Dear doc After sleep or while sleeping, I am having kind of pain in my shoulder. I am unable yo move my arm quickly, it hurts the knuckle joint. First you thought it may b due to the exercise, I was doing in gym, though I was lifting light weight. But from last 3 day I even did not go to gym. It always hurts only in left knuckle joint after or while sleeping. So I myself thought that it may be due to inappropriate sleeping position or the size of pillow. What according to you can b possible cause? How can I get rid of that? What is the perfect height of pillow ghat I must use and also the sleeping position? Could the cause be due to gymnastic, And if it is due to gymnastics, then should I stop doing exercise? But I really don't want to stop exercise Please help.

Dr. Sonia SharmaPhysiotherapist4yrs exp

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No 1: Rotator Cuff Isometrics it's really three exercises, but the simple, basic isometric exercise is too often over looked and under used. This is a shame as I find it very effective in reducing a lot of shoulder pains in many people that it rightly deserves my No 1 spot despite them being perceived as boring and simplistic nature. Although recently they are gaining some popularity and credibility again. Isometric exercises for those non therapists reading, is when a muscle/tendon is asked to contract but there is no movement of the joint and so no change in the length of the muscle/tendon, just like when you flex your pecs and biceps in the mirror after a shower? No! just me that does that then, ok moving on?! In my clinic I see a lot of people with acute shoulder pains brought on usually after an increase in activity, sport or training and most I beleive have a reactive cuff tendinopathy. Most of these shoulders have quite high pain levels for the first few weeks and we know that isometrics are great for reducing pain (source) and they do produce some significant forces and tension in the cuff, so can be thought of beginning the needed loading program. There are lots of variations and I don't think it matters too much how you do them, it's more important how hard and how much you do them, more on this in a bit. The isometric exercises I usually give are a'Back of the hand Wall Press' used when I suspect a more superior cuff tendinopathy, it's done simply by standing next to a wall and pressing the back of the hand into the wall in the scapular plane (called Scaption) at approx 30� of abduction. 

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