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 a Runny Nose and Your Pain Have in Common

Do you remember the last time that you caught a cold, the flu, or had Covid? If you are like me, you build a mountain of dirty tissues to keep your snot under control. Meanwhile, the little bug causing it runs around your body, creating chaos.

The pain you feel when exercising is a lot like your runny nose. Pain is a symptom of a larger issue and the key to finally fixing it is to correct that root cause.

Unfortunately, I find that most athletic physical therapy treatment for focuses on the symptoms, rather than the reasons the symptoms started in the first place. We wouldn’t blow our nose all day without taking medicine to kill the bug causing it, would we?!

At Cohen Health and Performance, the goal of every patient’s first performance physical therapy appointment at our Bethesda or McLean location is to discover the root cause of their symptoms. Once this has been identified, our physical therapists create a rehabilitation plan that is customized for every person that we see. Every person is different, with different reasons for an injury and different goals. If your physical therapist has a cookie cutter plan that they use for every patient with low back pain, for example, find another physical therapist!

How do you know if your physical therapy plan is a good one?

The end goals of the rehabilitation plan should be YOUR goals, not the goals of the physical therapist. The physical therapist should clearly describe how your plan is going to get you back to the activities that are most important to you, not what the insurance company wants to see.

For example, we help many runners overcome injury. Their first physical therapy appointment includes a running analysis if they are able to do so. Their rehabilitation plan then includes drills that will help them get back running ASAP. Below is an example of an exercise that we may give a runner with knee pain to prepare them for the stress of their training.

It is easy for physical therapy to become focused on outcomes that insurance companies want to see because that is what is required to get paid. This is why we advise our patients to look for a physical therapy clinic that works for their patients, not insurance companies!

3 Easy Exercises for Happy Knees

I can’t stand doing warmups. There I said it. Even though I’m a sports physical therapist both in Bethesda and McLean (yup, we opened our new location in McLean, Virginia!), and I know better, I just want to get into my workout without spending 15 minutes doing boring drills.

If you are anything like me, you want to spend the least amount of time warming up without increasing your risk of injury.

One way to reduce the amount of time that you need to warmup your knees are with home exercises that prepare your knees to handle more stress. Our athletic physical therapy patients (both youth athletes and active adults) see us in Bethesda and McLean for help with knee pain that limits them in the gym and/or out on the field. We commonly recommend that people perform drills that build the capacity of what the knees can handle. This means that the knees will be capable of handling more stress and be ready to go as soon as you walk into the gym.

Check out the videos below where I breakdown 3 drills that you can do at home for happy, healthy, and strong knees!

These are just a few examples of drills that help you with knee pain. If you are serious about finally solving the knee pain that is forcing you to modify your favorite workouts, don’t hesitate and contact us today to schedule an appointment in McLean or Bethesda. The root cause of your knee pain is unique and it is unlikely that the cookie cutter program you found online will do the job. We will show you exactly where your knee pain is coming from and provide a customized performance physical therapy plan to address it!

For Weekend Warriors Wanting to Avoid Knee Surgery

I probably don’t need to tell you this, but the best surgery is the one that is avoided. Disclaimer, as a sports physical therapist, I am a bit biased!

After knee surgery, your knee is not the same. Tissue may have been removed or artificial parts/pieces may have been put in. Regardless of the procedure, the skin was cut open, scar tissue formed, and time is needed time to heal.

This impacts the function of your knee and your ability to run and exercise as you had previously.

Now, I am not saying that surgery should never happen. What I’m saying is that it should be a last resort.

In my 12+ years working as a sports physical therapist, I have learned that people commonly have knee surgeries when there are things they can do to delay or avoid them altogether.

In many situations, the knee cannot handle the stress required of it for sports or your active lifestyle. As physical therapists, we commonly prescribe exercises that train the knee to handle all of that stress. In other instances, the knees are dealing with too much stress because another area isn’t doing its job. A thorough sports physical therapy assessment will determine what these areas are so that a comprehensive plan can be prescribed to fix it.

Whatever the reason is, a sports physical therapy assessment may be the secret sauce to finally solving your knee pain and avoiding the surgery you have been worried about! To schedule that, contact us today!

My Ankle Pops Every Morning

When your knuckles pop, ankle cracks, or hip makes that weird noise, do you wonder “is that bad?” Do I need to see a sports physical therapist or doctor for this?

Well, stop worrying about it because it probably isn’t a big deal if you don’t have any pain when the pop occurs.

I do a funny move as soon as I get out of bed and stand up in the morning. I keep my right heel on the floor and move my knee over my toes until I feel and hear a pop in the back of my heel. It freaks my wife, Deb, out every time.

Cracking or popping in a joint is similar to pressure being released from a soda bottle. Over time pressure builds within a joint and for some people, it feels good to release it. That is the noise you feel and hear.

Now, if there is pain when the pop occurs or that area feels unstable, contact us so that we can determine the root causes of these issues and determine if treatment is needed.

We will determine if your pain is related to arthritis, overuse, or another movement related issue that we can address in physical therapy and you can work on at home.

Below are a series of questions to ask yourself. If you answer yes to any of these, get some help!

1) Is the popping that I feel painful?
2) Has there been a recent injury to this area?
3) Does this area feel stable?
4) Do I have weakness in this area?

You may not even need to come into the office, a phone call may be enough. Check out our home page here and click the “free phone consultation” tab!

Create Your BS Meter

I’m lying on the couch as I got sucked into Instagram and all of their sports physical therapy videos. While scrolling, one exercise video grabbed my attention. This wasn’t because it was good information. It was because it wasn’t and had thousands of likes.

There is so much information out there and anyone with a social media account can have a platform. You have access to the best and the worst information. It is overwhelming!

You need a BS detector so that you aren’t doing bicep curls while standing on a ball, blowing up a balloon (not far off what I saw the other day).

So how do you determine when you should ignore a social media post?

Speaking in absolutes. Most times, the best answer that a professional can give you is “it depends.” Rarely is there a correct answer for every situation. For example, stretching or mobility is often promoted as a “fix” for a given injury. Yet, many people have more important problems to solve. For more information, check out our post, Is Mobility Overrated? It is impossible to know of every possible factor that could be contributing to pain or injury. Even the best among us cannot be 100% certain, especially on social media.

It is too complicated. An expert can take a complex topic and break it down so that it makes sense to you. Complicated medical jargon is a red flag that the presenter does not understand what they are posting.

Promoting personal success stories as evidence. Personal success stories are subjective and ignore the facts and research. Many influencers post personal success stories as evidence for their approach. This ignores all the other factors that may have contributed to the results being promoted (genetics, differences in lifestyle, priority differences, etc.). Quality research requires thousands of trials before it is valid. A case study of 1 or 2 people only applies to those 1 or 2 people!

P.S. If someone is promoting a “quick fix”….run!

Stop Standing Straight

“Stand up straight!”

If your parents were anything like mine, you heard that growing up and when I started my career as a physical therapist, I assumed that I would be telling my patients to do the same.

However, that has not been the case.

As a sports physical therapist here in Bethesda, I find this cue to be detrimental to how the body functions. In fact, correcting the need to stand up straight has been one of the most helpful suggestions during physical therapy sessions and throughout the injury rehabilitation process.

Standing up straight causes you to pull your shoulder blades down and back, which limits the amount of movement available to your shoulder blades. The shoulder blades are meant to elevate and abduct (move apart) as the arm is moving away from the body. Just try to keep your shoulder blades down and back as your reach for something!

The cue to stand up straight also commonly causes people to arch their back and tip their pelvis forward. This position places increased strain on the lower back and pelvis, while limiting the amount of motion that is available at the hips.

Correcting this posture is of particular importance for athletes. Every sport has an amount of movement that is necessary to perform it. Golf requires a large amount of rotation at the hips, serving a tennis ball requires a great deal of shoulder flexion, and sprinting requires lot of hip extension.

“Standing up straight” while performing these activities will limit the movements necessary to perform these activities and can often lead to injuries.

This is not to say that this cue is a bad thing. However, it is important to understand when this cue is helpful and when it is not.

Cues like “standing up straight” may work for drills such as deadlifts, rows, and farmers carries, however it is useful to forget this cue for other activities and when attempting to correct your posture!