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 Stretch Should You Be Doing?

Ten years ago, flexibility and stretching were all the rage, as well as a large component of the standard course of treatment in sports physical therapy. Many people had stretching in their daily routines, either as an athlete being told to stretch before and after practice from a coach, in a yoga studio by an instructor, or by a physical therapist in order to decrease pain. Now, the phrase “mobility” has been posted everywhere. “How to increase hip mobility to help improve your deadlift”, “Stretching Routines for Runners” and “is your ankle mobility plateauing your squat depth?” headlines can be seen from instagram and tiktok to google ads. But what is the difference between the two? Are they the same thing? What happened to the importance of stretching?

For starters, stretching or flexibility is the ability for a person to get into a position passively keeping one joint in mind. So if you want to bend down, are your hamstrings flexible and stretched out enough for you to touch your toes? To improve your flexibility, you stretch or lengthen your muscles to be able to achieve a goal.

On the other hand, mobility is the amount of active movement you have to reach a goal. For example with the “is your ankle mobility plateauing your squat depth” headline, can your ankle move enough and allow you to achieve a lower squat at your knees and your hips? To improve mobility, you typically need to target the joint itself, rather than the muscle tightness limiting a movement in stretching, in order to create more space for the bones to move on each other.

So how do you know if you cannot touch your toes due to muscle limitations, like in flexibility restrictions, or due to mobility issues? Like most questions in the physical therapy world, the answer is it depends. Physical therapists have a series of tests that can determine if the joint is unable to achieve a desired position due to muscle stiffness, joint tightness or an inability to control the motion that the body already has.

Below is an assessment and exercise that we use for many of our patients experiencing back pain. This helps us to determine the movement capabilities of the spine, including where it may be moving too much and/or not enough.

Once you figure out where your limitations are coming from, it is time to determine if you need to improve them. While these are hard questions to answer in a blog post, this is something that a physical therapist can help you distinguish by using various tests.

If this sounds like something you are interested in learning more about, contact us to receive a customized exercise program to improve either your flexibility or mobility (or both!).

Athletes Need Strong Breaks Before They Can Hit The Gas

Athletes must have great breaks before they are able to hit the gas. When they don’t, that is when they find themselves in a sports physical therapy setting.

If you are an athlete that wants to jump higher, run faster, and be more explosive, you must first know how to slow down. In fact, this is one of the first things that we work on with athletes during physical therapy and performance training.

Athletes that struggle to absorb the impact of their bodies during explosive movements have a far greater risk of lower body injury. This can be seen when landing from a jump or cutting to change direction as the foot contacts the ground.

A recent example occurred in the most recent Super Bowl. In the 2^nd half Odell Beckham Jr. tore his left ACL when he landed on his left leg as he slowed down to make a catch. While doing so his upper body was turned to the right creating a twisting motion at his knee as he attempted to slow down. He was unable to control the rapid breaking and twisting forces occurring at his knee, resulting in a large amount of stress to the ACL and the subsequent rupture of the ligament.

While none of us are athletes like Odell, we must all be capable of controlling the breaking forces that we experience when exercising, running, or playing recreational sports. The more aggressive and competitive the sport, the more force you must be capable of controlling.

This is especially true for youth athletes.

They play very competitive sports and are growing at the same time. Their soft tissues are adjusting to the changes occurring in their bodies and they have yet to develop all their athletic capabilities. These are just a few of the contributing reasons why lower body injuries like ACL tears are so prevalent in youth sports.

Below are 2 of the first drills that I teach to athletes when they are in physical therapy recovering from or seeking to prevent lower body sport-related injuries during personal training or performance training sessions.

Once you master these seemingly simple drills, you can step things up in a variety of fun ways!

Give these 2 drills a shot and let us know if you have any questions.

How to Train for Your First Race

Training for your first running race can be difficult – where do you start? What program do you follow? How long should you train for? What even is “training”? These are questions that we constantly ask as sports physical therapists and strength and conditioning professionals.

Training means conditioning your body to adequately manage the future demands you want to place on it. This typically includes gradually increasing your volume or intensity of physical exercise over time in order to perform your best, prevent injuries, and avoid needing a sports physical therapy clinic like us!

There are a million different answers and a million different resources on the Internet you can utilize, which can be overwhelming. Whether it’s a 5K, marathon, triathlon, or Iron Man, here’s a few tips you can follow to streamline your training process:

Establish your goals: Are you aiming just to finish the race? Or do you have a goal time in mind? This can help you determine your pace and intensity of training sessions.
Identify your starting point: AKA have you already done any conditioning for this activity? (ex: recreational running/biking/swimming) If you are starting from square 1, you will want to begin training earlier than someone who has been consistently exercising.
Utilize cross training: This can include an alternative form of cardio (swimming, biking, running, HIIT training) and strength training! Different forms of exercise will strain different tissues, and is important for preventing injuries.
Taper before your race: Give your body time to recharge 1-2 weeks before race day – you shouldn’t be at your heaviest volume the week before.
Follow a Program: Depending on when your race is, there are several great running programs you can find online that fit your own time frame. Running Training Plans. Nike.com has great running programs to download!

If you have any questions about the above, the sports physical therapists and performance training specialists are always here to help at Cohen Health and Performance. While the points listed above are a great starting point for getting into a running routine, we can help with insight into calculating correct mileage for risk reduction, strengthening your muscles to complement your training schedule, and helping you train along the way to your race!

Don’t Trust Your Pain

We have all experienced physical pain (in fact, my own history of low back pain is what interested me in sports physical therapy).

Maybe you injured your back lifting weights. Perhaps you hurt you shoulder playing catch with your kids. You may have irritated your knee when training for a marathon.

You decide to see your doctor, physical therapist, or medical provider of choice. They then prescribe the recommended treatment or “plan of care.”

Throughout the course of treatment, you determine if you are getting better by monitoring your pain. Is it decreasing? Is it staying the same or getting worse? If your pain is improving, the treatment is working. If not, it is failing. Pretty straight forward.

That is the way that standard physical therapy views treatment but is short sighted.

Modifying your daily activities or exercise routines will help pain quickly improve in the short term but the root causes of the pain remain. This is when many people stop going to physical therapy or performing their home exercise routine.

This pain-free period of time provides the body with an opportunity to address the root causes of pain. This is essential if you wish to prevent it from returning in the future while returning to full activity.

Pain is a prediction made by the brain. When pain continuously occurs during a movement or activity, the body learns to expect it. This expectation must lessen for pain to ultimately disappear during aggravating activities. If you really want to nerd out on pain science, check out this article by my friend and fellow physical therapist, Zac Cupples.

Imagine that you have lower back pain every time that you attempt to lift something off the floor such as deadlifting a barbell in the gym or emptying dishes out of the dishwasher.

The brain has an expectation that this bent over position will hurt. Therefore, similar positions must be experienced without pain. Does this mean that you should start deadlifting on day 1 of treatment. Absolutely not. The best solution is to start with something less threatening and build from there. Below is an example of a great activity that physical therapy patients with low back pain start with.

The brain will then determine that these positions are not threatening, ultimately reducing risk of pain in the future while facilitating a full return to active life.

If you are an active adult ready to solve chronic pain for good, contact us to receive a customized home exercise program today!

What a Foot and Ankle Surgeon Recommends For Youth Athletes

I recently had the pleasure of interviewing Dr. Thomas Sanders for the latest edition of the CHP Spotlight Interview Series. The mission of the CHP Spotlight Interview Series is to share information with you from the greatest experts in the fields of sports medicine, physical therapy, fitness 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, training, and sports medicine from experts surrounding us in Bethesda, DC, McLean and Northern Virginia.

If you or your child has suffered a foot/ankle ankle, don’t miss this interview! Dr. Sanders explains what you should do if you have experienced a foot/ankle injury and what risk factors your child can address right now to lower their risk of injury. He goes on to share when surgery may be appropriate and when conservative options like physical therapy are a better choice. He even shares his experiences as an athlete, playing rugby, and how that lead him to specialize in helping injured athletes!

Dr. Thomas Sanders, MD, is an orthopedic foot and ankle specialist at the Centers for Advanced Orthopedics in Northern Virginia and Chief of Foot and Ankle surgery for the INOVA Health system. Dr. Sanders specializes in the treatment of ankle arthritis, lower extremity trauma, and fractures of the ankle and foot. He also helps patients in the Washington, DC, area with post-traumatic reconstruction, midfoot and forefoot arthritis, flatfoot reconstruction, and bunions/hammertoes.

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

2 Drills to Improve Your Running Times

If you are a dedicated runner you likely have suffered an injury and maybe even gone to physical therapy. Whether you realized it or not, this injury limited your ability to train effectively.

Here in Bethesda (and soon to be, McLean!), physical therapy involves helping runners overcome injuries that otherwise would limit their ability to train, ultimately causing disappointing results.

There is not a one size fits all solution to helping runners. However, we often discover that runners are limited by the mobility of their hamstrings.

During a run, the hamstrings need the ability to lengthen as the thigh is in front of the body. This should be achieved without drastically changing the position of the pelvis. Many runners struggle to maintain control of their pelvis as the hamstring lengthens. This increases the stress placed onto a variety of soft tissues through the lower body and alters foot strike position.

Hamstrings, like many other muscles, must be strong when in lengthened positions. Otherwise the body will not allow you to keep any of the short-term flexibility improvements that you have made with stretching.

Below are 2 drills that you can incorporate into your strength training routine to improve hamstring strength and flexibility that the body will hold on to!

Kickstand RDL
Single Leg Eccentric Glute Bridge

A thoughtful and more scientific approach to training that is specifically designed for runners is likely all you need to drastically improve your running performance. It may not even require you to train any harder, just smarter!