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.

Should Your Knees Really Go Over Your Toes?

“Your knees shouldn’t go over your toes.”

You’ve probably heard this advice before, especially when it comes to squats, lunges, and split squats.

It’s been repeated so often that it can start to sound like a rule. But the reality is a little more complicated.

Your knees naturally move forward over your toes when you walk, go up stairs, step off a curb, run, jump, and change direction.

So instead of asking, “Should my knees go over my toes?”, a better question is:

“Can my knees tolerate the stress I’m asking them to handle?”

This distinction matters when we’re talking about knee pain, rehabilitation, and performance.

Your Knees Are Designed to Move

Think about how you move throughout a normal day.

When you walk down the stairs, your knee moves forward.

When you step off a curb, your knee moves forward.

When you jump and land, your knee moves forward.

These movements aren’t inherently bad for your knees. In fact, they’re necessary for many of the things we ask our bodies to do.

The problem is that if a knee is irritated or hasn’t been exposed to a particular type of stress for a while, suddenly asking it to handle a large amount of that stress may cause symptoms.

That doesn’t mean the movement itself is bad.

It may simply mean your knee needs time to build its capacity.

Knee Pain Doesn’t Mean You Should Avoid Movement

This is an important distinction when treating knee pain.

If a particular movement hurts, it’s understandable to want to avoid it completely. Sometimes modifying that movement is exactly what you need in the short term.

But avoiding a movement forever isn’t necessarily the solution.

Instead, we want to understand why the movement is causing a problem and determine what your knee can currently tolerate.

From there, we can gradually increase the demand.

That’s how we build tolerance.

How We Can Progress Knee Loading

One of the exercises we commonly use to demonstrate this concept is the split squat.

A traditional split squat allows the front knee to move forward over the toes.

For someone with a sensitive knee, we may start by limiting how far the knee travels forward or shifting a little more of the weight toward the back leg.

That’s okay.

We’re simply finding an appropriate starting point.

As the knee becomes more tolerant, we can gradually allow more forward movement.

That increased range of motion becomes part of the progression.

We’re not necessarily adding more weight or more repetitions. We’re changing the demand placed on the knee.

Over time, the goal is for the knee to become comfortable handling positions and loads that previously caused problems.

Your Sport Determines What Your Knee Needs to Handle

Not everyone needs the same level of knee capacity.

Consider a basketball player.

Basketball involves frequent jumping, landing, sprinting, and cutting. Those movements can require significant knee flexion and forward movement, particularly when performing them on one leg.

If an athlete wants to return to basketball, their rehabilitation should eventually prepare them for those demands.

It’s not enough to simply make the knee feel better during basic exercises.

We need to build the capacity required for the activity they actually want to return to.

The same principle applies whether you’re an athlete, someone who enjoys lifting weights, or simply someone who wants to move comfortably throughout everyday life.

Stop Thinking of Movements as Simply “Good” or “Bad”

One of the biggest problems with fitness advice is that movements often get labeled as either good or bad.

But your body doesn’t work that way.

A movement that bothers one person may be completely appropriate for someone else.

The amount of stress your knee can tolerate depends on several factors, including your current strength, training history, injury history, activity level, and goals.

That’s why rehabilitation needs to be individualized.

Instead of avoiding a movement because you’ve been told it’s “bad,” we should ask whether your body is currently prepared to handle it.

If it isn’t, we can work on building that capacity.

Physical Therapy for Knee Pain in McLean and Bethesda

If you’re dealing with knee pain, have a history of knee issues, or want to improve your knee capacity, the goal shouldn’t simply be to avoid movements that cause discomfort.

At Cohen Health & Performance, we look at the bigger picture to understand what’s contributing to your symptoms and what your knee needs to be able to handle.

Our approach to physical therapy for knee pain in McLean and physical therapy for knee pain in Bethesda focuses on individualized rehabilitation and progressive loading based on your goals.

Whether you’re trying to return to a sport, get back to training, or simply move without worrying about your knees, we want to help you build the capacity to do the things that matter to you.

Your knees aren’t meant to avoid stress.

They’re meant to adapt to it.

Why a Well-Rounded Training Program Can Make You Better at What You Love

If you love lifting weights, it can be easy to spend most of your training time in the weight room.

If you love running, you might naturally gravitate toward running more often.

There is nothing wrong with having something you enjoy and want to be good at. In fact, having a type of exercise that you genuinely enjoy can make it much easier to stay consistent.

But as adults, there is a lot of value in being a little more well-rounded.

Recently, I found myself putting this into practice while preparing for a HYROX competition.

I’ll be honest. HYROX wasn’t exactly something I volunteered for. But as I started training for it, I realized it was filling an important gap in my normal routine.

I love lifting.

Strength training is a huge part of my training, and maintaining muscle mass and strength becomes increasingly important as we get older. Strength training can also support bone health, physical function, and our ability to stay active.

But that doesn’t mean cardiovascular fitness should take a back seat.

Your Cardiovascular Fitness Can Support Your Strength Training

It might seem like strength training and cardiovascular training are completely separate.

They’re not.

Think about what happens during a typical workout.

You finish a set, rest, and then get ready for the next one. Your body needs to recover between those efforts.

Having a well-developed cardiovascular system can help you recover between sets, exercises, and workouts.

Your cardiovascular system also plays an important role in how your body delivers oxygen and nutrients and produces energy during exercise.

That means improving your cardiovascular fitness can complement your strength training, even if getting stronger or building muscle is your primary goal.

You don’t have to become a distance runner to get those benefits.

Adding some cardiovascular work to your routine can be enough to fill a gap that may otherwise be overlooked.

The Same Principle Works for Runners

The relationship works both ways.

If you’re someone who loves running, adding strength training can help you build the strength and muscle needed to support your activity.

Running places repeated demands on your body. Having adequate strength and capacity can help you better tolerate those demands and continue doing the activities you enjoy.

Again, the goal isn’t to turn every runner into a powerlifter.

It’s about developing the physical qualities that support your primary activity.

You Don’t Have to Specialize in Everything

When we’re younger, many athletes specialize in a particular sport.

A football player trains for the specific demands of football.

A swimmer trains for swimming.

A basketball player spends a significant amount of time developing the qualities needed for basketball.

That level of specialization makes sense when performance in a specific sport is the primary goal.

As adults, our goals often change.

Maybe you still play a sport recreationally. Maybe you lift because you enjoy it. Maybe you run because it helps you stay active.

You may not need to specialize to the same degree.

Instead, building a broader base of fitness can help you stay healthy, capable, and active for the long term.

That might include:

Strength training
Cardiovascular training
Mobility work
Power and speed
Balance and coordination

The exact combination will depend on you and what you want to be able to do.

Your Weakest Link Can Limit Your Strongest One

One of the biggest takeaways from this is that the qualities you neglect can eventually become the things that limit your performance.

If you love lifting but have poor cardiovascular fitness, you may find yourself struggling to recover between sets or workouts.

If you love running but don’t spend much time developing strength, you may be missing an opportunity to improve your overall physical capacity.

Adding something outside your normal routine doesn’t necessarily take away from the activity you love.

It may actually help you do it better.

Training Should Support Your Goals

The best training program isn’t necessarily the one that focuses exclusively on your favorite type of exercise.

Sometimes, it’s the program that fills in the gaps.

For example, if your primary goal is building strength, you may benefit from strategically adding cardiovascular training.

If running is your priority, incorporating strength training may help you build the capacity needed to continue running.

The key is finding the right balance.

You don’t need to completely change your routine. A few well-planned additions can make a meaningful difference.

Sports Physical Therapy in McLean and Bethesda

At Cohen Health & Performance, we work with athletes and active adults who want to do more than simply recover from an injury. We want to help people build the physical capacity they need to continue doing the activities they enjoy.

That may mean returning to a sport after an injury, improving strength and conditioning, or figuring out how different types of training can work together.

If you’re looking for sports physical therapy in McLean or sports physical therapy in Bethesda, our team can help you understand where your training may have gaps and create a plan around your goals.

Your training should support the activities that matter most to you, not limit them.

Sometimes, becoming better at what you love means getting a little better at something else, too.

Are You Really Ready to Return to Your Sport? Why Loading Matters in Knee Rehabilitation

Getting back to your sport isn’t just about feeling better.

It’s about making sure your body is ready to handle what your sport is actually going to demand from you.

This is especially important when you’re recovering from a knee injury. Whether you’re dealing with chronic knee pain, recovering from an ACL injury, or working your way back after surgery, getting out of pain is only one part of the process.

The next question is: Can your knee handle the demands you’re asking it to handle?

At Cohen Health & Performance, this is a big part of how we approach rehabilitation. We don’t want to simply get an athlete to a baseline level of strength and send them on their way. We want to prepare their body for what comes next.

And one of the biggest pieces of that process is loading.

Your Body Needs Stress to Adapt

When you’re dealing with an injury, it can be tempting to protect the area as much as possible.

That makes sense early in the recovery process. If a tissue is irritated or you’ve recently had surgery, we need to respect the healing process and gradually reintroduce movement and load.

But staying too cautious for too long can create another problem.

Your body needs an appropriate amount of stress to adapt.

Think about strength training. If you want to get stronger, you need to give your muscles a stimulus that challenges them enough to create an adaptation.

Rehabilitation works in a similar way.

As your recovery progresses, we need to gradually expose your knee and the surrounding tissues to more of the forces they’ll eventually have to handle.

The key is finding the right amount at the right time.

Getting Stronger Is Important, But It Isn’t the Finish Line

Let’s say you’re recovering from an ACL injury.

Getting your strength back is a major milestone.

But imagine you’re a basketball player.

Being able to perform a controlled squat or leg press is one thing. Being able to jump, land, cut, sprint, and repeat those movements throughout a game is another.

That’s why we can’t stop rehabilitation once an athlete reaches a basic strength benchmark.

We need to continue progressing.

Can you jump?

Can you land?

Can you accelerate?

Can you decelerate?

Can you change direction?

More importantly, can you do all of those things repeatedly without your knee breaking down?

That’s what sport requires.

Intensity Matters

When we talk about loading, we’re not just talking about how much weight you’re lifting.

Intensity matters.

For example, someone recovering from a knee injury may start with exercises like sit-to-stands, bodyweight squats, or goblet squats.

Those exercises can be extremely useful during the right stage of rehabilitation.

But eventually, the body may need a greater stimulus.

That could mean progressing to heavier resistance, using a barbell, changing the tempo of an exercise, or increasing the amount of time a tissue spends under tension.

The exact progression depends on the individual and where they are in their recovery.

The goal isn’t simply to make an exercise harder.

The goal is to provide enough stimulus for the body to adapt to the demands that are coming next.

Your Knee Needs to Handle Volume Too

There’s another part of loading that often gets overlooked: volume.

Imagine you’re a basketball player who can perform one high-quality jump without pain.

That’s a great start.

But a basketball game doesn’t ask you to jump once.

You may jump repeatedly throughout a game, then practice the next day, then play another game later in the week.

Your body needs to be prepared for that workload.

So rehabilitation needs to consider not just whether you can perform a movement, but how often you can perform it and how well you tolerate that volume over time.

This is particularly important when returning to a full sports schedule.

Preparing Tendons for the Demands of Sport

Tendons also need to adapt to the demands placed on them.

For example, athletes recovering from ACL reconstruction can sometimes develop issues involving the patellar tendon or quadriceps tendon.

If the goal is to return to high-level sport, we need to gradually build the loading capacity of those tissues before the athlete is suddenly exposed to the much higher demands of competition.

That might involve progressively heavier strength exercises, changes in tempo, plyometrics, running, jumping, and other movements depending on the athlete’s sport and stage of recovery.

The process should be gradual and intentional.

The Goal Isn’t to Load as Much as Possible

More isn’t always better.

There is a window where the amount of stress is enough to stimulate adaptation without exceeding what the body can currently tolerate.

That’s where the skill of rehabilitation comes in.

Too little loading may not provide enough stimulus for the body to adapt.

Too much loading may cause symptoms to flare up or potentially set the athlete back.

The goal is to find the right amount of stress for that individual at that specific point in their recovery.

And that amount will change as the athlete gets stronger and more capable.

Physical Therapy for Knee Pain in Bethesda and McLean

If you’re dealing with knee pain, recovering from an ACL injury, or trying to return to your sport after surgery, rehabilitation should be about more than simply getting out of pain.

At Cohen Health & Performance, we look at the bigger picture. We consider your current capabilities, your injury history, your sport, and the demands you’ll need to handle when you return.

If you’re looking for physical therapy for knee pain in McLean or physical therapy for knee pain in Bethesda, our team provides individualized rehabilitation designed around your specific goals.

Whether you’re an athlete returning to competition or an active adult who simply wants to move without limitations, we’ll help you progressively build the strength, capacity, and confidence you need.

The goal isn’t just to get you feeling better.

It’s to make sure you’re ready for what comes next.

Shoulder Pain? Here’s Why the Right Diagnosis Matters More Than the Right Exercise

Shoulder pain is frustrating.

It can make lifting uncomfortable, limit your workouts, and even affect simple daily activities.

Recently, I found myself dealing with a shoulder issue of my own.

It wasn’t severe enough to stop me from training, but it was nagging enough that I knew I needed to figure out what was going on before it became a bigger problem.

So I did what we encourage our patients to do every day.

I had another physical therapist evaluate it.

As physical therapists, we’re trained to assess movement and diagnose injuries. But it’s surprisingly difficult to evaluate yourself objectively. Having someone else take a step back, perform the right tests, and look at the full picture makes a huge difference.

In my case, we identified that one of my rotator cuff muscles, the supraspinatus, was irritated.

That diagnosis changed everything.

The Best Exercise Depends on What’s Actually Causing Your Pain

If you’ve ever searched for shoulder pain exercises online, you’ve probably found hundreds of videos and programs promising quick relief.

Some are well intentioned.

Some are based on good research.

The problem is that none of them know why your shoulder hurts.

Two people can both have shoulder pain but need completely different treatment plans.

One person may have irritation in a rotator cuff tendon.

Another may have limited shoulder mobility.

Someone else may have weakness that’s affecting how their shoulder moves.

The symptoms can feel similar, but the underlying problem is very different.

That’s why trying random exercises often leads to frustration.

Before choosing the right treatment, you need the right diagnosis.

Your History Matters

The shoulder doesn’t exist in isolation.

When we evaluate someone, we don’t just look at the painful area.

We want to understand how the symptoms developed.

Previous injuries.

Training volume.

Exercise selection.

Work demands.

Movement habits.

All of those factors help explain why pain developed in the first place.

For me, years of football, my current training routine, and the specific demands I place on my shoulder all influenced the plan we created.

That’s why rehabilitation should never be copied from someone else.

It should be built around you.

Teaching the Shoulder to Work Together Again

Pain doesn’t just affect one muscle.

It can change how the entire shoulder functions.

One of the first goals in my rehabilitation was improving how my rotator cuff muscles worked together to stabilize the shoulder.

We started with simple weight-bearing exercises that encouraged the shoulder muscles to coordinate and create a stable base before progressing to more demanding movements.

As the shoulder became more tolerant of load, we gradually introduced exercises that specifically challenged the irritated tissue.

The progression mattered just as much as the exercise itself.

Loading an irritated muscle too early can increase symptoms.

Waiting too long can delay recovery.

Finding the right balance is one of the most important parts of rehabilitation.

There Isn’t One Perfect Shoulder Exercise

People often ask what the best exercise is for shoulder pain.

The answer depends on the person.

The same exercise that helps one individual could make someone else’s symptoms worse.

That’s why rehabilitation isn’t about collecting exercises.

It’s about understanding when to use them, how much load to apply, and how to progress them over time.

Those decisions should always be based on a thorough evaluation.

Sports Physical Therapy in Bethesda and McLean

Whether you’re dealing with shoulder pain from lifting, throwing, tennis, pickleball, CrossFit, or another activity, getting the right diagnosis is the first step toward recovery.

At Cohen Health & Performance, we take the time to understand not just where your shoulder hurts, but why it’s hurting. Our one-on-one approach combines movement analysis, strength testing, and individualized rehabilitation to create a plan that’s built around your goals.

If you’re looking for sports physical therapy in Bethesda or sports physical therapy in McLean, our team is here to help. We work with active adults and athletes to identify the root cause of pain, improve movement, and get you back to training and competing with confidence.

The sooner you understand what’s driving your symptoms, the sooner you can stop guessing and start making meaningful progress.

Is Your Training Preparing You for Your Sport? Why Sport-Specific Training Matters Before the Season Starts

Why sport-specific training matters before your fall season

As summer comes to an end, athletes everywhere are getting ready for the fall sports season.

Whether it’s football, soccer, basketball, field hockey, or another fall sport, practices are about to become more intense and competition is right around the corner.

The question is, has your training prepared you for what you’re actually about to do?

This is one of the biggest mistakes we see every year. Athletes spend the offseason improving their fitness, but as the season approaches, they don’t make the transition to sport-specific training. As a result, we often see a spike in hamstring strains, hip flexor injuries, calf strains, and other soft tissue injuries during the first few weeks of the season.

The good news is that many of these injuries are preventable.

General fitness is only the first step

Building an aerobic base is important.

Long runs, steady bike rides, and other endurance workouts improve your cardiovascular fitness and help create a solid foundation for training.

The problem comes when that’s the only type of training you’re doing right before your season begins.

Most sports don’t require continuous, steady movement.

Football players sprint for just a few seconds before the next play.

Basketball players accelerate, stop, cut, jump, and change direction throughout the game.

Soccer players alternate between jogging, sprinting, recovering, and repeating that cycle for an entire match.

If your training doesn’t resemble those demands, your body may not be ready when practices become more intense.

Your body adapts to the stress you give it

One of the amazing things about the human body is its ability to adapt.

If you consistently expose your body to a certain type of stress, it becomes better at handling that stress over time.

That’s why preparing for your sport means training the movements, speeds, and intensity you’ll actually experience during competition.

Athletes searching for Chevy Chase physical therapy often ask how they can reduce their injury risk before the season begins. One of the biggest factors is making sure training reflects the actual demands of their sport instead of relying solely on general conditioning. Whether you’re recovering from a previous injury or simply trying to stay healthy throughout the season, preparing your body for the stresses you’ll actually experience is one of the most effective ways to improve both performance and durability.

For an athlete who’s been running several miles each day, the next step may be adding sprint intervals.

Instead of one continuous run, perform repeated short sprints followed by recovery periods. Over the following weeks, gradually increase the effort while maintaining good movement quality.

This allows your muscles, tendons, and nervous system to adapt before the season begins instead of being surprised by the sudden increase in workload.

Every sport has different demands

Sport-specific training isn’t one size fits all.

Football players benefit from explosive, short-duration sprints because most plays last only a few seconds.

Soccer players often need longer sprint intervals because the game requires repeated high-intensity efforts over a much longer period.

Basketball players should also spend time working on jumping, landing, acceleration, deceleration, and change of direction.

The goal isn’t simply to get tired during a workout.

The goal is to prepare your body for the exact stresses you’ll encounter once competition begins.

Why we see so many injuries early in the season

Every fall, we treat athletes who develop muscle strains shortly after practices begin.

In many cases, the injury isn’t caused by one specific event.

Instead, it’s the result of a sudden increase in workload.

Practices become longer.

The intensity increases.

Athletes sprint more often.

They cut harder.

They jump more frequently.

If the body hasn’t gradually adapted to those demands beforehand, the risk of injury increases.

That’s why preseason preparation matters so much.

Train for the sport you play

As your season approaches, ask yourself one simple question:

Does my training look like my sport?

If the answer is no, it may be time to adjust your program.

Making that transition before preseason starts can help improve performance while reducing the risk of unnecessary injuries.

Sports physical therapy in Bethesda and McLean

If you’re dealing with a muscle strain, recovering from an injury, or simply want to make sure you’re prepared for the upcoming season, our team is here to help.

At Cohen Health & Performance, we work with athletes of all ages to develop individualized rehabilitation and performance programs based on the specific demands of their sport. Whether you’re looking for sports physical therapy in Bethesda or sports physical therapy in McLean, our one-on-one approach helps athletes recover efficiently, reduce injury risk, and return to competition with confidence.

The best time to prepare for your season is before injuries happen. If you or your athlete wants to head into the season feeling strong, healthy, and ready to perform, schedule an evaluation with our team today.

CHP Spotlight Interview: Nutrition, Performance, and Recovery with Registered Dietitian Emily Arkin

At Cohen Health & Performance, we often talk about the importance of looking at the whole athlete. Great training and great physical therapy matter, but they are only part of the equation.

In our latest CHP Spotlight Interview, we sat down with registered dietitian Emily Arkin, founder of RD Emily & Team, to discuss one of the most overlooked aspects of performance, recovery, and long-term health: nutrition. Emily and her team work with athletes, active adults, and individuals navigating a wide variety of nutrition concerns, helping people cut through the noise and create sustainable strategies that fit their lives.

Meet Emily Arkin, RD

Emily Arkin is a registered dietitian and owner of RD Emily & Team, a group nutrition practice serving the DC, Maryland, and Virginia area. Her team specializes in sports nutrition, eating disorder recovery, gastrointestinal health, cardiometabolic health, and more. Their approach focuses on helping people make informed decisions about nutrition without relying on restrictive diets or one-size-fits-all recommendations.

One of the Biggest Problems Facing Young Athletes

One of the most valuable parts of our conversation centered around a challenge we frequently see in high school athletes: under-fueling.

According to Emily, many young athletes simply are not eating enough to support the demands of training, competition, recovery, growth, and everyday life. This is often unintentional. Busy schedules, school, practices, games, social activities, and a lack of planning can make it difficult for athletes to consistently consume enough calories throughout the day.

The consequences can be significant:

Slower recovery between practices and games
Increased fatigue
Reduced performance
Difficulty building strength and muscle
Higher risk of recurrent injuries
Poor sleep and recovery

As Emily explains, nutrition is not separate from athletic performance. It directly impacts how athletes train, recover, adapt, and stay healthy throughout a season.

Why Nutrition Advice for Athletes Is Different

One topic that generated a great discussion was the difference between nutrition advice for the general public and nutrition advice for athletes.

Many nutrition messages online focus on avoiding sugar, cutting calories, or restricting certain foods. While those recommendations may make sense in some contexts, athletes have very different demands.

Emily explained that carbohydrates, including simple sugars in the right situations, can be valuable fuel sources for training and competition. Athletes often need strategies that support performance and recovery rather than simply following generalized nutrition trends.

The takeaway?

Athletes are not the general population. Their nutritional needs should reflect the demands they place on their bodies.

Nutrition and Injury Recovery

As physical therapists, one area we are particularly passionate about is helping injured athletes return to the activities they love.

During our conversation, Emily discussed a common mistake athletes make after getting injured: dramatically reducing their food intake because they are no longer training at full capacity.

While it may seem logical to eat less when activity levels decrease, recovery itself requires energy. Healing tissues, maintaining muscle mass, and supporting rehabilitation all require adequate nutrition. Athletes who aggressively cut calories during recovery may unintentionally make the rehab process more difficult.

This is something we see regularly at CHP. The best rehabilitation program in the world can only take someone so far if recovery, sleep, stress management, and nutrition are not supporting the process.

Performance Is Bigger Than Any One Provider

One of the themes that emerged throughout the interview was the idea that optimal performance requires a team approach.

Physical therapists, strength coaches, physicians, nutrition professionals, parents, and athletes all play important roles. When these pieces work together, athletes are positioned to recover more effectively, perform at a higher level, and stay healthy longer.

If you are an athlete, parent, coach, or active adult looking to better understand how nutrition impacts performance and recovery, we encourage you to watch the full CHP Spotlight Interview with Emily Arkin.

At Cohen Health & Performance, we believe the best outcomes happen when every aspect of health and performance works together. Nutrition is one of the most powerful tools available, and this conversation is packed with practical insights to help you get more out of your training, recovery, and overall health.

To learn more about Emily, click on the link! https://www.rdemily.com