Foam Rolling: Should You Do It?

Foam rolling is a very common recovery tool among athletes and exercise enthusiasts. Simply pop your head inside a gym here in Bethesda and you will likely see several people lying on the ground, rolling on these objects. Many people now own foam rollers for home use. We are often asked about them as they are also commonly used in sports physical therapy.

How do you know if you should foam roll? If you are already using this tool, should you continue?

Like most things, it depends. More specifically, it depends on why you are using the foam roller. Foam rollers do not “break up” tissue as is often believed. Our body is not that fragile. Could you imagine what your body would do lifting weights if tissues could be drastically changed by a round piece of foam?

However, if you are using the foam roller because it feels good and the routine of “rolling out” helps to get you in the right mindset for training (if used prior to exercise) or recovery, keep it up. The sensory input of the roller moving up/down the body’s tissues can feel good, similar to a massage and often helps people relax.

A foam roller is not going to do any harm. Whether or not you should use one depends on the reasons why you are doing so.

If you have any further questions about this or something else in the field of physical therapy/strength and conditioning please feel free to contact Dr. Cohen or Dr. Immermann.

E-mail: info@cohenhealth.com
Phone: (240) 686-5609

What Is Good Posture?

“I know, my posture is terrible.”

Sometimes our patients/clients will come to us concerned about their posture.

People are classically taught to “sit up straight,” or stand with their chest out and shoulder blades pulled down and back. This is often seen as the counter to slouching which is commonly looked down upon.

I rarely think of posture as good or bad.

Most people think of posture as a static (non-moving) position. However, our posture, much like movement, is always changing. The body constantly adapts to more efficient and comfortable positions based on demand.

Think of your most recent workday. Your resting posture was likely much different at the end of your workday when compared to when you first sat down in the morning. In the morning you may have been much more upright and aware with your coffee kicking in. However, you later began to slouch and melt into your chair as the afternoon lull approached.

Your posture likely appeared very different in both of these situations and an assessment of your posture would therefore also appear different depending on the time of day it was done.

“Does this mean that posture doesn’t matter?”

No, that is not the case. What it does mean is that there are other things that warrant more attention. Practicing high movement quality every day, taking walks outside to break up continuous bouts of desk work and getting a full night’s sleep will have a greater impact on your health then constantly worrying about your resting posture.

Check out additional blogs from Cohen Health and Performance for more information on how to incorporate healthy lifestyle habits into your routine.

Why Your Back Pain Won’t Go Away

Have you tried everything and still have low back pain? Is your daily pain limiting your workout of the day?
Here are some reasons your back pain won’t go away…

1) A Poor Night’s Sleep
Sleep is the best recovery tool that we have. From an evolutionary perspective, we better have a great reason for leaving ourselves unconscious and vulnerable for a number of hours! Research indicates that quality of sleep plays a crucial role in improving outcomes in chronic pain patients.

Make sure that you have a high-quality mattress. A poor-quality mattress can leave your back feeling worse due to a lack of support. For this reason, a high quality, firmer mattress is often best. Be sure to test out multiple mattresses to determine which one is best and most comfortable for you. This is also not the time to get cheap! Think of this as an investment as we use it for at least 8 hours every day. One-third of your life is spent in bed!

Furthermore, no more sleeping on your stomach. Sleeping on your stomach increases the compression on your lower back. Initially it can be extremely challenging to sleep on your side or back when you are not accustomed to it. However, it will become significantly easier with a little bit of repetition.

2) Addiction to Technology
According to recent research, the average person spends about nine hours per day using electronic devices. This will increase tension in a number of areas including the lower back.

Try setting limits on your technology use or maybe even give yourself a technology curfew at the end of the day. This will help reduce your technology use and can even help improve your quality of sleep by reducing blue light exposure before bed.

3) Stress
The body is very resilient, however, it can still only handle so much stress. Stress can be both physical and emotional. The body is limited in the amount of physical stress that it can handle when it is pre-occupied with emotional/psychological stress. Research indicates that people struggling with anxiety and depression are more likely to experience a number of orthopedic pains including lower back pain. This can often lead to a downward spiral of emotional/psychological stress contributing to lower back pain and lower back pain leading to more stress.

If you feel that you could reduce your stress, try meditating or deep relaxation techniques. Not sure how to go about that? There are many great apps that you can use on your phone to help guide you. You can even do something as simple as setting aside time to sit and relax and reflect on your day.

4) Not Getting a Comprehensive Treatment Plan
If you are receiving treatment for back pain and symptoms are not getting any better, you have to consider the possibility that your treatment plan may not be comprehensive enough. Back pain is very complex and is influenced by a number of factors, including many that were not described in this article. A comprehensive evaluation is essential to determine the root causes of pain and assess the numerous factors that contribute to this issue.

Effective treatment targets the root issue and doesn’t just chase symptoms. This is essential to provide fast and long-lasting results. Do not trust your back to just anyone!

If you continue to have symptoms, remember that we specialize in helping athletic people just like you get out of pain and back to doing those activities that you love.

Call to learn more or to schedule an appointment. If you aren’t sure if we are the right place for you, please sign up for a free consultation to determine if we are the right people to help you!

Why Is My Shoulder Popping?

Do you ever feel like your shoulder is popping and wonder why? There are multiple reasons for this common issue. The shoulder is a complex joint with the largest and most variable ranges of motion in the body. It is comprised of bone, ligaments, cartilage, and tendons that allow for the ease of movement in so many different directions, however it runs the risk of becoming unstable when movement quality is poor. This is why the shoulder is a commonly injured joint that results in shoulder pain.

Before you assume the worst, ask yourself the following:

1) Is the popping I feel painful?
2) Has there been a recent injury of my shoulder resulting in any pain?
3) Does my shoulder feel stable?
4) Is it accompanied by any weakness?

Clicking and popping can occur for many reasons. If it is painless, it can be just a harmless joint noise known as crepitus, which is simply pressure being released from the joint. This is what occurs when you crack your knuckles. On the other hand, if it is associated with pain, something is getting irritated.

Repetitive over use of the shoulder can result in irritation/inflammation of a number of tissues within the shoulder. Two examples are bursitis and tendinitis which seem to be common sports injuries here in Bethesda. These conditions occur from movement compensations in conjunction with too much of the same activity that causes swelling in the bursa sac and rotator cuff tendons. Bursae are fluid filled sacs that cushion each joint in your body, in this case, the shoulder. The tendons are the cords that connect the muscle to the bone. The rotator cuff tendons can become worn down slowly over time much like the sole of a shoe that eventually wears apart. If left untreated, the result is a tearing of the rotator cuff tendon causing increased pain and an inability to exercise or train fully. Limitations can even progress further effecting sleep, strength, and the ability to use the arm with many daily activities.

Pain can also occur with popping due to degenerative arthritis from years of wear and tear. This occurs when the cartilage that protects the bone has worn down and becomes rough. If the joint is no longer smooth and there is increased friction, it can develop injury through the joint rubbing together like two pieces of sand paper. The result is increased joint inflammation and shoulder pain. If left untreated, this can also limit the ability to exercise and train fully.

Shoulder pain and impingement occur when the space between the top of the shoulder blade (called acromion) and the top of the upper arm bone (called head of the humerus) is narrowed due to movement compensations, eventually resulting in swelling and inflammation which further limit this space. This causes a pinching of the rotator cuff tendons and bursa. Untreated, this too can limit the ability to exercise fully and eventually interfere with day to day activities.

Shoulder instability occurs when the head of the upper arm bone (humerus) is unable to stay centered on the shoulder socket (glenoid) during movement. This places increased strain on various structures within the shoulder joint potentially irritating the cartilage (labrum) of the shoulder, resulting in increased pain and weakness. This can cause increased risk of arthritis.

Despite, everything that was just described, that is not what is important! The most important thing is to figure out why the popping, tendinitis/bursitis, arthritis, impingement or instability started in the first place.

Small rotator cuff tears, labral tears, arthritis and joint damage is common within the shoulder however there is still a great deal that you can do (without surgery) to get out of pain and back to performing the activities that you love.

The question you need to ask yourself is, “what movement compensations do I have that are irritating my shoulder?” Addressing this by seeing a quality sports physical therapist will allow you to continue to exercise and enjoy your active lifestyle. To read more great articles like this, check out www.cohenhp.com!

Do You Accept Health Insurance?

At Cohen Health and Performance, we are frequently asked this question when someone initially comes to us for help with the pain and limitations that are hindering their active lifestyle.

This is a very reasonable question, however, the answer is much deeper than a simple yes or no.

The mission of CHP is to enhance the lives of individuals who want to live an active lifestyle by providing elite level physical therapy and empowerment for continued health and wellness.

This mission guides the decisions that we make, and when deciding whether or not we would be in-network with health insurance, the decision was obvious. It would be impossible to fulfill our mission and help people who care deeply about their health, get out of pain and back to enjoying their active lives as quickly as possible if we were in-network with health insurance.

Due to declining reimbursement rates from health insurance companies, in-network physical therapists are forced to see 2-3 patients per hour. This often results in treatment that is very “cookie cutter” or “one size fits all.” Creating and implementing a customized treatment plan would simply not be possible in the 20-30 minutes an in-network physical therapist has with his/her patient.

The limited amount of individualized care an in-network physical therapist can provide to his/her patient often necessitates that the patient is seen 2-3 times per week. Much of each visit is delegated to assistants, aides or techs. Furthermore, treatment has to often rely on modalities that do not require personal attention such as ultrasound and electric stimulation. These modalities have questionable evidence to advocate for their use and do nothing to help patients address the root causes of their pain. This is not to belittle the clinicians that are in-network with health insurance, as they are left with little choice.

At CHP, we are out of network with health insurance. We are able to help people get better, faster, and in less visits. Furthermore, we are able to educate people about how to sustain their results and prevent future re-occurrence. Very often we help patients that did not get results with in-network care.

Due to the high quality of care we are able to provide and the subsequent results that we are able to achieve, people often assume that they are going to have to invest a lot more money to see us. This is often not the case.

The investment in our services are greater on a per session basis, however, less overall sessions are required. When seeing an in-network provider, a small co-pay will accumulate quickly with 2-3 visits per week. Furthermore, we provide receipts that our patients can use to submit to their health insurance company for out of network reimbursement and they can use their health savings or flexible spending account if they have one.

Even more importantly, it is easy to get caught up in the financial investment, however, do not forget that you are investing in your health! Do you really want the cheapest option?

Feel free to reach out to Dr. Cohen and Dr. Immermann at info@cohenhealth.com if you have questions about how our out of network clinic can help you get back to doing the activities you love.

Introducing Our New Performance Physical Therapist

We would like to welcome, Dr. Alex Immermann, our new Performance Physical Therapist, to the Cohen Health & Performance family. He has passion for using his specialized background to meet the needs of clients wherever they fall upon the spectrum between rehab and performance development. His professional aspiration is to get less people rehabilitating and more people training.

Drawn to sports medicine after his own youth soccer experiences, he graduated with his BS in athletic training from Boston University and worked as a Certified Athletic Trainer (ATC) prior to PT school. He then graduated magna cum laude from The George Washington University with his Doctorate in Physical Therapy. While at GW he interned with EXOS (formerly known as Athlete’s Performance), getting the opportunity to learn from a world-renowned sports medicine/performance team treating many of the world’s most elite athletes. Prior to moving back to the DMV area, Alex was a Staff Physical Therapist with Elite Performance and Rehabilitation in Santa Barbara, CA. There he gained valuable experience working with general orthopedic clients as well as a wide variety of amateur and professional endurance, martial arts, volleyball, and tennis athletes.

Alex is a certified Strength and Conditioning Specialist through the National Strength and Conditioning Association. He is also a certified in Functional Range Conditioning (FRCms) a comprehensive system of joint mobility training meant to optimize human function through a focus on building true mobility, joint integrity, and body control/awareness.

We are very excited to have Alex join our team in helping you get back to the active lifestyle that you love!