Recently I went for my yearly physical with my Primary Care Physician. My PCP is a great guy and we get along very well. However, on my most recent visit he spent about 5 minutes with me, simply glossing over test results to make a determination about my health status. His evaluation was simply based on a sheet of paper rather than an interaction with the person sitting in front of him. This often leads to prescription of medication, rather than a discussion about lifestyle changes or a root cause that may have led to an abnormal test result.

Unfortunately this is often the case in the health care field. Symptoms are often simply addressed as they come along. The body is not appreciated in its entirety, as health care providers are simply too busy to take a comprehensive look into things. This does not only occur with medical doctors as this happens just as frequently in other fields, including Physical Therapy (Gasp!).

Now, please do not interpret this as a rant against other health care practitioners. They are often left with no choice. The health insurance industry consistently limits reimbursement to health care providers which limits the amount of time and quality of care they can provide to each individual patient. For these reasons, visits often become very “cookie cutter.”

If you go to Physical Therapy because of lower back pain then you get put on the lower back pain protocol, shoulder pain=shoulder protocol, etc.

This may work for some people however does not for those looking to live an active, pain free and healthy life.

Every health care practitioner should treat each patient as an individual. The underlying cause of shoulder pain is almost always completely different from one person to the next. These underlying causes must be addressed for a patient to get out of pain, back to doing what they love and prevent it from becoming a chronic issue.

For this reason I now seek out practitioners that are out of network with health insurance. This will enable them to provide me with the highest quality of care possible and treat me as an individual.

As a Physical Therapist, husband and active person, my health is paramount and the most important thing that I can invest in. Without one’s health, everything else is impossible to enjoy. This approach would create a society that is much more active, less dependent on medication and healthier as a whole.

For this reason we are also out of network providers here at Cohen Health and Performance. We strive to provide the highest quality of care possible as this enables us to get our patients better, faster.

We take this very seriously as the health and happiness of our patients is paramount. We work to ensure that our patients function at the highest level possible and can return to doing what they love, even when they have been unsuccessful in Physical Therapy or care somewhere else.

If I sound passionate about this, it is because I am. People have the ability to become pain free and free from limitations within their life. Our mission at CHP will always be to take care of our patients the best we possibly can which is something everyone should seek from all of their health care providers.

Genetics play a large role in the person that you become. DNA is a large molecule, shaped like a double helix and contains all of the genetic coding that shapes who we are and who we become. This coding is inherited from our parents and the generations prior to them.

Therefore it would seem that in many cases our destiny is predetermined and there is nothing that we can do to avoid many of the ailments that we endure.

Our genetics do play a large role and predispose us to certain ailments, such as having a “bad back” or bunions. However we are not a slave to our genetics and there is a great deal that can be done to avoid things that we are at a high risk for.

Our genetic coding can be turned on or off in response to our life experiences. You may be predisposed to having a bunion on your big toe, however you can learn to avoid placing excessive strain onto the inside of your big toe by wearing proper fitting shoes and walking optimally (a great physical therapy clinic can help you with that!). You will still have a genetic predisposition to having a bunion however now will not develop one.

Osteoblasts are the cells that make bone and are stimulated by stress and pressure. Proper footwear and optimal walking mechanics will lessen the strain on the big toe, decrease stimulation of the osteoblasts, and avoid the development of a bunion.

It is essential to understand that we are not helpless to our genetics. We must be aware of our genetic predispositions so that we can learn how to avoid turning this coding on.

For more information regarding this subject check out the book above or contact info@cohenhealth.com.

It is a fascinating read for nerds like me!

Are Custom Orthotics Right For You?

Custom orthotics are often necessary to achieve proper foot function and movement as part an optimal sports physical therapy plan of care. Poor foot mechanics result in increased stress to the foot, ankle, knee, hips and lower back. For some, optimal footwear can do the trick, however many others require further assistance.

Many people have extremely flat feet, often categorized as pronated or pes planus. In these cases, there is minimal presence of or an absence of the medial longitudinal arch of the foot. The medial aspect of the foot has collapsed to the floor resulting in an unstable foot/ankle complex. This will often result in excessive internal rotation of the tibia above the ankle which places increased stress onto the knee. The body will then be forced to compensate above the tibia in response to what is happening below. This will place further stress onto the knee, hips or lower back (just to name a few).

Other people are the opposite extreme and are have incredibly high arches. I recently had a patient that was very proud of her “dancer’s feet.” However, these can present their own set of problems.

A very high arch (a supinate foot or pes cavus) is extremely stable and stiff, therefore there is very little pronation and shock absorption that occurs. This results in increased stress placed onto the feet, ankles, knees, hips and lower back when impacting the ground during walking, running or jumping. Furthermore, a high arch displaces the body weight laterally to the outside of the feet as the medial aspect of the foot is largely lifted off of the ground. This places further strain on soft tissue structures and increases the risk for a number of injuries including lateral ankle sprains.

These are just two commonly occurring issues however there are a number of foot dysfunctions that necessitate the use of an orthotic.

If you are unsure as to whether or not you need custom orthotics contact info@cohenhealth.com to find out.

There are plenty of crazy people who love to exercise outdoors in the cold weather. You may even be one of them!

There is nothing wrong with this. In fact exercising in the cold even has some health benefits.

However soft tissue injuries are more likely to occur when exercising in the cold. Muscles and tendons are less elastic and more likely to strain from the rapid lengthening and shortening that occurs during exercise.

The first lady of CHP learned this lesson the hard way. Debbie thought that she could perform a very abbreviated warmup before partaking in a sprinting workout. However when initially accelerating for her first sprint she strained both of her quads.

How could this happen? She is married to a brilliant clinician (take a guess at who is writing this post?) after all!

Sprinting causes rapid lengthening and shortening of the quadricep muscles during the drive (pushing) and recovery (flexion) phase of the running cycle. Debbie’s muscles were still cold and unprepared for this rapid change in length resulting in a strain.

What could she have done differently?

Debbie was already doing a great job of incorporating functional movements into her warmup that replicate the running pattern. She performed a series of lunges, single leg squats and light jogging.

However, she was still cold as the temperature was below freezing.

She needed to add more repetitions of movement, a larger variety of movement and/or a greater volume of movement. Even more light jogging would suffice.

The goal is always to have a light sweat before the meat of the workout begins. The forehead should be glistening (this works for bald guys like me).

Warming up is much more important as the weather becomes colder and is a mistake that even the best of us can make!

-Dr. Zachary Cohen PT, DPT, CSCS

Now is often the time that many people are feeling guilty from indulging over Thanksgiving and the days of leftovers that follow. I have felt this way and understand that it may be tempting to repeatedly kick your butt in the gym to pay for all of the stuffing and pumpkin pie you ate.

However, could the time spent eating and relaxing with family actually have provided something good for you?!

Yes! Now, I’m not saying that stuffing your face with loads of holiday goodness is healthy, however some time away from the daily grind can be just what the Doctor ordered.

The Washington, DC area is an amazing place that is filled with incredibly driven, hard working people. They work long hours, often sleep too little, and deal with a hectic metro system or the crazy DC traffic. On top of all that, they attempt to kick their butt in the gym.

Does this sound at all like you?

If so, you likely gained a great deal from the time away over Thanksgiving.

The reason is simple. The body functions best in a position of balance. When the body starts from a place of neutrality it can easily adjust to demands placed upon it. It can ramp things up to meet a challenge, such as getting through a tough workout, or ramp things down to digest a big meal (you may have recently experienced this). However, the body becomes imbalanced if you are consistently stressing it without slowing things down.

As the day to day stress accumulates from a lack of sleep, long hours at the office and other stressors, the body becomes less able to ramp it up as the body is already there. This is similar to driving a car close to the engine’s maximum capacity and then ask it to drive harder.

Eventually the body becomes fatigued, workouts become a struggle and you find yourself making a few extra runs to Starbucks just to get through the day.

In this case, Thanksgiving allowed the body to relax, recover and slow the engine down a bit.

The only problem is that you can’t have an extended holiday every month to recover. However, you can learn to implement methods into you daily life that allows the body to recover from your daily stressors. This allows you to be more productive at work and in the gym when you need to turn things up, and even allow you to sleep better when you need to wind it down. A more balanced body can better adjust to what is asked of it.

Some methods worth exploring include meditation, journaling, a relaxing walk, or even some time alone practicing relaxed breathing in a dark room without a cell phone, computer, tv, etc. Yes, we all need more time away from our technology!

Implementing methods such as these are an easy way to get the body back closer to normal. This will have a profound effect on your energy levels, mood and productivity.

Now, I must mention that constant stress can lead to physical pain. In this case help from a physical therapist or another health care provider may be warranted. To determine if this is necessary for you, feel free to contact me at the e-mail address or phone number below.

Balance is an incredibly powerful thing and something we have control over. We simply need to recognize the stressors we all have in our lives and implement methods to balance them when needed.

For more information regarding this please feel free to contact me at zacharyc@cohenhealth.com or (240-686-5609).

Dr. Zachary Cohen PT, DPT, CSCS

Months ago, my wife was watching television as I overheard a talk show conversation discussing the definition of beauty. They concluded that it was symmetry. The more symmetrical a person’s face was, the more attractive it was considered. This belief can be extended further into other areas. In bodybuilding, a criteria that the competitors are judged upon is the symmetry of the body.

However, what if I told you that none of us are symmetrical?

Does this mean that the talk show hosts were wrong or that the bodybuilding industry needs to totally change their judging criteria? No, well maybe. However this is essential to understand so that we can fully appreciate the human body.

We have a liver on our right side, heart on our left side, 2 lobes in our left lung, 3 in our right lung and a brain that processes information more effectively in the left hemisphere (which controls the right side of the body). These side to side differences, just to name a few, greatly influence the body’s patterns of movement.

These asymmetries result in people often shifting to the right and compensating to get left during walking and other activity. Take a look around and you will notice that the majority of people have a right shoulder that is lower then the left.

When the body is functioning optimally, we manage these asymmetries and can go to both sides well. However for a variety of different reasons we can stuck oriented to the right.

One way to manage this imbalance is to ensure that you can properly feel your left side. This is especially important as we are sitting at our desks working for extended periods. When you are sitting, can you feel your left sit bone? Is your left foot centered on the floor?

If not, go ahead and find these areas.

In standing it is common to roll onto the outside of the feet, specifically on the right as we shift towards that side. If you sense this occurring attempt to find and feel the right arch of your foot without your knee collapsing inward.

As you attempt to correct this, are you noticing that your back is over-extending? Perhaps your right hip is hiked up too much which is further driving you into the right side. These are things that can be corrected, just to name a few!

Our asymmetries predispose us to many common issues and areas of stress or strain. A high quality physical therapist or health care practitioner must understand this to provide the highest level of care possible. This is essential to get people out of pain and functioning at a very high level.

Furthermore, the next time a tv host talks about symmetry, you can understand that is impossible!