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.

My athlete got injured. Now what?

What should my athlete do after an injury? How can they get back on the field as quickly and safely as possible?

Let’s answer these questions by examining the sports physical therapy process for the most common soft tissue injury in soccer, a quad strain. For more information on soft tissue injuries and the difference between strains and sprains, check out last week’s article, here.

Soccer players risk having soft tissue injuries due to the sport’s high volume of sprinting, kicking, and cutting. Kicking-related injuries represent the largest portion, with the rectus femoris muscle, part of the quadriceps group, being the most commonly injured muscle.

The rectus femoris muscle crosses both the hip and the knee. As an athlete winds up to kick a soccer ball, the rectus femoris muscle quickly stretches and rapidly contracts to kick the ball. Any muscle that quickly and continuously lengthens and shortens is at an increased risk of injury, especially across multiple areas like the hip and knee.

Immediately after the injury occurs, the athlete should be examined by a physical therapist or sports medicine physician to determine the severity of the injury and course of action. Imaging may be helpful in some cases but is not always necessary.

The physical therapy/rehab process for a muscle strain can be divided into 3 distinct phases .

Injury Management Phase
The goals of this phase are to reduce pain and inflammation, restore the range of motion of the muscle, and re-introduce pain-free functional movements. Injured tissues need this time to recover and heal, but that does not mean complete rest. Light strengthening exercises and mobility drills help to stimulate healing, which is why immediately starting physical therapy is so important.

Examples of early-phase exercises for a quad strain may include:

Once athletes demonstrate full range of motion without pain and perform basic bodyweight movements, they progress to the next rehabilitation phase. Unfortunately, this is where traditional PT stops, and many athletes struggle to bridge the gap from rehab to performance.

Strength Training Phase
Many athletes still have significant strength deficits at the start of this phase.

Strength training improves the quality of the injured tissue and reduces the risk of reinjuring the muscle. This is when it is time to get in the weight room.

Examples of strength training exercises for an athlete recovering from a rectus femoris or quad strain include:

Sport Specific Training
What must the injured tissue be capable of to safely return to sport?

This phase of rehab requires a strong understanding of an athlete’s sport as the injured area must be ready for everything that is about to be thrown at them.

The rectus femoris is injured because of continuous, rapid lengthening and shortening. This must be replicated and trained as a part of the rehab process, preparing the athlete for the demands of soccer.

Here are some examples of movements that may be used during this phase.

These 3 phases apply to all muscle strains, but each muscle strain recovers at a different rate. The area of the body that is injured, severity of the injury, and several other factors impact how quickly an athlete will return to the field.

If you have an athlete with a muscle strain, schedule an appointment with a physical therapist or sports medicine physician right away. Early treatment has been proven to get athletes back on the field sooner, and more successfully. If you are suspicious that you or your child has a muscle strain, schedule an evaluation with us right away.

Fall injuries are piling up

Are you the parent of a high school athlete? If so, you may have noticed that injuries are piling up. We have seen many of them here at Cohen Health and Performance in McLean and Bethesda for sports physical therapy.

Some of these injuries are traumatic, like an ACL tear, but soft tissue strains and sprains are the most common injuries that our physical therapists see.

While these words are nearly identical, they are not the same.

A strain is an injury to the muscle itself. Muscle strains often occur in the lower body with high-velocity movements like sprinting, cutting, and kicking. They also occur in the upper body with contact or a fall, although less common. Common lower-body muscle strains occur in the hamstrings, calves, quadriceps (particularly the rectus femoris muscle), and adductors.

If you athlete has strained a muscle, they will feel pain in the affected muscle right away. They are likely to describe a sensation of tearing or pulling of the muscle. Strains of the lower body usually do not happen with contact and occur when an athlete moves at a high speed or decelerates.

A muscle can be self-diagnosed at the time of the injury with a few simple assessments.

Pain with touching the injured area
Pain with stretching the affected muscle
Pain and/or weakness with contraction of the affected muscle
Possible bruising or discoloration of the skin over the injured area

A sprain is an injury to a ligament. Common sites for sprains are the ankle and knee. A sprain occurs when an area is overstretched, the ligament is injured, and potentially partially or fully torn. Sprains commonly occur as an athlete lands or steps on an opponent’s foot, or their limb gets twisted into an awkward position.

A sprain can also be self-diagnosed following using similar assessments to a muscle strain.

Pain with palpating the injured area
Pain with moving and bearing weight through the affected joint
Bruising and swelling of the affected area

The key difference in distinguishing between these two injuries is the location. Sprains will be localized to a joint and a strain is localized to a muscle.

Future blog posts will include examples of how you or your athlete can manage each of these injuries.

If you are suspicious that you or your athlete has sustained a soft tissue injury, it is important to have it examined by a physical therapist as soon as possible. We will assess the injury’s severity and provide detailed guidance on how to get back in the game as quickly as possible!

It’s an athlete’s right of passage

The first time may have happened as you landed from a jump playing basketball or making a cut while playing soccer. And since that first time, it has happened several more times.

What should you do the next time you sprain your ankle? Should you go to an athletic physical therapy clinic like ours in McLean and Bethesda?

Most likely, it will be swollen and painful, but you should be able to put some weight through it.

If you cannot put any bodyweight through your ankle, see a physical therapist or doctor immediately.

Assuming a fracture has been ruled out, it is time to start the physical therapy process immediately. The sooner you get started, the quicker you recover!

Initial goals are to reduce swelling, restore the range of motion to the ankle, and get back to walking pain-free, without a limp.

Range of motion is often restricted by joint swelling, and below are a few tips to help.

Move the injured ankle through a comfortable range of motion. This can be drawing circles with your ankle, drawing out the ABCs with your ankle, or pumping your ankle up and down. The important thing is that the joint is being moved.
Elevate the limb above the heart as much as possible.
Perform aerobic exercise that elevates your heart rate to increase blood flow to the area, which will help clear out extra fluid in the joint. An exercise bike is recommended so that weight bearing is not an issue.

Next is strengthening.

Once you have restored the normal range of motion and can comfortably bear weight through the injured joint, it is time to start building up the ankle’s tolerance to higher loads and the demands of life/sport. This will be a combination of strengthening and balance exercises.

Here are a few exercises to help you work on strengthening and balance.

Single leg stance with rotation
Front foot elevated heel raise
Multidirectional RDL

Finally, the fun phase. Sport-specific movements! Movements during this phase are tailored to your sport, often involving change of direction/cutting drills. Various jumping and hopping movements, called plyometrics, are also included.

Below are 2 examples of plyometrics drills we have used with our athletes.

Alternating split stance leaps
Lateral bounds

It is important that you feel 100% confident in your ankle before you are finished with rehab.

If you or someone you know recently sprained their ankle, reply to this email and accelerate your return to the field!

Nagging injury? Don’t miss this interview!

In this very special edition of the CHP Spotlight Interview Series, I chatted with my physical therapy colleague, Dr. Kelly Henry.

Her recent article about dry needling created a lot of interest and several questions (check that out here). What better way to answer them than to ask the expert herself?

As many of you know, Dr. Kelly is the Clinic Director of our McLean location and an amazing sports physical therapist and strength coach.

In this interview, we tackled many of your questions such as:
-Does dry needling actually work? If so, how?
-Can dry needling help me with my injury?
-Does it hurt?!

If you have a frustrating injury that just won’t go away and/or are considering physical therapy, don’t miss this interview!

To learn more about Dr. Kelly, click here.

Hidden injury risks in youth sports

Today’s article is from Dr. Samuel Kinney! Dr. Sam is a Performance Physical Therapist at our McLean location. In addition to being an amazing sports physical therapist and strength coach, Sam was a successful collegiate athlete. Learn more about Dr. Sam here. Enjoy!

What a great time of year to be a physical therapist! Our summer athletes that were injured or training with us are healthy and starting their fall sports seasons.

One of the most rewarding parts of being a sports physical therapist is seeing the athletes I helped return to the field and benefit from all their hard work from the summer.

But I can’t help but be a little nervous sometimes. There is always a risk of injury, and one of the greatest risks for a young athlete is specializing in one sport too early.

Sports specialization is defined as:

“intentional and focused participation in a single sport for most of the year that restricts opportunities for engagement in other sports and activities.”

Many athletes strongly desire to participate in their sport year-round and are pressured to do so. They have been led to believe that this will enhance their athletic success and potential to play “at the next level.” Yet, there is very little data to support this idea. On the contrary, there is strong support in the medical community for athletes to diversify their sporting activities during the off-season.

The main problem with sport specialization at a young age is that it increases an athlete’s risk for an overuse injury, and overuse injuries account for over 50% of injuries in young athletes. Common overuse injuries at CHP include back injuries like spondylolysis, foot and ankle problems, anterior knee pain, and muscle strains. Year-round play of one sport places continued stress through the same joints and tissues without the opportunity to recover.

How can we solve this problem?

First, a well-rounded strength and conditioning program with sport-specific considerations reduces injury risk by increasing the amount of work that the body can handle. As a result, athletes become more resilient to the stresses placed on them in sports. For example, improving the strength and stress-tolerance of a baseball pitcher’s rotator cuff protects against the high forces involved in pitching.

Second, participate in a secondary sport during the off-season of the main sport. This provides a break from the repetitive movements of the primary sport (e.g., repetitive throwing, hitting, jumping) and allows the athlete to explore different movement patterns. This can also improve performance in their primary sport by improving sporting decision-making and problem-solving and giving them a wider range of movements to utilize.

Finally, use the athlete’s age to guide the training load. A simple formula to use is:

Workload hours/week < age.

For example, a 12-year-old athlete should participate in their sport (including practices) less than 12 hours per week.

The topic of injury reduction is complex, and this is just scratching the surface of how we can reduce the risk of injury for youth athletes. If you are looking for ways to reduce the risk of injury for yourself or your child, contact us schedule an evaluation. We will consider all the factors at play and devise an individualized plan to keep you or your child in action!

Runners: Here is a quick workout for you

I get it. Running is a lot easier than going to the gym. Just throw on your running shoes, walk out the front door, and you are good to go! Meanwhile, the gym requires you to leave the house, get in the car, drive there, and fight for equipment and space with others. Not to mention that the traffic in McLean and Bethesda is no joke!

By now, you probably know that cross-training is essential to improving running performance and avoiding physical therapy. But many runners find it hard to make time for anything besides running. It is easy to fall into the trap that we have seen many runners fall victim to. This is the mindset that the only thing that counts towards training is the miles they log. But this is not true!

Cross-training is essential for runners because it helps prevent injury, build/maintain strength, and improve your run times and muscular endurance! Lifting weights and moving your body in varied ways from your typical movement patterns (running is repetitive!) builds resilience to injury. A typical cross-training program for a runner should include strength training of not only your lower body, but upper body and core as well. Lower body strength is important for power production and single leg control during your run. Core and upper body strength will help you maintain efficient running posture and overall muscular conditioning. Cross-training doesn’t have to be long and daunting. 2 sessions per week of 30 minutes of strength training is a great place to start! Below is an easy full-body template and example workout to try at the gym or home!

Step 1: 5-10 minutes warm-up

Get your muscles warm
This can include jogging, biking, or dynamic stretches

Step 2: Full Body Circuit

Choose 1-2 exercises for your lower body, and 1-2 exercises for your upper body
Include compound movements! This includes exercises that use your lower body, upper body, and core to work together
Perform each exercise for 8-10 repetitions, and repeat the circuit for 3-4 total rounds

Step 3: Core and Plyometric Finish

Choose 2-3 core exercises and 1-2 plyometric exercises
Perform each exercise for 20-30 seconds, and repeat the circuit for 3-4 rounds

Example:
1. Jog on the treadmill at 5-6 MPH for 5 minutes

2. Perform 3 rounds of the following circuit:
A. Reverse Lunge x10 reps on each leg
B. Dumbbell Bench Press x10 reps
C. Goblet Squat x10 reps
D. Shoulder press x10 reps
*Choose a weight that is challenging for you, but you can complete all 3 circuits

3. Perform 3 rounds of the following circuit:
A. Sprinter Step Up x 30 seconds
B. Side plank x 30 seconds on each side
C. Russian twists x 30 seconds

If you are a serious runner that is looking to step up your performance or avoid injury, contact us for a customized cross-training program designed by our resident triathlete, Dr. Kelly Henry!