often more relevant than practising in a clinic. It also removes the fatigue of travel — which, after a stroke, can be considerable.

We serve Hanwell, Ealing, Northfields, Greenford, Brentford, Southall, Perivale, Acton, Isleworth and Chiswick from our Hanwell base. Our full home visit physiotherapy guide covers costs, what happens in a first appointment, and how to prepare.

How much does private stroke physiotherapy cost, and how do I start?

Private physiotherapy in London typically runs from around £65 for a follow-up session to £150 or more for a longer initial assessment, with home visits usually priced at the upper end of that range because they include travel. For our current published fees, please see the CK Physio bookings page, where prices are listed in full.

You do not need a GP referral to see a private physiotherapist. Self-referral is the norm in private practice. We do, however, work in close consultation with GPs and consultants where appropriate, and we recognise BUPA and AXA PPP for eligible patients.

Every physiotherapist at CK Physio is a Chartered Physiotherapist registered with the Health and Care Professions Council (HCPC). You can see our full list of professional memberships on our accreditations page, and you can read about our clinic and clinicians on the about us page. Feedback from patients we have supported over the years is on our testimonials page.

Frequently asked questions

Related reading from the CK Physio blog

• Common questions about neurological physiotherapy treatment
• Rehabilitation of stroke patients through physiotherapy treatment
• How physiotherapy helps stroke survivors work toward rehabilitation
• Home visit physiotherapy in West London: your complete guide
• Outpatient rehabilitation and physiotherapy treatment
• Benefits of physiotherapy for treating mobility issues in older people

References

1. Stroke Association. Stroke statistics. Available at: https://www.stroke.org.uk/stroke/statistics
2. National Institute for Health and Care Excellence. Stroke rehabilitation in adults (NG236). Published 18 October 2023. Available at: https://www.nice.org.uk/guidance/ng236/chapter/Recommendations
3. Intercollegiate Stroke Working Party. National Clinical Guideline for Stroke for the UK and Ireland, 2023 edition. London: Royal College of Physicians. Available at: https://www.strokeguideline.org/
4. Royal College of Physicians. New National Clinical Guideline for Stroke (2023) now published. Available at: https://www.rcp.ac.uk/news-and-media/news-and-opinion/new-national-clinical-guideline-for-stroke-2023-now-published/
5. NHS. Recovering from a stroke. Available at: https://www.nhs.uk/conditions/stroke/recovery/
6. Corbetta D, Sirtori V, Castellini G, Moja L, Gatti R. Constraint-induced movement therapy for upper extremities in people with stroke. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD004433. Available at: https://www.cochrane.org/evidence/CD004433_constraint-induced-movement-therapy-upper-limb-arm-recovery-after-stroke

Disclaimer: This article is provided for general information only and is not a substitute for individual medical or physiotherapy assessment. If you have had a stroke or think you may be having one, call 999 immediately. For personalised advice on stroke rehabilitation, please speak to your GP, stroke consultant, or a HCPC-registered physiotherapist.