Author: Zachary Cohen

Dr. Zac began his career working in professional sports. He noticed a large discrepancy between the quality of care that elite athletes receive when compared to the normal active public. This inspired him to create Cohen Health and Performance, a place that treats everyone as if they are a professional athlete! He graduated summa cum laude from Northeastern University in 2011 with his Doctorate in Physical Therapy, and also became a Certified Strength and Conditioning Specialist (CSCS). While at Northeastern he worked as a Physical Therapy Graduate Assistant for the New England Patriots, and served as a strength and conditioning coach for Northeastern University athletics. Prior to moving to Maryland, Zac was a Performance Physical Therapist with EXOS (formerly known as Athletes' Performance) in Dallas, TX where he treated and trained the world's most gifted athletes from throughout the NFL, MLB, NBA, MLS, and various Olympic teams.

What Are Regenerative Therapies?

The fields of athletic/performance physical therapy and regenerative medicine commonly overlap. Below is a special guest post from Dr. Mayo Friedlis. Dr. Friedlis is a physician with Stem Cell Arts in Chevy Chase, a certified Regenexx provider. Their board certified physicians have over 20 years of experience doing Regenerative therapies and Dr. Friedlis has been practicing there since 1983.

At CHP, we commonly receive questions about the regenerative medicine. It is a relatively new area of medicine and you may have questions such as; What is regenerative medicine? Does it work? Can it help me?

Dr. Friedlis was kind enough to answer these questions and many more. Check out the great information he provided us below!

Regenerative therapies offer an opportunity to stimulate the body to heal itself. These treatments use platelets or stem cells or other growth factors from the body to stimulate the body’s own healing mechanisms to build new tissue or heal tissue that is injured. But when should you turn to something like this?

Many injuries can be healed by the body on its own, often with proper exercises or other maneuvers to restore the body’s equilibrium and balance. But what if the pain remains despite these measures?

Regenerative therapies and surgical interventions need to be thought of differently. We are used to turning to surgical treatments as a last resort when we cannot stand the problem any longer and live our lives to the fullest.

Regenerative therapies are the exact opposite. They work best when used earlier. They help the body to heal, preventing further damage and degradation of the structures. Think about regenerative therapies when first-line interventions are ineffective and you have not been able to fully return to the activities that you enjoy.

The earlier you intervene, the greater chance your body has of completely healing from injury. For athletes, it’s never enough to just treat the pain. Regenerative therapies (much like physical therapy) help to treat the actual cause of the pain. That’s where Regenerative therapies excel.

The other question I get asked often is what regenerative therapy is appropriate? The answer is, it depends. It depends on what structure is injured. Ligaments and tendon structures such as the rotator cuff, hip labrum, meniscus or other ligament structures do very well with prolotherapy or PRP (platelet rich plasma). Joint degeneration and osteoarthritis, are more successful with stem cell treatment.

Success of treatment also depends on the extent of injury. A small ligament or tendon tear, or meniscal tear does well with prolotherapy or PRP. However a larger tear will require an approach involving stem cells. Mild arthritis can be treated with PRP or prolotherapy but more severe arthritis will benefit more from stem cell treatments.

In conclusion, Regenerative treatments should be sought earlier rather than later. Delayed treatment can result in additional injuries or compensatory changes.

-Dr. Mayo Friedlis, MD

**To learn more about Regenerative Medicine, Stem Cell ARTs, and Dr. Friedlis, please visit their website!

3 Indications You Should Ignore a Social Media Post

Today there is more access to information then ever. This access to information is no more prevalent than in the realms of health, medicine, fitness/performance, or any other area of athletic physical therapy. Anyone with a social media account can quickly find thousands of posts related to these topics which creates a whole new challenge.

Because everyone can promote themselves as an expert on social media, it is essential to have a discerning eye for quality information. Unfortunately, social media platforms, such as Instagram, do not promote posts based on the validity of the information presented.

Amongst such a vast array of information, how do you determine when you should ignore a social media post related to health, fitness, or performance physical therapy information?

The presenter speaks in absolutes. Commonly the best answer that a professional can give you is “it depends.” The reason for this is that a person’s experience is context dependent and is the result of several different factors that must be considered together. For example, stretching or improving mobility is often promoted as a “fix” for a given injury. However, this does not apply to those that have more important problems to solve or possess full range of motion in the area being discussed. For more information on this topic, check out our post on Is Mobility Overrated? Furthermore, it is impossible to know of every possible factor that could be contributing to pain, injury, limitations, or challenges. Therefore, even the best among us cannot claim to be 100% certain, especially on social media.
The information is unnecessarily complicated. An expert can take a complex topic and break it down so that it makes sense to you. Overly complicated terminology and unnecessary use of medical jargon are red flags that the presenter may not fully understand the material being presented.
Promoting personal success stories as evidence. Personal success stories are anecdotal. The definition of anecdotal is “not necessarily true or reliable, because based on personal accounts rather than facts or research.” Many medical and fitness professional post personal success stories as evidence for the validity of their method, approach, or something that they are attempting to market. This ignores all the other factors that may have contributed to these results (see #1 above). Even if the results being presented are valid, it only applies to the person being shown. Quality research commonly requires thousands of trials before being considered valid. A case study of 1 or 2 people only applies to the people being referenced and ignores your unique circumstances.

**Bonus: If a presenter promotes “quick fixes”, run!

Discerning quality from poor information is very challenging in the modern age. Everyone can promote themselves as an expert, however there are several ways to determine when it is best to ignore a presenter. These are just a few of several ways that you can do so.

Photo Credits

“Social Media” by MySign AG is licensed under CC BY 2.0

Why We Need to Stop Comparing Adult Movements to Children’s

It has become common in fields of physical therapy and performance training to compare adult movement to the ways that babies move. You may have spoken to a professional that uses this comparison in their approach.

The logic usually goes something like this…“Humans were born with the ability to squat fully, and our modern lifestyles robbed us of that ability, so we need to regain it.”

Sounds understandable, right?

I thought so too. I even took a couple of continuing education courses based loosely upon this concept. The class instructors showed pictures of babies at various development stages and attempted to teach movements that mimicked these phases. The idea was to help adults gain back some of the movement capabilities that they once had as children and this new freedom of movement would help to alleviate pain and resolve injury.

Adults Are Not Babies

While I think we’d all love to be able to squat to the floor, crawl around all day, and never get tired, the truth is that we are not babies anymore.

Babies have a large amount of joint laxity that allows them to get into a variety of different positions, that we don’t have as adults. Babies also have a very large head in relation to the body, which helps to provide a counterbalance for easy squatting. In fact, according to Healthline, many of a baby’s bones are composed of cartilage, a type of connective tissue that is tough but flexible. This cartilage turns to bone as we grow.

Their bodies are still growing and changing. They fall often and make mistakes (essential for learning), which flexibility and mobility help with. Because of this, the ability to squat to the floor is normal for a baby. The same cannot always be said for adults.

Adults are not babies, and we cannot use a baby’s movement as a model for how an adult should move. Not only do babies have much different bone and structural compositions, but all adults have different movement capabilities due to variations in torso lengths and body proportions (among other reasons). Using singular movement standards would overlook this critical aspect.

It is nice to think that we could be able to squat to the floor like we once did when we were a toddler. However, adults are not babies, and our bodies are not the same as they once were.

Because of this, we do not expect our physical therapy patients to squat to the floor. It is essential for all of us to set realistic movement standards that will help to live pain-free and healthy lives. For help in the arena, talk to our experienced physical therapy team in Bethesda!

Why Is It So Hard to Return to Running After an Ankle Sprain?

Ankle sprains are commonly perceived as a mild injury, however, they often cause runners and other athletes to seek physical therapy.

The severity of these injuries are often downplayed as athletes return to running and sport far too quickly.

The most common form of an ankle sprain is an inversion sprain. In this instance, the foot is usually planted as the ankle turns inwards causing the outside edge of the foot to roll onto the ground (hence the term “rolled ankle”). As this occurs the ligaments on the outside of the ankle are damaged and usually torn to some degree.

The severity of the injury and number of ligaments involved dictate the grade of the ankle sprain, ranging from grade 1 through grade 3.

After an ankle sprain occurs, it is essential to rule out a fracture. An athlete is instructed to have an X-ray if he/she/they is unable to bear weight on the injured leg and/or has severe pain around the malleolus (prominent ankle bone on the outside of the ankle).

If an athlete does not have any of the findings mentioned previously or an ankle fracture is ruled out, then we can move on to returning to running!

When running there is not a single time when 2 feet are on the ground at once. Therefore, the body is constantly bounding from one leg to the other, forcing the ankle to repeatedly absorb the impact of the entire body.

Unfortunately, after an ankle injury the stress capacity (the amount of cumulative stress an area can handle prior to injury) is limited. For this reason, the recovery from an ankle sprain often takes much longer than necessary. Runners and many other athletes commonly attempt to run before the ankle is ready.

All injured tissues must progressively re-acclimate to the amount of stress associated with running or the sporting activity.

A thoughtful and progressive return to running may begin with non-weight bearing movements, then progressed to include non-impactful weight bearing activities such as squats, split squats, and lunges. Next, single leg activities can be included such as single leg balance drills and single leg squats before progressing to plyometric drills that involve jumping off 2 legs and finally, hopping on 1 leg.

Finally, activities such as jump roping, short runs, and longer runs are implemented into the routine!

In conclusion, every ankle sprain is different, and it is essential to ensure that a trained medical professional assesses the injury to rule out a fracture. Finally, the professional can design the optimal return to sport program for you.

Visit our website for help in this regard and for more information on how we can help!

A Window to Cardiovascular Health

“Casual Runner” by Chris Hunkeler is licensed under CC BY-SA 2.0

Resting heart rate paints a vivid picture of cardiovascular health and impacts the body’s response to sports physical therapy interventions. RHR, or resting heart rate, is the number of times the heart beats per minute when the body is not physically active — such as when sitting.

According to the Mayo Clinic, the “normal” range for a resting heart rate is between 60 and 100 beats per minute (BPM), though resting heart rates vary from person to person based on various circumstances. For example, resting heart rate is significantly influenced by mood, environment, cardiovascular fitness, and stress.

As a rule of thumb — as cardiovascular health increases, resting heart rate tends to decrease. Therefore, athletes often have lower resting heart rates than those that do not regularly exercise. That said, resting heart rate is an important measure for anyone looking to improve their overall health.

What Your Resting Heart Rate Says About Your Cardiovascular Health

The heart is responsible for pumping blood and oxygen throughout the body. An elevated resting heart rate causes increased strain on the heart, often linked to high blood pressure, high cholesterol, and a higher risk of heart disease.

A resting heart rate of more than 100 BPM is called tachycardia, whereas an RHR below 60 beats per minute is called bradycardia.

Other than a few exceptions (for example, medications that lower the heart rate), a lower resting heart rate is an indication that the heart is more efficiently pumping blood, requiring fewer beats per minute to distribute blood throughout the body. Because each beat is more powerful, the heart is much stronger than one with a high resting heart rate.

Fortunately, there are many ways to improve resting heart rate, thus improving overall cardiovascular health.

How To Improve Your Resting Heart Rate

This is where cardiovascular exercise comes in handy. A recent study conducted at the University of Lousiville concluded that regular exercise effectively lowers resting heart rate, which reduces the risk of cardiovascular disease.

We think of cardiovascular exercise as strength training for the heart. Aerobic workouts, like walking, jogging, or swimming, train your body to use oxygen more efficiently, which gradually reduces your resting heart rate and breathing rate — both of which are important factors of cardiovascular health.

A more efficient heart can even help athletes recover quicker between grueling workouts. Plus, it allows many of our physical therapy patients in Chevy Chase and Bethesda to better adapt to the physical demands of their lives.

Final Thoughts

Resting heart rate is an important measure of cardiovascular health. A significantly high resting heart rate often correlates with many health problems such as cardiovascular disease, high blood pressure, and high cholesterol. Conversely, a low resting heart rate indicates a strong, healthy cardiovascular system.

If you’re struggling to improve your resting heart rate, try adding in regular cardiovascular exercise to gradually improve cardiovascular efficiency. Resting heart rate will improve as a byproduct.

If you’d like to work directly with a physical therapist in Chevy Chase or Bethesda to help you with this, please contact us today to schedule a free consultation!

Is Mobility Overrated?

Mobility has become a popular buzzword in the sports physical therapy community in Bethesda and Chevy Chase. While it is an important aspect of health and fitness, could mobility be getting more attention than it actually deserves?

What Is Mobility?

The term “mobility” refers the quantity of available movement — and how freely and efficiently you’re able to do so. Popularized by the sports physical therapy and training community, mobility is important for everyone, whether you’re an elite athlete or a busy working Mom.

Mobility is an important part of a well-designed injury rehabilitation and prevention program. It is also used to improve the quality of life for our physical therapy patients in Chevy Chase and Bethesda.

While very important, many experts feel that the booming popularity of mobility overshadows several other key health factors. In particular, the added focus on mobility often leads to a lack of attention on other important health factors, such as strength, cardiovascular health, and other global health behaviors.

What The Mobility “Craze” Makes Us Overlook

Although mobility is an important aspect of a healthy body, mobility alone won’t provide the quick fix you might be looking for. Instead, there are several complex contributing factors that need to be properly managed to improve your overall health.

Strength Training

Lean body mass and strength are some of the greatest indicators of the overall health of an individual. In fact, according to a study done by Harvard University, something as simple as grip strength can help measure an individual’s risk of heart attack, stroke, or cardiovascular disease.

Focusing on mobility alone overlooks the importance of strength training. According to The Mayo Clinic, strength training can help you manage or lose weight, increase metabolism, protect your joints and ligaments, and improve your ability to do everyday activities.

Cardiovascular Exercise

Another important measure of the overall health of an individual is cardiovascular fitness. A simple way to gauge cardiovascular health is by measuring your resting heart rate — the number of times your heart beats per minute when not physically active.

Although the normal range of a resting heart rate is between 50–100 beats per minute, a resting heart rate greater than 90-100 BPM can put unnecessary strain on the heart. A high resting heart rate has even been linked to high blood pressure, cholesterol, and even heart disease.

By solely focusing on mobility, cardiovascular health may be overlooked.

Global Health Behaviors

Outside of strength and cardio training, there are several other important contributing factors to an individual’s health — specifically sleep, nutrition, and social connection.

Sleep plays a crucial role in your physical health. Not only does sleep heal and repair your muscles, heart, and blood vessels, but a recent study discovered done by the National Heart, Lung, and Blood Institute discovered a link between sleep deficiency and an increased risk of heart disease, kidney disease, diabetes, and high blood pressure.

Final Thoughts

All in all, mobility is only one aspect of staying healthy and active — it isn’t the only thing that should be focused on. Health is achieved through the successful balance of multiple variables, including mobility, strength training, cardiovascular exercise, and various other global health behaviors.

If you’re looking for a comprehensive program to improve your health, fitness, and quality of life, our physical therapy team in Bethesda and Chevy Chase can help. Contact us today for a free consultation!