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.

A Physical Therapist’s View: How Does LeBron’s Ankle Injury Impact His Season?

Los Angeles Lakers star LeBron James is out “indefinitely” after suffering a high ankle sprain in a recent game against the Atlanta Hawks. “Indefinitely” paired with “high ankle sprain” is usually a bad sign in the sports world. However, from a performance physical therapy and performance training perspective, LeBron’s injury would likely have been much worse had it not been for his rigorous off-season training program.

A high ankle sprain occurs when there’s tearing or damage to the ligaments (known as the syndesmosis) located above the ankle. Less common than low ankle sprains, high ankle sprains caused by a sudden turning, cutting, or twisting motion. Athletes playing high-impact sports that require frequent running and jumping, such as basketball, soccer, football, and lacrosse, are at higher risk for these more severe sprains.

The average recovery for high ankle sprains can take significantly longer than typical sprains. In general, it takes roughly 6–8 weeks to fully, though it can take up to 3 months in severe cases. LeBron is expected to be out “indefinitely” as he recovers from his recent injury. However, given his intense training and recovery regime, it’s likely that he’ll be back on the court sooner than expected.

After watching the gruesome video of Solomon Hill tripping into LeBron’s ankle, it would have been easy to assume a severe injury. However, LeBron’s off-season training program may have kept his ankle sprain from becoming something more serious. Still dominant in his 18th year in the NBA, LeBron’s continued focus on training and recovery is very apparent. For the past 16 years, LeBron has worked with trainer Mike Mancias, who helped LeBron continue to dominate by focusing on nutrition, mobility, and strength training.

Most people think that strength training can prevent injuries. However, strength training often just prevents injuries from becoming more serious. It’s hard to avoid certain things from happening in a game. That said, off-season training can help prevent injuries from becoming severe.

Two Common Reasons You Have Neck Pain (And How to Fix It)

Neck pain is a common complaint of people seeing a physical therapist in Chevy Chase or Bethesda. Although a variety of different factors can cause it, two of the most common explanations of neck pain and discomfort are rib cage stiffness or overtraining.

One effective treatment of neck pain can be to reduce any rib cage stiffness that may be causing a lack of mobility below the neck. The muscles of the upper back and shoulders attach directly to the neck and can cause tension when unable to expand freely. To have pain-free neck mobility, the rib cage must be able to expand 360 degrees.

One simple method to improve rib cage stiffness is with a breathing exercise such as Rockback Breathing off an elevated surface (see below).

Rockback Breathing on a Bench

Another common cause of neck pain in our patients is overtraining. When patients disregard the warning signs and continue to push themselves, there is an increased stress response throughout the body. This causes the accessory respiratory muscles to work harder, thus developing neck stiffness and discomfort.

If overtraining is the issue, it can help take a couple of days to give your body time to rest and recharge. Similarly, it can be invaluable to work directly with a professional to ensure overtraining doesn’t become a long-term issue. Although it’s enticing to continue to train harder, you can usually achieve better results by giving your body more opportunity to recover.

When your neck pain has persisted for longer than a few weeks, it’s time to meet with a professional who can help identify more subtle reasons for the discomfort. If you’re in the Bethesda or Chevy Chase area, our physical therapists can help you get back to living your life pain-free!

3 Critical Questions To Ask Your Physical Therapist on the First Visit

Physical therapy (both in person and virtual physical therapy) is most effective when you are actively involved. While the physical therapist is responsible for identifying issues and developing a plan, the patient should be actively involved by asking questions and providing necessary background information. Here are three important questions to ask your physical therapist to get the most out of your session in Chevy Chase or Bethesda.

1. Why did this happen, and how can we ensure it doesn’t happen again?

Solving the underlying issue and resolving any pain or discomfort is essential when working with a physical therapist. But beyond that, you also want to ensure that the problems don’t resurface. By asking about the root cause of the injury or pain, you’re able to better prevent the problem from becoming a long-term issue.

2. What do I need to be doing at home?

Unfortunately, time with a physical therapist is limited. Outside of a few hours a week, most time is spent away from your PT. When meeting with a physical therapist, it’s vital to clarify any exercises you should or shouldn’t be doing at home. A great physical therapist will make sure you have the tools and exercises needed to take control of your health, both inside and outside of the session.

3. How can you be sure I’ll make progress?

If you decide to work with a physical therapist, the intention should be to progress towards your goal. Oftentimes the healthcare system will establish general objectives, such as reaching a “baseline” or returning to ADLs (active daily activities). Although these standard guidelines are a good starting point, the purpose of physical therapy is to reach your goals, not the goals of the insurance companies! By asking this question directly, you set a clear intention for the results you desire.

Physical therapy works best when there’s an active partnership between you and the PT. The more engaged you are in your health, the more progress you will make. By asking these three essential questions, you’ll set clear intentions for your physical therapy and build a better working relationship as a result.

Why the rates of athletic injuries are on the rise

With the weather warming up, COVID-19 cases decreasing, and spring sports starting up again, many young athletes are looking forward to making their return to sport. While excitement is high to get back out there and compete, it is important to prepare your body correctly to avoid injuries and stay healthy. Proper performance training in the Bethesda and Chevy Chase area can be the difference between a dream season and being forced to watch from the sideline!

After a long layoff from sport, the inherent risk of sustaining an injury is high, as one’s body is not used to performing sport-specific athletic activities. That’s why it is important to take some time before the season starts to get your mind and body ready for healthy peak performance.

Studies show that strength and conditioning training in athletes reduces sports injuries by 33% and overuse injuries by nearly 50%. So, it is important to get started with some simple, comfortable exercises in order to get back into playing shape and stay healthy.

A great way to start preseason training is with individual sport-specific drills with an emphasis on conditioning. From here, the athlete can progress into sport-specific drills with a partner or opponent. Then, go ahead and ramp up the activity into team drills, scrimmaging, and finally, game play. You see this progression in professional and collegiate sports, as activity is gradually increased as the body is able to adapt to the increased culminating stress.

The best way to get a sport-specific program that meets the needs of an individual athlete is to see a professional who can create a program based on his/her unique strengths and weaknesses. So, if you’re looking for optimized programs after a long offseason or injury, look into performance training in Bethesda or Chevy Chase and get that dream season off to the right start!

Cheers to a great new season and be sure to have some fun!

How Stiff Ankles Lead to Back Pain

Those of you that have been to athletic physical therapy have likely learned about how a limitation in one area of the body can contribute to pain or injury elsewhere. It is common to find that runners, fitness enthusiasts, and other active people experiencing chronic lower back pain also have stiff ankles.

Exercises such as squats and lunges are a staple of many workouts and group exercise classes. These movements, in addition to many others, require a great deal of ankle dorsiflexion (the action of the knee moving over the toe). If an individual has stiff ankles and wishes to perform these activities, he or she must compensate and figure out another way to complete the exercise.

People are forced to reach their bottoms farther backwards when stiff ankles prevent their knees from advancing far enough beyond their toes. This pushes belly button forward in an effort to avoid falling backwards. As a result, the lower back arches excessively, compressing the area, and often results in discomfort.

Check out the article below from fellow Northeastern University Alumni, and former Physical Therapist for the Red Sox, Mike Reinold, to learn how you can measure if you have enough ankle dorsiflexion.

Ankle Mobility Exercises to Improve Dorsiflexion

Now that you measured your ankle dorsiflexion, what do you do about it if it?

In addition to some of Mike’s great recommendations, we suggest that you try the activities below from Dr. Cody!

If any of these activities cause pain or result in a pinching sensation in the front of the ankle, please contact us.

Have fun!

Why Your Big Toe Matters

Our poor big toes. They are one of the unsung heroes of our lower extremity and are integral for walking, running, and optimal function during standing activities. We commonly focus portions of treatment within an athletic physical therapy session to big toe function.

The big toe helps with shock absorption and propulsion while often bearing over 50% of our body weight. It provides an essential role in sustaining the arch of the foot, thus setting the stage for optimal function of the rest of the foot.

For these reasons, people that suffer big toe amputations typically experience balance deficiencies and struggle with a variety of upright activities.

The great toe needs approximately 60 degrees of extension for walking, specifically during the terminal phase of gait (push off) when the weight is on the front of the foot and the heel is off the ground.

Even more motion is needed for running and athletic activities like sprinting. We commonly find that our athletic patients have limited great toe mobility which forces the body to compensate, and increases the risk for overuse injuries elsewhere.

A good target for a committed runner or athlete is 90 degrees of great toe extension, which you can test on yourself!

Begin seated with your foot flat and relaxed on the ground. While keeping the balls of your feet on the ground, use your hand to lift your big toe up towards the ceiling. Can it reach 90 degrees and get perpendicular to the ground?

If not, our Director of Education, Dr. Alex Immermann has a fantastic drill to help you! Check it out below!

Big Toe Extension PAILs/RAILs

If this drill created any pain or discomfort, please contact us.