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 is blood flow restriction training? Should I try it?

Think of the last time that you injured your arm or leg or needed physical therapy. If you haven’t had an extremity injury, or needed sports physical therapy, congratulations, and I guess you must use your imagination.

You saw your doctor for help, and they told you to rest your injured limb for at least 4 weeks. You have no choice but to relax and allow your injured limb to get small and weak.

This is where blood flow restriction (BFR) training is a helpful part of the physical therapy process. A cuff or strap is placed tightly around a limb to reduce blood flow but not entirely block it. Exercise is then performed in this state.

This allows you to exercise at a lower intensity but enjoy many benefits of high-intensity training, such as muscle growth and improved strength.

While BFR can’t replace regular training, it is an excellent option for people that want to speed up their return from injury or are searching for ways to exercise without beating up their joints.

But restricting blood flow sounds sketchy. Is it safe?

Yes. Research has shown that BFR is safe when used with patients with no contraindications to it. As with all things, it can be unsafe when misused or placed in the wrong hands.

At Cohen Health and Performance, we use BFR both in McLean and Bethesda to limit weakness and muscle atrophy after surgery. Our patients recovering from knee surgery, such as an ACL reconstruction, have seen great results. When more strength is preserved, people have a faster recovery.

But the benefits extend far beyond people recovering from surgery. People struggling with chronic and overuse injuries can use BFR to maintain their strength without interrupting recovery. This helps people to return to the entirety of their active lifestyles much quicker.

Interested in using BFR to speed up your recovery from an injury or help you with your training? Contact us!

The Best Sitting Posture

This is the best sitting posture.

Many physical therapy articles and rehab blogs discuss the importance of sitting posture and how perfect sitting posture is essential to avoid neck and back pain. Here are a few examples of what I found in several articles online.

Sit with your feet flat on the floor. This position helps to distribute your weight evenly and reduces pressure on your lower back.
Support your lower back. If your chair doesn’t provide enough support for your lower back, consider using a lumbar roll or cushion. This can help maintain the natural curve of your spine and prevent low back pain.
Sit up straight. Sitting up straight helps to maintain good posture and reduce strain on your back. Avoid slouching or leaning forward.

While these may be helpful recommendations as part of the physical therapy process, they miss the most important thing.

There is no perfect sitting posture, and the “best” posture is the one that is constantly changing.

When standing, we naturally sway and shift our weight forward and back or from one foot to another. Unfortunately, this goes away as we sit and concentrate on something…like this blog I’m writing!

The longer we concentrate on something, muscular tension increases. This keeps us still and helps us focus better on what is in front of us. Unfortunately, too much muscular tension leads to discomfort.

Does this mean you must get up every 10-15 minutes and move around? In a perfect world, sure, but there may be better solutions if you try to get stuff done.

As I am writing this article, I am fidgeting. My sitting posture is changing, and I am shifting my weight from one side to the other. I sometimes cross one leg under the other and raise or lower my chair.

But one more part of sitting posture may be most impactful.

Give your eyes a break.

Research shows a connection between high levels of focus on a screen and discomfort in the upper body.

Optometrists recommend the 20/20/20 rule to help with this. The 20/20/20 rule states that for every 20 minutes of focus-intensive work, you should take a 20-second break and look 20 feet away.

This helps to reduce your focus on a single point and, as a result, reduces tension in your upper body.

Our bodies typically don’t respond well when we ask them to be still for long periods. A more active approach to sitting helps us avoid the discomfort that may come with it.

If you are interested in learning other strategies that can be used to sit comfortably throughout your day, contact us!

ACL Rehab: Why Most Athletes Still Aren’t Ready For Sport

Imagine this. You had surgery to repair your knee’s ACL (anterior cruciate ligament) 4 months ago and have been going to sports physical therapy ever since. At first, you were on crutches, your knee was swollen, and you could barely bend it. After several weeks of physical therapy, you regained your entire range of motion and learned to walk normally again. You just started running and can’t wait to return to practice or the activities that will make you feel like an athlete again!

But, your physical therapist is discharging you from physical therapy…

This is common because insurance companies don’t consider return-to-sport activities as “medically necessary,” and most traditional physical therapy clinics don’t offer return-to-play programs.

I call this phase of rehab “the gap .”The gap occurs during the time between physical therapy and performance training/personal training.

Most athletes aren’t ready to return to their sport when discharged from physical therapy because they haven’t bridged the gap from rehab to performance.

At this stage, athletes are pain-free, have a full range of motion in their knee, and may even have regained all their strength. But they still need to train their knee to use that strength explosively and tolerate the impact of cutting, jumping, and sprinting.

Unfortunately, many athletes skip this phase of ACL recovery and return to sport before their knee is ready. This increases the risk of re-tearing their surgically repaired ACL or injuring the other knee.

Programs designed to help athletes bridge the gap begin with tests to evaluate how close an athlete is to return to sport. These tests typically consist of hops, agility tests, and movements specific to the athlete’s sport.

The single-leg hop test is the first test we have our athletes perform in our Bridge The Gap ACL program. Research suggests the surgically repaired leg should be at least 90% as strong as the other leg before starting a sport-specific activity. Both sides should be equal before an athlete returns to practice.

Here is an example of a single-leg hop test.

Sports physical therapists use the results of these tests to design a training program that integrates principles from physical therapy, strength and conditioning, and sports performance.

Research suggests that the earliest an athlete can return to play after ACL surgery is 9 months (longer for youth athletes). For that reason, most bridge-the-gap programs are 2-4 months.

Interested in seeing if the our Bridge the Gap ACL Program suits you? If you or your child is recovering from an ACL repair, contact us to learn more!

Cryotherapy, what’s the verdict?

I was at a conference a few months ago with a group of physical therapists and personal trainers, and we were discussing the day’s events over a meal. The conference also had different companies pitch their products and services to the healthcare providers that were in attendance. One of them was a cryotherapy company and their rep recognized us.

He came to our table and gave us his pitch.

“Cryotherapy will help your patients reduce pain, enhance their muscle recovery, decrease inflammation, and improve their overall wellness.”

Have you heard something similar and wondered if Cryo is all they say it is? We have gotten many questions within our physical therapy clinics in Bethesda and McLean with questions related to Cryo.

First let’s talk about what cryotherapy is. The body is exposed to extremely low temperatures for a short period of time, usually a few minutes. There are several forms of cryotherapy, but the most popular is whole-body cryotherapy. This involves standing in a chamber filled with liquid nitrogen vapor for a few minutes that can get as low as -200 or -300 degrees Fahrenheit (yes, you read that correct).

Cryotherapy is a matter of debate in the medical, physical therapy and training community, with some studies showing positive results while others have shown little to no effect.

Proponents of cryotherapy claim that it can help with a variety of conditions, including chronic pain, arthritis, inflammation, and depression. The theory is that the cold temperatures cause the body to release endorphins, which are natural painkillers, and reduce inflammation in the affected area. Some studies have shown that cryotherapy can help to reduce pain and inflammation in people with rheumatoid arthritis, but more research is needed to confirm this.

Claims are also made that it can help with muscle recovery after exercise. The theory is that the cold temperatures cause blood vessels to constrict, reducing blood flow to the affected area. Then, when the body warms back up, blood vessels dilate, which increases blood flow and promotes healing. Some studies have shown that cryotherapy can help with muscle recovery, but others have shown little effect.

So, what is the verdict? Cryo is new and as with all new things, the evidence is limited, early research is mixed, and more is needed. Also, don’t forget that there are risks associated with the super cold temperatures involved with Cryo, such as skin damage and frostbite.

If you are planning on giving Cryo a shot, please talk to your physician and make sure it is safe for you to do so!

3 Tips to Help You Find the Best Shoe

Minimalist shoes, running shoes, cross-training sneakers, weightlifting shoes. As sports physical therapists, personal trainers and performance coaches in McLean and Bethesda, we are asked all sorts of footwear questions. If you are like me, and do several different things, it may seem that you need a special shoe for each activity.

In my closet you can find running, hiking, cross-training, basketball, and special weightlifting shoes. But these days I mostly use 1 pair for all of my training.

I’m more of a generalist now. I dabble in many different things but spend most of my “fitness time” exercising in the gym. Sorry ego, my days of being a specialist are behind me.

If you are training for a particular sport or are a high-level runner, you are a specialist and likely need a special shoe for your sport (and the footwear recommendations in a sports physical therapy setting will be different). But if you are a generalist like me, you need a shoe that is comfortable, designed for your foot type, and can do everything that you need.

Here are 3 things that you should look for to choose the right shoe for you.

It must have a firm and snug heel cup. Your heel sits at the base of the shoe, in a place called the heel cup. The heels cup should fit snugly around your heel and should not be much wider than your heel itself. This prevents your heel from sliding within the shoe, which may negatively impact foot mechanics.
The shoe must have a toe break that bends where you toes bend. Place your shoe on the ground and hold it there. Pull the front of your shoe up from under it. The folding point of the shoe should be located where your toes bend. If your shoe folds at another location, your shoe is not accommodating to the mechanics of your foot and can lead to breakdown within the structure of the foot itself.
You should be able to feel the entirety of both your feet on the ground as you are standing still in your shoes. People are often unable to feel their arches, which results in more stress on the areas that have more contact with the ground.

There are 26 bones and 30 joints within the foot. This results in many ways that our foot can compensate but these 3 tips can help solve these issues.

Would you like help finding the right brand and model shoe for you? Our performance physical therapy team would be happy to provide you with recommendations based on the brands and models that are on the market right now!

CHP Spotlight Interview with Sports Medicine Physician, Dr. Richard Edgar

Why do so many field sport athletes and runners suffer lower body soft tissue injuries, like hamstring strains?

As with all sports, injuries are part of the game and it is impossible to avoid them altogether. But being aware of risk factors can reduce the risk and is an essential component of the physical therapy process. There has been research studying the influence of strength imbalances of opposing muscles. One of the most common comparisons is with the hamstrings and quadriceps, called the hamstring to quadriceps strength ratio.

Research in physical therapy and sports medicine journals suggest that the hamstrings should be at least 60% as strong as the quads, especially among athletes.

Don’t miss my latest interview with Dr. Richard Edgar where we discussed topics like this and so much more! Dr. Edgar is a Primary Care Sports Medicine physician at the Anderson Orthopaedic Clinic. He specializes in non-operative treatment of musculoskeletal injuries and has an extensive sports background himself.

The mission of the CHP Spotlight Interview Series is to share information with you from the greatest experts in the fields of sports medicine, sports physical therapy, personal training, and performance. Now, more than ever, there is a seemingly infinite amount of information available and finding the most credible information is a challenge. The good news is that we are here to help you find the best information related to physical therapy, personal training, and sports medicine from experts surrounding us in Bethesda, Chevy Chase, DC, McLean and Northern Virginia.

If you or someone you love has had a sports related injury, don’t miss this interview!

To learn more about Dr. Edgar, click here and check out our interview below!