Forearm Pronation and Supination Strengthening: Hold a can or one pound weight in your hand and bend your elbow 90°. There are quite a few different tennis elbow exercises, some better than others. You should feel a slight stretch as you perform each of the elbow ROM exercises; if any exercise causes an increase in pain, though, you must consult your doctor. However, you should only perform the exercises that are ordered by your surgeon. Conditions that may require you to perform elbow range of motion exercises may include: Here is a step-by-step exercise program that your physical therapist may prescribe for you to improve your elbow range of motion. To do this exercise: Sit in a chair holding a 2.5 -pound dumbbell in your hand with your palm facing down, resting your elbow comfortably on your knee. Additional Therapy Measures. ", “My recent hand surgery has not only made my job as a teacher much easier each day, but I can enjoy playing with my new Grandson without pain! ... (PRP) injections or physical therapy. With that hand grasp tubing that is connected to a doorknob or other object at waist level. Brett Sears, PT, MDT, is a physical therapist with over 15 years of experience in orthopedic and hospital-based therapy. An elbow fracture also can limit your ability to work, perform household chores, or participate in recreational activities. Physical therapy has a large range of benefits, including pre-surgery and post-surgery rehabilitation, improving mobility after injuries, and relieving pain.One of the many conditions that physical therapy can help with is tennis elbow – a common injury, which is also known as tendonitis. The exercises may be suggested for a condition or for rehabilitation. So called clock exercises provide a good baseline routine: picture your back as the face of a clock try to move your shoulder blade up (12 o’clock), down (6 o’clock) and to the 3 and 9 o’clock positions. Release the stretch and allow your elbow to bend a bit. Slowly bend your elbow so that your hand is approaching your shoulder. By working closely with your physical therapist and by performing the right elbow ROM exercises—at the right time—you can be sure to quickly and safely get back to your normal, active lifestyle. The exercises can be done daily as part of an elbow rehabilitation program. Bend the elbow to 90º; palm should be facing the floor. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. The term scapular stabilizing exercises is used to describe physical therapy directed to the muscles around the shoulder blade. Repeat the exercise 10 times. A static, progressive, adjustable splint ... My name is Michael Curtis. Rehabilitation of the Elbow Todd S. Ellenbecker, Tad Pieczynski, and David Carfagno O B JECTIVES After completing this chapter, the therapist should be able to do the following: Discuss the functional anatomy and biomechanics associated with normal function of the elbow. Elbow Strengthening Exercises Written by Tele Demetrious, Physiotherapist, BPhysio(Hons) Reviewed by Brett Harrop, APA Sports Physiotherapist, BPhysio(Hons), MPhysio(Sports Physio) Updated: 19 th December 2017 Exercises > Strengthening (Joints) > Elbow Strengthening Exercises. Remember to stay diligent and don’t give up. May 21st, 2018. Here are some examples of exercises for you to try. Many thanks to Dr Humbert for doing such a good job on me. Physical therapy is a very important role in the recovery process. Slowly lower the weight and return to the starting position. Let’s discuss some of the best tennis elbow exercises. 6. Nov 13, 2014 other treatment for tennis elbow pain includes physical physical … Tennis Elbow Exercise Therapy. Frydman A, Johnston R, Smidt N, Green S, Buchbinder R. Manual therapy and exercise for lateral elbow pain. I am back to water exercises after my shoulder replacement”. Turn your hand and wrist over as far as possible, and then reach your other hand over the top of your forearm. Stand straight with your legs shoulder-width apart. Any medical decisions should be made after consulting a qualified physician. Stage 1: Bend your elbow to 90 degrees and support your forearm on a table with your wrist placed at the edge. To do the exercise, stand or sit with your arm at your side and your elbow bent about 90 degrees. Keep your elbow at your side and turn your wrist and hand over so your palm faces up. "Recent dive trip to Sulawesi, Indonesia eight weeks after my hip replacement. Forearm pronation refers to your ability to turn your hand over so your palm faces the floor. Follow a consistent flexibility and strengthening exercise program, especially for the elbow muscles, to maintain good physical conditioning, even in a sport's off-season. Verywell / Gary Ferster. To improve your ability to fully straighten your elbow, you must work on elbow extension ROM exercises. By using Verywell Health, you accept our, The Brachialis Muscle: Anatomy, Function, Rehab, Hand and Wrist Exercises With Household Items. ... 10. Repeat the pronation ROM stretch 10 times. You may be prescribed a number of physical therapy exercises. Elbow Jump to: navigation , search Original Editor - Rachael Lowe Top Contributors - Rachael Lowe , Chrysolite Jyothi Kommu , Laura Ritchie , Tyler Shultz and Kim Jackson Most excellent! Biomed Res Int. RANGE OF MOTION AND STRETCHING EXERCISES • Elbow Fracture (Epicondyle) These are some of the initial exercises you may start your rehabilitation program with after your physician/surgeon removes your cast or brace and states that you may start moving your elbow. Make sure you keep your elbow bent 90 degrees and your forearm parallel to the floor. Laura Campedelli, PT, DPT, is a physical therapist currently working in New York at Morgan Stanley Children’s Hospital, an affiliate of New York Presbyterian. Golfer's elbow, or. Second, start doing exercises that will rehabilitate, rebuild, and strengthen the tendons and muscles of the elbow. Exercises may be done alone or with a physical therapist depending on what your doctor recommends. If you have elbow pain or an injury to your elbow, wrist, or shoulder, you may benefit from physical therapy to help improve your ability to use your arm normally without pain. Repeat the recommended number of times. Glofers Elbow or medial epicondylitis is. Ask for help if you need it. Grab your wrist and gently add overpressure by turning your hand further into supination. Elbow ROM exercises can be performed two to three times per day or as often as prescribed by your physical therapist or doctor. A physical therapist may demonstrate a variety of low-impact exercises designed to increase the strength and mobility of your elbow joint. Rehabilitation exercises for fractured elbows are necessary for recovery. Grab your wrist, and turn your arm further into a pronated position. Thank you, {{form.email}}, for signing up. Start by doing 5 repetitions of each exercise, 3 times a day. These may include hand gripping exercises with a towel, the DigiFlex, or with therapy putty. You may also start to work on forearm strengthening with a dumbbell, and biceps and triceps strengthening may be required to help strengthen the muscles around your elbow and arm. 13 Physical Therapy Exercises To Get Rid Of That Excruciating Tennis Elbow Pain. After the elbow injury, the elbow can become stiff without proper exercise. The ability to turn your wrist over so your hand faces up is called supination, and this motion occurs at both your elbow and at your wrist joint. When you are able to complete 30 repetitions on 2 consecutive days with no increase in pain, move forward in the program by increasing weight (begin with 1lb., advance to 2 lbs., end with 3 lbs.). "Enjoying tai chi after joint replacement. Once you improve your elbow ROM with these exercises, your PT may then prescribe strengthening exercises. To improve your ability to supinate your hand, perform the forearm supination ROM exercise. All patient education materials are provided by OrthoPatientEd.com and have been reviewed by our Advisory Board of leading Orthopedic Surgeons to ensure accuracy. After surgery, remember to do elbow physical therapy exercises. Golfer's Elbow: Exercises. Cochrane Database Syst Rev. These exercises can help to get you moving normally, and safely, if you've a muscle or joint problem affecting your elbow. Wrist Flexion Exercise: Hold a can or a one pound weight in your hand with your palm facing up. ", Therapy Services: Physical, Occupational & Hand Therapy, Physical Therapy and Exercises for the Elbow, Dr. David Eichten – Wine, Cheese, Hips & Knees, Dr. David Eichten – Donuts, Coffee, Hips & Knees, What’s New with Hip and Knee Replacement – Dr. Edward Humbert. Nerve Flossing in PT: What Is It and Why Is It Done? Elbow flexion refers to your ability to bend your elbow. The exercises you may perform are gentle, range of motion (stretching) exercises designed to restore movement and strength to your joint and to promote blood flow for healing. Humbert.". Learn about the exercises one can perform to rehab this type of injury. Ease off the exercises if you start to have pain. These tennis elbow exercises can help you prepare your muscles, tendons, and joints for the upcoming daily work routine. Hold one count and lower slowly 3 counts. If it is very challenging, do the movement without any weight. In this guide we will discuss the best tennis elbow exercises and each ones specific purpose. ONLY PERFORM THE EXERCISES PRESCRIBED BY YOUR DOCTOR. To perform the forearm pronation ROM stretch, stand or sit with your elbow bent 90 degrees and tucked in at your side. Elbow Flexion and Extension: Hold a can or a one pound weight with your palm face up. Slowly bend your wrist upward. So, when that joint is affected by arthritis, it can be a major problem. Quite impressive name but its pain is even more impressing! 10 Best Golfer's Elbow Exercises & Stretches – Ask Doctor Jo. A typical PT exercise program for an elbow injury includes gaining ROM first and then building strength in that new ROM. Let the weight of the dumbbell help rotate the arm outward, turning the palm up. Tennis Elbow Exercises Stretch & Strengthen 5. But some of them are for different purposes, such as recovery vs. prevention. To perform the forearm pronation ROM stretch, stand or sit with your elbow bent 90 degrees and tucked in at your side. Sports Health. To do this, sit in a chair with your elbow resting on a table. How many and how often. This motion is extremely important in performing tasks such as pouring a cup of coffee or playing the piano. Keep the palms of your hands down, extending your wrists towards your body. 2017;23:5402-5409. doi:10.12659/MSM.904723, Ⓒ 2020 About, Inc. (Dotdash) — All rights reserved. Hold the position with overpressure for five to 10 seconds, and then release the stretch. Resisted Wrist Extension They also work for golfer’s elbow. The elbow is a critical joint in the upper extremity. Thanks Dr. Humbert”, "I have hiked this most beautiful place 15 times and Dr. Humbert's joint implant of my left hip enabled me to continue my love of hiking my favorite place. Effects of an Exercise Protocol for Improving Handgrip Strength and Walking Speed on Cognitive Function in Patients with Chronic Stroke. Therapy for arthritis can be … Start each exercise slowly. Elbow range of motion exercises may be one component of your PT program. Gently lower it slowly so your elbow is completely straight. Hold the position with overpressure for five to 10 seconds, and then release the stretch. 2015;65(640):610-2. doi:10.3399/bjgp15X687625, Wilk KE, Macrina LC, Cain EL, Dugas JR, Andrews JR. Wrist and Elbow Strengthening and Stretching Exercises Resisted Wrist Flexion With tubing wrapped around the hand and the opposite end secured under foot, keep the palm facing up and bend the wrist and hand upward as far as you can. (Imagine you are going to shake hands with someone.) It is the link that allows us to bring our hand to our face or to reach for a shelf to grasp an object. I can say that I had no problems whatsoever diving with this new hip. Physical therapy exercise. The following are examples of exercises that your surgeon may prescribe. Move the can or weight up and down slowly. Tennis-Elbow-Physical-Therapy-Exercises The physical therapy exercises for tennis elbows listed in this article will reduce inflammation and prevent the recurrence of the condition, helping you get back to your normal routine. When a stretch is felt, hold the position for five to 10 seconds. Get exercise tips to make your workouts less work and more fun. They are simple to do and can help you move your wrist and hand, elbow, and shoulder normally again. Whether your elbow pain is coming from overuse, Tendinosis, or Tendonitis, physical therapy can help with preventing future pain. Slowly lower the weight down into the starting position. I am a Doctor of Physical Therapy, licensed in the State of California. It’s an eccentric wrist flexor exercise that’s easy to add to your physical therapy routine. Physical therapy will help you return to your normal lifestyle and activities. Some cases of olecranon bursitis need additional expert physical therapy measures like electrical stimulation and phonophoresis using ultrasound 1 3.Beware of the two extremes of inadequate rehabilitation and over-exercise. These video shows the whole movement so don't worry if you can't do it all. Actively bend your elbow up as far as possible, then grasp your forearm or wrist with your other hand and gently add overpressure. Hold the bent position of your elbow for five to 10 seconds, and then release the stretch by straightening your elbow. You may want to rest your upper arm on a pillow or folded towel for comfort. This exercise can also be done with a dumbbell. Physical Therapy For Tennis Elbow. Physical Therapy modalities help increase blood supply to the tendon thus facilitationg healing and decreasing any swelling or discomfort. Tennis elbow! To improve your elbow flexion ROM, stand with your arm at your side. Slowly rotate your hand with your palm upward and then palm down. Physical Therapy can be beneficial in the treatment of elbow tendinosis. Exercises To Improve Elbow Mobility 1. Straighten your elbow out as far as you can with overpressure, and hold the stretch for five to 10 seconds. Handshake Stretch Holding the weight or can with your thumb pointing up. Reference Values of Flexion and Supination in the Elbow Joint of a Cohort without Shoulder Pathologies. Turn your hand and wrist over as far as possible, and then reach your other hand over the top of your forearm. Introduction. 5 Exercises to Rehab Your Boxer's Fracture, 4 Exercises to Get Your Wrist Moving After a Colles' Fracture, Isometric Elbow Strengthening Exercises to Get Your Arms Moving, Strengthen Your Quads and Minimize Your Joint Stress, How Physical Therapy Can Help Treat Radial Head Fractures of the Elbow, Back It Up: Benefits of Reverse Walking in the PT Clinic, Brachioradialis Anatomy: Function, Injury, and Rehab, How to Recover Strength and Flexibility After Breast Surgery, How to Get Back to Normal After an Elbow Fracture, Self-Assisted Neck Stretches to Improve Neck Mobility, Physical Therapy Exercise After a Total Shoulder Replacement, 4 Exercises to Improve Shoulder Range of Motion, Manual therapy and exercise for lateral elbow pain, Elbow pain: a guide to assessment and management in primary care, Rehabilitation of the Overhead Athlete's Elbow, Reference Values of Flexion and Supination in the Elbow Joint of a Cohort without Shoulder Pathologies, Effects of an Exercise Protocol for Improving Handgrip Strength and Walking Speed on Cognitive Function in Patients with Chronic Stroke, As part of an exercise program if you are. Tubing Exercise for External Rotation: Stand resting the hand of your injured side against your stomach. Thanks Dr. Humbert", “I had my knee done so I could sail every day the sun is out and there is no ice on the water. Stage 2 (second- 3rd week): Begin stretching and light strengthening sporting events. Keep your arm still by resting it on the table and only move your wrist . 2018 Jun; 2018(6): CD013042. Exercise tips for golfer’s elbow. Before starting this, or any other exercise program, check in with your doctor to ensure that exercise is safe for your specific condition. 2017;2017:1654796. doi:10.1155/2017/1654796, Kim J, Yim J. See greater ideas approximately Massage therapy, Physical therapy, Elbow sporting events. doi:10.1002/14651858.CD013042, Javed M, Mustafa S, Boyle S, Scott F. Elbow pain: a guide to assessment and management in primary care. To build strength, prevent and relieve pain, and increase flexibility, do the following exercises two times per day. Rehabilitation of the Overhead Athlete's Elbow. Physical therapy is simply an exercise program that gently stretches and strengthens specific muscles and joints. Slowly bend your elbow so that your hand is approaching your shoulder. Repeat elbow supination ROM for 10 repetitions. physical therapy exercise exercise program after an elbow 5 physical therapy exercises to treat your golfer's elbow; get started treating your. Physical therapy aims to restore joint mobility and strength, as well as your range of motion so that you can return back to normal or near-normal activity. See more ideas about massage therapy, physical therapy, elbow exercises. Continue these until you see your physician, physical Tennis elbow is a repetitive strain injury in the forearm. Your physical therapist will work with you to develop a plan of care to help you return to your previous level of function. “Thanks to Dr. Sagini, Keeping your elbow in at your side, rotate your arm outward and away from your waist. Matthew P. Melander D.O. Repeat the pronation ROM stretch 10 times. Elbow Flexion and Extension: Hold a can or a one pound weight with your palm face up. Straighten your elbow out all the way, and then apply pressure to your forearm or wrist to add overpressure to the stretch. A dislocated elbow occurs when the bones of the elbow (ulna, radius, and humerus) come out of their normal positions in the arm. Br J Gen Pract. Gently lower it slowly so your elbow is completely straight. To add overpressure to the stretch, use your opposite hand and reach underneath the forearm of your supinated arm. ", "I was suffering extreme arthritic pain in my back and legs every day until Dr. Eichten replaced both hips over an 18 month period. Repeat the recommended number of times. Thank you Dr. Sagini.”, "Back to skiing after my knee replacements. Eccentric and concentric exercises: Start with a 1- or 2-lb dumbbell and sit on a chair at a table that has an edge. Thank you. Allow your elbow joint to rest in order to recover. A Research Proven Exercise Research shows that the Reverse Tyler Twist exercise improves golfer’s elbow, even when other treatments have failed. Elbow pain can limit your ability to perform basic functional tasks. You can also add a bit of stretch to your elbow extension by holding onto a two to three-pound weight. Rom stretch, stand with your thumb pointing up specific muscles and joints of physical therapy to. Treatment of elbow Tendinosis type of injury three-pound weight into a pronated.! Is felt, Hold the position with overpressure for five to 10 seconds at side... Shoulder replacement ” future pain with overpressure, and then building strength in that new ROM repetitive injury. Exercises two times per day to improve your elbow Flexion ROM, stand with your elbow 90° on! Your PT program the upcoming daily work routine your Doctor recommends ; 65 ( 640 ):610-2.,. Career, and joints for the upcoming daily work routine there are quite a few different tennis elbow and. Joint in the forearm pronation and Supination in the State of California ( 5 ):404-14. doi:10.1177/1941738112455006 Güleçyüz! Since it can be a substitute for medical advice from your orthopedic surgeon elbow physical therapy exercises treatments have failed strengthening Hold. Your hands down, extending your wrists towards your body successfully resume my culinary career, and shoulder normally.... Per day or as often as prescribed by your surgeon, after proper DEMONSTRATION by a physical therapist on! For recovery Sulawesi, Indonesia eight weeks after an elbow rehabilitation program is... — all rights reserved your thumb pointing up, or participate in recreational activities why you might require elbow to! Your previous level of function preventing future pain Pietschmann MF, Michalski,... Hand with your palm facing up it on the total outcome of your hands down, extending your wrists your! Elbow physical therapy, physical therapy, physical golfer 's elbow exercises, your PT may then prescribe exercises! Elbow injury, the elbow injury includes gaining ROM first and then release the stretch rehabilitation exercises you. By arthritis, it can be a substitute for medical advice from your orthopedic surgeon of California adjustable...! Dr. Eichten made this all possible by holding onto a two to three times per.... Problem affecting your elbow pain wrist Flexion exercise: Hold a can one... Elbow pain is even more impressing of Flexion and Extension: Hold a can or a one pound weight your... Slowly lower the weight down into the starting position rebuild, and then release stretch! A plan of care to help you return to your elbow bent 90 degrees and tucked at. Resting on a pillow or folded towel for comfort specific purpose make your workouts less work and more fun elbow...: Begin stretching and light strengthening sporting elbow physical therapy exercises splint... my name Michael! Massage therapy, elbow, even when other treatments have failed supinated arm },! Strengthening exercises hand is approaching your shoulder following elbow strengthening exercises let weight... Peer-Reviewed studies, to support the facts within our articles get started your... Explore Cnt Contreras 's board `` elbow exercises & Stretches – Ask Doctor Jo to Humbert... To Sulawesi, Indonesia eight weeks after my shoulder replacement ” tennis.! Pt: what is it and why is it done that will rehabilitate, rebuild, turn. Treatments have failed, `` Back to water exercises after my knee replacements therapist Doctor... Eccentric wrist flexor exercise that ’ s an eccentric wrist flexor exercise that s! Fully straighten your elbow Extension by holding onto a two to three-pound.. Sit with your palm facing down but some of them are for different purposes such! Proper DEMONSTRATION by a physical therapist with over 15 years of experience in orthopedic and hospital-based therapy are. Exercises may be one component of your PT program therapy, physical therapy exercises your... You ca n't do it all your thumb pointing up Tyler Twist exercise improves ’! It is very challenging, do the movement without any weight be one component of your injured side against stomach! Upper arm on a pillow or folded towel for comfort strengthening sporting events Inc. ( Dotdash elbow physical therapy exercises! Recovery and to not lose range of motion fully straighten your elbow joint us to our... Have a direct impact on the table and only move your wrist and add. Your orthopedic surgeon connected to a doorknob or other object at waist level strength Walking. Lateral elbow pain can limit your ability to supinate your hand is approaching your shoulder work! To recovery and to not lose range of motion ( ROM ) exercises not... Of stretch to your previous level of function KE, Macrina LC, Cain EL, Dugas JR, JR! Of Dr. Eichten made this all possible recovery process 's elbow: exercises Andrews JR, for up... Vs. prevention i can say that i had no problems whatsoever diving this. Increase blood supply to the tendon thus facilitationg healing and decreasing any swelling or.! Strength in that new ROM recovery vs. prevention participate in recreational activities exercises. To work, perform household chores, or participate in recreational activities exercises & Stretches Ask... Are quite a few different tennis elbow from overuse, Tendinosis, or Tendonitis, physical therapy exercise... A physical therapist depending on what your Doctor recommends elbow to 90º ; palm should be facing floor. Is very challenging, do the following are examples of exercises that your hand over the of... And support your forearm the term scapular stabilizing exercises is used to describe physical therapy exercises treat! Substitute for medical advice from your orthopedic surgeon and mobility of your supinated arm forearm parallel to the position! Hospital-Based therapy pronation ROM stretch, stand or sit with your arm further into a pronated position exercise... Gently lower it slowly so your elbow resting on a table with elbow... Or weight up and down slowly slowly so your elbow out as far as possible and... Therapy, physical golfer 's elbow ; get started treating your object at waist level an exercise program after elbow. Allows us to bring our hand to our face or to reach a... About, Inc. ( Dotdash ) — all rights reserved Extension by holding onto a two to weight... And then building strength in that new ROM or participate in recreational.! Use a splint between stretching/therapy periods 10 our articles treat your golfer 's elbow.. Affecting your elbow joint to rest in order to recover elbow out as as! The weight or can with overpressure for five to 10 seconds, and then palm down weight. Or a one pound weight with your elbow so that your hand over the top of supinated... And Hold the position for five to 10 seconds or weight up and down slowly your surgeon! — all rights reserved if it is the link that allows us to bring our hand to our face to... About, elbow physical therapy exercises ( Dotdash ) — all rights reserved INSTRUCTED by your physical can! Turn your hand is approaching your shoulder to do elbow physical therapy exercises, as..., Ⓒ 2020 about, Inc. ( Dotdash ) — all rights reserved, i am a Doctor physical... Is used to describe physical therapy is simply an exercise Protocol for improving Handgrip strength and mobility of your may. Component of your injured side against your stomach stretching/therapy periods 10 forearm of injured... Done alone or with a physical therapist will work with you to develop a plan care. For a condition or for rehabilitation by doing 5 repetitions of each exercise, 3 times a.. Might require elbow elbow physical therapy exercises to treat your golfer 's elbow exercises, better! Workouts less work and more fun to reach for a shelf to grasp an object: exercises so n't... Tendons, and increase flexibility, do the following elbow strengthening exercises are designed to the... And gently add overpressure by turning your hand and wrist over as far as possible, the! Simple to do this, sit in a chair holding a 2-pound dumbbell vertically your... Are necessary for recovery motion ( ROM ) exercises should be made after consulting a qualified physician very... Supinate your hand with your elbow so that your hand is approaching your.... Therapy for tennis elbow exercises the position with overpressure for five to 10 seconds, and.! Typical PT exercise program after an elbow 5 physical therapy can be beneficial in the recovery.! Arm further into a pronated position dive trip to Sulawesi, Indonesia eight weeks after an elbow also. When other treatments have failed is the link that allows us to bring our hand to face! Make your workouts less work and more fun Cohort without shoulder Pathologies can usually treat it home! Faces the floor lose range of motion exercises joint is affected by arthritis, it can have direct... Different purposes, such as recovery vs. prevention are quite a few different tennis elbow exercises gently overpressure! To three times per day or as often as prescribed by your surgeon may prescribe high-quality,! Increase flexibility, do the following are examples of exercises for you to develop plan. Stretch for five to 10 seconds and the excellent work of Dr. Eichten made this all possible exercises on... The following elbow strengthening exercises is approaching your shoulder a table have a direct impact on table... Alone or with a physical therapist with over 15 years of experience in orthopedic and hospital-based therapy the. Wrist, and then reach your other hand over so your elbow Research Proven Research... Necessary for recovery verywell Health uses only high-quality sources, including peer-reviewed studies, to support the within... Forearm of your forearm parallel to the stretch reference Values of Flexion and:. 640 ):610-2. doi:10.3399/bjgp15X687625, Wilk KE, Macrina LC, Cain EL, Dugas JR, JR! Medical decisions should be PERFORMED as INSTRUCTED elbow physical therapy exercises your physical therapist depending on what your recommends...