PT vs Opiods

If you’re in pain, try physical therapy before relying on painkillers
with advice from Clif Rizer, DPT/ATCret/CSCS


You are on your way home from working out at the gym or playing a game of softball. You press on the brake to slow down at a stoplight, and pain sears through your knee. It’s not the first time this has happened, so you decide to talk to your doctor. Do you ask for painkillers, or do you talk to your physician about seeing a physical therapist?

There’s no question that pain hurts, says Clif Rizer a physical therapist and the owner of Gabriel Rehabilitation, a private physical therapy practice. It’s how you respond to the pain that will affect your health in the long run.

If you merely rely on painkillers to treat pain, particularly opioid painkillers, you could be setting yourself up for long-term problems like depression and addiction without ever treating the cause of the problem.

There are many reasons patients come to rely on opioids to treat pain. Clif notes that there are many reasons patients come to rely on opioids to treat pain:Bottles-of-pills-300x200

Busy physicians want to make patients feel better, and narcotics do that.
Many injuries involve back, shoulder or other musculoskeletal injuries, and narcotics are the most common prescription for such pain.
Direct dispensing by physicians may play a role in the growth of narcotic prescriptions. Dispensing medications is a primary revenue generator for many doctors today.
Injured patients often simply pressure their MDs to prescribe opioids.
Meanwhile, the U.S. is seeing a surge in prescription drug use. While many patients do need such drugs, our society is also seeing the downside of their usage — the Centers for Disease Control and Prevention (also known as the CDC) has calculated that there were five times as many deaths from opioid overdoses in 2016 as there were in 1999.

This is one of the reasons the CDC is recommending that Americans consider other ways to manage pain, including weight loss, less addictive over-the-counter medications, and physical therapy.

Physical therapy has been shown to be extremely effective in reducing pain if one has low back pain, arthritis in your hips or knees, or fibromyalgia.The American Physical Therapy Association, along with the CDC, notes that physical therapy is especially helpful in certain situations. If you have low back pain, arthritis in your hips or knees, or fibromyalgia, physical therapy has been shown to be extremely effective in reducing pain. And if the pain has lasted longer than 90 days, it is considered to be chronic pain, a condition for which the CDC notes “clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient.”


I am reminded of a saying in the physical therapy community: Opioids lead to dependence, but physical therapy leads to independence. While it does take more time than popping a pill, PT can’t create an addiction, and there is no risk of overuse. Plus, if you work with a physical therapist, we can help you set and reach goals for a healthier life, moving more and feeling better.

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Sitting pretty: Proper sitting posture


with advice from Clifton Rizer, DPT, CSCS, ATret

Most of us spend more time at the office than we do at home, which is why it’s so important to consider how our behavior at the office can affect how we feel at home. If you sit at your computer for several hours each day, are you sitting pretty?

Before you look at yourself in the mirror, reflect on your desk and workspace. Specifically, you should think about the angles in your body as they interact with your desk. Your eyes should be approximately 18 inches away from your computer screen and they should align with the middle of the screen, to avoid looking down or up too much, which could cause neck strain in the long run. In the same manner, your chair should be centered with the monitor to minimize twisting the head in order to see the screen.

Take a look at your chair now, and how you sit in it. Adjust the chair’s height in order to be able to rest your elbows at about a 90-degree angle on your desk; if the chair’s arms get in the way, it’s probably better to remove them.

Your forearms should be parallel to your desk and your wrists should be as flat as possible. Use mouse and keyboard supports to maintain this posture. And your knees should also be bent at a 90-degree angle. If your feet don’t reach the floor, you can use a foot support in order to properly support the weight of your legs.

Once your desk is properly set up, you can think about your sitting posture. Lumbar support is essential to support the back and reduce back strain. If your office chair is not supportive enough, you can use a rolled up towel or purchase a back support like the LoveHome Memory Foam Lumbar Support Back Cushion The back support will reinforce the natural curve of the lumbar spine. In turn, this straightens the neck, shoulders and upper back. When you’re sitting at your desk, your torso, neck and head should all be upright, without any slouching or straining.

  Other office behaviors are just as important keep your desk — and the space underneath it — clear of clutter, in order to enable easy movement around your workstation. Frequent phone users should use a headset to avoid balancing the phone between their shoulder and ear, which can create neck and back pain. And frequent movement is key — stand up once an hour to stretch your back or take a walk to the building cafeteria to grab a drink.

If you’re concerned about your work space, use this OSHA worksheet to evaluate how your desk is set up. Or contact a physical therapist near you to evaluate your entire office, ensuring a healthier — and happier — team.

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Frozen Shoulder



Like back pain, shoulder pain can be caused by many things — stress, exercise (or the lack thereof), working in the same position for a long period of time. But if you have chronic shoulder pain and stiffness, as well as limited movement in your shoulder joint, especially over a longer period of time, you could have adhesive capsulitis, more commonly known as frozen shoulder.
Clinically speaking, “a frozen shoulder is the inflammation, scarring, and shrinkage of the capsule around the shoulder joint,” the cause of the inflammation and scarring is often unknown, unfortunately. Several factors can increase one’s risk for developing adhesive capsulitis:


Being a woman age 40 or older (which is why adhesive capsulitis is sometimes also referred to as “40-year-old shoulder“).

A previous injury or illness that caused prolonged immobilization of the shoulder, like a stroke or treatment of breast cancer, or having to wear an arm sling.
Having such conditions as diabetes, hyperthyroidism, hypothyroidism, heart disease, tuberculosis, and Parkinson’s disease.

The Mayo Clinic says that frozen shoulder develops over a long period of time, and that there are three stages of the condition: the freezing stage, when any shoulder movement of your shoulder causes pain, and you start having limited movement in the joint; the frozen stage, when the pain is less intense, but the shoulder is more stiff, making it more difficult to use the joint; and the thawing stage, when your shoulder recovers and you can use the joint more easily.
Physical therapy can certainly help to reduce the pain associated with adhesive capsulitis, while increasing your shoulder’s range of motion. During physical therapy a patient with a frozen shoulder will be treated with a combination of passive stretching, joint mobilizations, and therapeutic exercise. An ultrasound may also be utilized in order to increase tissue extensibility and circulation, in order to maximize the benefit of these treatments.

If these treatments aren’t successful, your doctor may recommend steroid injections to decrease pain and increase mobility. A doctor can also manipulate the shoulder joint while the patient is under general anesthesia in order to restore shoulder mobility when the patient is in a relaxed, pain-free state. In the worst cases, a surgeon may go into the joint to remove scar tissue. All of these treatments would most likely be followed up with physical therapy to maximize the shoulder’s range of motion. If you’ve been having chronic shoulder pain and limited joint mobility for a long time, see your physical therapist for an evaluation — early treatment often leads to a shorter recovery.

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Attention baby boomers: Stay healthy while staying fit


“Sixty is the new 40,” say many early baby boomers celebrating their 60th birthday in the past few years.

This generation of 76 million people born between 1946 and 1964, determined to ward off aging, has focused more on exercise and wellness than did their parents. They were at the forefront of the aerobics and fitness movement that began in the 1970s and are now flocking to health clubs in even greater numbers.

But, as a result, increasing numbers are suffering from “Boomeritis” — the phenomenon of boomers becoming injured while exercising and playing sports at a level often too intense for their aging bodies.

Sound familiar?
It’s not just about soreness or stiffness. As boomers refuse to let injuries get in the way of their exercise routines, they’re undergoing complex knee and hip replacements and surgical repairs to the shoulder, ankle and elbow. Orthopedic surgeons say they are performing such surgeries more often on patients in their 40s, 50s and beond than in the past.

7314251 tenns

Physical therapists are also treating more boomer patients than ever, not only for rehab after injuries and surgeries, but also for customized fitness training geared to their musculoskeletal limitations.
staying healthy and avoiding injuries
If you’re a boomer, regular exercise is key to preventing or improving chronic conditions that come with increasing age. But you may need to make some modifications to avoid injuries.

Here are some tips for staying healthy and avoiding injury — at any age.

Moderate cardiovascular exercise will improve the quality of your life, but be sure to get screened by a physician first.

Exercise at a pace appropriate for your age and past activity level. Adjust your activities and know that you have limitations: You may only be able to get your heart rate up so high, you may have joints that are not as flexible, or you may have arthritis.

Seek the advice of physical therapists to work on your flexibility, strength, endurance and posture. You need to know what posture to have while sitting at a computer, as well as how to set your computer station ergonomically to reduce the risk of neck, shoulder and hand injuries.

Stretch on a daily basis. Try to incorporate gentle stretches for your neck, back, arms and legs.
outdoor yoga

Perform gradual strengthening exercises. Begin with light weights and gradually increase the resistance, don’t be afraid of heavy weights but progress slowly.

Eat well-balanced meals with protein at each meal, including plenty of fruits and vegetables. Drink water daily.

A loss of mobility following injury, hospitalization, or even sustained sitting positions at work can speed the deterioration of muscles, joints and bone. A physical therapist can help you regain mobility and improve quality of movement.

Exercise mentally, not just physically, by doing crossword puzzles, jigsaw puzzles, sudoku, Scrabble and other mind games.


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Osteopenia vs Osteoporosis

Yesterday’s medical term Tuesday attracted multiple questions about osteopenia versus osteoporosis and also prevention/treatment possibilities. Osteopenia and osteoporosis are related conditions that both concern bone loss or decrease in bone quality. If you compare them to our South Florida summer weather osteopenia is like a tropical storm and osteoporosis is like a hurricane. Someone with osteopenia is more likely to fracture a bone than someone with normal bone density but less likely to fracture a bone than someone with osteoporosis.


Osteopenia and osteoporosis have multiple causes which can include:


hormonal changes (decreased estrogen or testosterone with aging)


excessive alcohol consumption

small framed people


medications (particularly corticosteroids)


chronic inflammation (rheumatoid arthritis)


Treatment for osteopenia and osteoporosis:

Treatment typically includes lifestyle modifications to increase calcium uptake into the bone as well as potential prescription medication that increases bone density if the person is at a high risk of fracture in the next 10 years. These risk factors are reviewed by the person’s physician looking at past medical and family history to determine on a case-by-case basis possible pharmaceutical intervention.

The following non-pharmaceutical treatment options are recommended:

Vitamin D

800 IU for women over 71

600 IU for women under 71 and men


1200 mg for women over 50 and men over 71

1000 mg for women under 50 and men under 71


limit alcohol consumption to less than 2 drinks per day


just stop its bad for everything!

Weight-bearing exercise: at least 30 minutes daily

weight lifting


stair climbing



*NOT swimming or bicycling

If you already have osteoporosis avoid excessive bending or twisting and high impact exercises without qualified supervision.


The good news is that frequently, bone loss can be slowed or stabilized with lifestyle changes or medication if necessary. If you have more questions about osteoporosis or other conditions send us a message.  If you are looking for a specific exercise program call or stop by and we can help you design something that fits your needs and goals while protecting your bones. Continue reading

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What every golfer should know about injuries

What every golfer should know about injuries
with advice from Clif Rizer, DPT, ATC, CSCS


Whether you just started hitting the links or have been playing golf for years, understanding the variety of injuries that can result from playing golf will help your game, as well as your overall wellness.
For beginners, injuries can often happen because of poor body mechanics. While many people may think it’s simple to pick up a set of clubs and hit the links, a bad golf swing can lead to years of bad habits (and bad scores).
If you’re new to the sport, consider taking some lessons with a teaching pro —the PGA certifies teachers who can ensure that you learn the game with proper form. If you’ve tried playing and have felt pain during your swing, consider consulting with a physical therapist, whose musculoskeletal expertise can reduce pain and improve your game. As a Titleist Performance Institute Certified medical professional , Clif is an expert in evaluating a player’s golf swing and pinpointing where an error occurs in its mechanics.

More seasoned players can experience a variety of pain and problems. Harvard Medical School study underscored overuse as the key reason golfers have back, shoulder and elbow problems, unsurprising when you consider how many times a golfer swings his clubs during a round of 18.
Many golfers experience back pain due to a lack of mobility in the hips and lower back, and weakness in the lower back and core muscles. Clif cautions golfers to seek help from a physical therapist if they experience back pain, especially with bending or twisting; excessive back stiffness during or after playing golf; muscle spasms; or pain or weakness in the legs. “A physical therapist can address such pain, then assess the person’s movement patterns and golf swing to determine the probable cause of the pain.”
Golfers are also prone to medical or lateral epicondylitis, also known as tennis elbow or golfer’s elbow. While the pain may be felt in the elbow, he says, it is often a cause of poor swing mechanics or weak back muscles. Tightness in the back or improper form can lead to compensation, putting more strain on the elbow joints. If the golfer feels pain in the elbow, especially while gripping a club, or a loss of grip or wrist strength, it’s time to consult a PT about the problem.
Shoulder injuries are less common for the casual player but are one of the most common injuries for professionals. Excessive force on the joint can cause tendinopathies, rotator cuff tears and labrum tears. Clif cautions golfers to be aware of pain in and around the shoulder joint and arm, clicking and popping in the joint with movement, and shoulder weakness that makes it difficult to move. Such symptoms are signs to seek medical treatment, as such tears can only get worse with further activity.

Finally, all players, especially those that are retired or nearing retirement age, should be aware of arthritic pain in all of their joints. Such knee and hip pain may cause golfers to compensate and adjust their swing mechanics without even realizing it. Arthritis shouldn’t stop you from playing golf; in fact,playing golf and being active can actually reduce arthritic symptoms. That said, if you do suffer from arthritis, it’s a good idea to have your swing evaluated to make sure that your swing mechanics haven’t changed for the worse as you’ve aged.
There are a variety of things a golfer can do to reduce her chance of injury. Clif suggests investing in a walking cart for your clubs if you usually walk the course: “It has been shown that you are twice as likely to injure your back if you carry your clubs,” he says.
Having a more efficient swing can also reduce injury. An efficient swing will be different for each player, depending on his body type and strength, but it can be improved by working on strength, flexibility and muscle control. As a Titleist Performance Institute Certified medical professional, Clif is certified to evaluate swing mechanics and to create a strengthening program that will optimize a person’s golf swing.
Several stretches and exercises can help players to improve their game and reduce pain — and the chance of injury. Clif strongly advises warming up before walking to the first tee. “A proper warm-up should be dynamic,” he says, “increasing your heart rate and taking your joints through full ranges of motion.” He recommends starting with squats, lunges, trunk rotations and arm circles, then gradually working from half-speed swings with short irons to full swings with a driver.
A variety of exercises off the course will help to strengthen your core and reduce injuries. These can be done on your day off or before hitting the links.

Pigeon stretch
Increases flexibility in the lower back, glutes and piriformis muscles.
Open book stretches
Improves thoracic (chest) rotation, allowing for a more efficient swing and less strain on the lower back.
Half-kneeling hip flexor stretch
Limits hip flexor tightness, which weakens the glutes and overworks the lumbar paraspinal muscles.
Activates the glutes and strengthens the core, leading to a more efficient and powerful golf swing.
Latissimus stretches
Improves flexibility in the latissimus, increasing the ability to bring the lead arm across the body in the back swing and to rotate the trunk away from the target.
Lateral shoulder rotation stretches
Enables the trail arm to assume the proper position at the top of the backswing.
Looking for a physical therapist to treat golf injuries?
Click here to find a Physiquality therapist in your neighborhood

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Tiger Woods walking tall and stronger than in 3 years… I am Tiger Woods

Have you watched any of the US Open over the last 2 days?  Did you see the back 9 that Tiger played 2 weeks ago @ the Memorial?  A lot has been written about Tiger is back and the articles and interviews will explode if he closes the deal this weekend.  How his head is back in the game, his iron play is the best, his putting… and on and on, BUT have you seen Tiger walk this week?  Yes, walk, kneel, climb out of the occasional bunker he is in, and last night make a shot while kneeling and putting his surgically repaired knee is some crazy angle that made my knee feel sore.  These are the strange but fascinating things to me that I look for during an athletic event.  He has finally recovered from knee (possibly experimental) surgery see this link for explanation of the double strand ACL repair.

If you watch on ESPN classic the extra round he played @ the 2008 US open he is dragging himself around the course the leg is not doing what he wants because the ACL is gone and the stability of the knee has left with it.  After surgery well we know that he had some issues but I think the personal stuff received too much credit for his decline in the rankings.  He was still slogging along in 2010 and even 2011 missing cuts dropping out early because he is afraid he might irritate his knee or Achilles.

So what am I saying?  It takes time to heal you can’t trick the human body into healing faster than it’s going to.  You can put it in the best environment for recovery; good food, rest, physical therapy, massage, eastern medicine, the list goes on and on, and Tiger had the money to get all of these and reports lead us to believe he did, but you can’t buy time.  I have many patients in similar scenarios most not in their 30’s and few are professional athletes but they have had knee surgery and they do expect to go back to active lifestyles.  Many NFL players that experience major knee injuries and then require surgery struggle their fist year back and then have a breakout year the next ( Willis McGahee) In a separate study reported in The American Journal of Sports Medicine in March 2011, Adern et al reported on RTP 12 months after ACL reconstruction in Australian athletes. These athletes in competitive level Australian football, basketball, netball, or soccer had a return rate to competitive sport of 33% at twelve months. However, 47% indicated in this short term study that they planned on returning.  Ardern et al concluded that people may require a longer rehabilitation period to return to competitive sports than previously believed.

There was a popular Nike comercial about 10 years ago.  I am Tiger Woods it promoted Tiger and the fact that a new minority and youth movement was happening in golf

Well there are many South Floridans in their 60s,70s, 80s, and even 90s that have had knee, hip, back surgery that expected to be back on the golf course in 6 months or less.  Remember Tiger is still relatively young has unlimited resources and took 3 years to recover from surgery.  But he did recover and is golfing better than anyone else right now on a surgically repaired knee.

So for all you seniors with titanium knees and spinal fusions don’t give up on getting out there just set realistic time frames and goals and go for it! Walk tall and strong You are Tiger Woods!

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