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.

The mental side of physical therapy

As physical therapists, we recognize the emotional and psychological impact that comes with being sidelined due to injury. An injury can feel like a part of an athlete’s identity has been taken away, and it’s crucial for us to address this throughout their rehabilitation. Physical therapy is not just about healing the body; it’s about nurturing the mind as well.

The Importance of Staying Connected During Rehabilitation

During rehab, we encourage athletes to stay connected with their team in some capacity, whether it’s attending practices or participating in team activities. This helps maintain their sense of belonging and identity. As they progress through physical therapy, it’s easy to focus solely on physical exercises and overlook how they might be feeling mentally. Staying engaged with their team can significantly boost their morale and provide a much-needed sense of normalcy.

The Psychological Challenges of Returning to Sport

As your child approaches their return to sport, they will face multiple challenges, including the pressure to perform at their peak, stress about their performance, and the fear of re-injury. These mental barriers can be as debilitating as the physical injury itself. If these mental barriers aren’t addressed, they can increase the risk of re-injury. Therefore, it’s vital to incorporate psychological support into physical therapy programs.

Bridging the Gap Between Physical and Mental Readiness

Return-to-sport testing provides valuable information about an athlete’s physical readiness but often lacks insight into their mental preparedness. To bridge this gap, we incorporate mind-body techniques early in the rehabilitation process. Visualization and mental rehearsal of successful performance, followed by controlled physical drills, are key components. Gradual exposure to movement patterns, speed, and endurance levels within a controlled environment helps build confidence and reduce fear of re-injury. This holistic approach to physical therapy fosters a sense of independence and confidence in the athlete, making their return to sport more seamless and subconscious.

The Role of Coaches and Parents in Supporting Athletes

As coaches and parents, we can support our athletes by maintaining open communication about their mental health, setting realistic timelines and expectations, and building a strong support system around them. A fearful athlete will second-guess their every move, while a confident one will perform at their best. Your support and understanding during this time are invaluable to your child’s recovery and overall well-being.

Practical Steps for Incorporating Mental Health in Physical Therapy

1. Open Communication: Encourage athletes to express their fears and anxieties. Acknowledging these feelings is the first step toward overcoming them.

2. Setting Realistic Goals: Work with the athlete to set achievable goals. This not only helps in tracking progress but also boosts their confidence as they hit each milestone.

3. Mind-Body Techniques: Incorporate techniques such as mindfulness, meditation, and visualization. These can help athletes mentally prepare for their return to sport and reduce the fear of re-injury.

4. Gradual Exposure: Slowly reintroduce athletes to the sport. This could start with light exercises and progress to more intense drills as their confidence grows.

5. Support System: Create a network of support that includes coaches, family, friends, and mental health professionals. This ensures that the athlete has a robust support system to rely on throughout their recovery.

The Long-Term Benefits of Addressing Mental Health in Physical Therapy

Incorporating mental health into physical therapy not only aids in the immediate recovery process but also has long-term benefits. Athletes who receive comprehensive care that addresses both their physical and mental health are more likely to return to their sport stronger and more resilient. They are better equipped to handle the pressures of competition and less likely to experience re-injury.

Physical therapy is a multifaceted process that goes beyond physical rehabilitation. By addressing the mental and emotional aspects of recovery, we can help athletes return to their sport with greater confidence and reduced fear of re-injury. As physical therapists, coaches, and parents, it is our collective responsibility to support our athletes holistically.

Your support and understanding during this time are invaluable to your child’s recovery and overall well-being. Please feel free to reach out if you have any questions or need further assistance. Together, we can ensure a successful and well-rounded recovery for your athlete.

Runners, don’t make this mistake

It is no secret that runners must complete a strength training program as part of their physical therapy and cross training routine, in addition to their running. Whether through social media, talking with your running friends or coach, or simply your own intuition, every runner has heard that they should be strength training. But is it as simple as picking up a 10-pound dumbbell and knocking out a few squats and deadlifts? Of course not.

There are so many benefits that strength training can offer a runner. Here’s just a few:

Decreased risk of injury
Improved running efficiency
Stronger tendons

Most runners we work with are endurance junkies, they love the feeling of pushing their bodies hard for long periods of time and the feeling of their heart pumping. A big mistake runners often make with their strength training is trying to make it feel like an endurance event, either by doing sets of 20-30 reps or doing circuit-style training with minimal rest.

One key variable is needed to effectively achieve the previously mentioned benefits of strength training: load. Strength training needs to be heavy, challenging the targeted muscles and tendons far beyond what they encounter regularly; otherwise, those tissues have no reason to adapt and get stronger.

Strength training for runners should focus on moderate to heavy weights that allow 6-10 repetitions per set. This range optimizes muscular strength by optimizing the intensity required for muscle adaptation. Additionally, adequate rest between sets (typically 1-2 minutes) allows muscles to recover and perform optimally during subsequent sets.

Remember, the goal of strength training for runners is not to mimic the cardiovascular demands of running but rather to complement it by building foundational strength and resilience in key muscle groups. By prioritizing proper form, progressively increasing the intensity, and allowing for adequate recovery, runners can maximize the benefits of their strength training regimen and enjoy improved performance and longevity in their running careers. Below is an example of a quick lower-body strength training session I recently created for a runner.

A) Heels elevated kettlebell cleans: 2×5

B) Safety Bar Squats (heavy): 3 sets of 6

C1) Kickstand RDL with a dumbbell: 3×8/side

C2) Weighted lateral step downs: 3×8/side

**C1 and C2 are a superset (perform 1 set of the first exercise, then the first exercise of the next exercise before resting and performing round 2)

D1) Prone Hamstring Curls: 3×12

D2) Double leg resisted calf raises (3 seconds on the way down): 3×12

So, next time you hit the gym or dedicate time to strength training at home, focus on lifting heavier weights with proper form and ample rest. Your body will thank you with increased durability and efficiency on the road or trail.

Speaking of durability, we are excited to announce our Running Technique and Performance Lab this Saturday at 10am at our McLean location. We’ve made some thrilling updates! This workshop is a must-attend for any runner aiming to prevent injuries and achieve new personal records this running season. Don’t miss out!

Learn more and sign up by clicking here!

I had to be the bad guy

“My Doctor Said I’m Cleared to Play!”

My patient was thrilled. After months of recovering from knee surgery, she finally received the green light to return to playing soccer. This moment was the culmination of many weeks of hard work, dedication, and patience. The journey to recovery had been long, and now, she was eager to step back onto the field.

Unfortunately, I had to bring her back to reality.

The surgeon had done an excellent job—the surgery went smoothly, the knee healed perfectly, and there was no swelling or pain. But while his job was complete, mine was far from over. This is where physical therapy plays a crucial role in the rehabilitation process. Despite making significant progress in rehab, the muscles around her repaired knee were still about 30% weaker than those on the other side. Our force plate technology (learn more about that here) revealed that her ability to absorb shock on the repaired side was compromised, and her reaction time was slower.

As much as I wanted to give her the news she was hoping for, allowing her to return to play immediately would have put her at high risk of re-injury. This is a common misconception; many think that being “cleared” by the doctor means they are ready to return to their pre-injury activities without further physical therapy. However, this is far from the truth.

This scenario is common and understandable. It’s easy to think that rehab is over when the doctor says, “you’re cleared.” But in reality, it’s just the beginning. Physical therapy is an essential step that ensures the body is fully prepared to handle the demands of sports or physical activities.

“Cleared” means the doctor’s role is complete, and now it’s up to us, the physical therapists, to ensure that you return to play, training, or your active lifestyle as safely as possible. Physical therapy bridges the gap between surgery and full recovery, focusing on strength, flexibility, and functional movement.

So, how do we determine when you’re ready to get back in the game? Here are a few key factors we continuously assess throughout the rehab process:

Range of Motion

Range of motion is a critical aspect of recovery. After surgery, it’s common for the injured area to lose some of its normal movement capabilities. Physical therapy aims to restore this range of motion to be equal to the other side of the body. This balance is essential for preventing compensatory movements that could lead to further injury.

Strength Testing

Strength testing is another fundamental component of physical therapy. The previously injured side should be within 10% of the uninjured side, but ideally, it should be equal. This ensures that the repaired area can handle the same amount of stress and load as the uninjured side, reducing the risk of re-injury.

Functional Testing

Functional testing is specific to your sport or activity and is a cornerstone of physical therapy. It includes various tests designed to evaluate how well the injured area performs in real-world scenarios. Here are a few examples:

Hop or Jump Testing: Measures your ability to absorb impact on one side compared to the other. This should be within 10% of the uninjured side, but ideally equivalent. This also gauges how reactive or “bouncy” one side is compared to the other—the closer to equal, the better!
Running Analysis: Running analysis is a crucial part of physical therapy for athletes. It involves assessing your running form, stride, and overall biomechanics to ensure that you can run efficiently and without pain. Learn more about that here!
Throwing Assessment: For baseball players and other throwing athletes, a throwing assessment is essential. This evaluation helps ensure that your shoulder and arm can handle the repetitive stress of throwing without causing further injury.

Physical therapy doesn’t just focus on the injured area; it considers the whole body. This holistic approach helps identify any weaknesses or imbalances that could lead to future injuries. By addressing these issues, physical therapists can create a comprehensive rehab plan tailored to your specific needs and goals.

Importance of a Thorough Return-to-Play Assessment

The last thing anyone wants is a re-injury or a new injury because the body wasn’t 100% ready to return. A thorough return-to-play assessment is essential for anyone looking to resume their sport, activity, or active lifestyle as safely, quickly, and effectively as possible. Physical therapy is integral to this process, providing the necessary guidance and support to help you achieve your goals.

Physical therapy involves various techniques and exercises designed to restore function, improve mobility, and prevent further injury. But it is not a one-size-fits-all approach. Each rehab program is customized to the individual’s specific needs, goals, and progress. This personalized care ensures that you are fully prepared to return to your desired activities with confidence.

Physical therapy is a vital component of the recovery process, ensuring that you return to your sport or active lifestyle safely and effectively. The journey from surgery to full recovery involves more than just being “cleared” by the doctor; it requires the expertise and support of physical therapists to guide you through the final stages of rehab. By focusing on strength, flexibility, and functional movement, physical therapy helps you achieve your goals and reduces the risk of re-injury. So, when your doctor says you’re cleared to play, remember that physical therapy is your partner in achieving a complete and lasting recovery.

Secrets to avoiding athlete burnout

I recently had a conversation with the parent of a young athlete I was treating for an injury through physical therapy. This athlete’s schedule was as demanding as a college athlete’s, despite not even being able to drive yet.

He was dedicated to one sport but was playing on multiple teams and training with a personal coach. Eventually, his body couldn’t keep up, and he had to take a break due to an injury.

As I spoke with his parent, the young athlete was eager to jump back into his sport and make up for lost time. Unfortunately, this is a common scenario. Once an athlete feels better, they often return to the same routines that led to their injury in the first place.

The Role of Physical Therapy in Preventing Overuse Injuries

Focusing on a single sport can cause the body to move in repetitive ways, increasing the risk of overuse injuries. While specialization can make athletes more efficient in their chosen sport, it can also limit their mobility and overall athletic development. Physical therapy can play a crucial role in mitigating these risks by addressing imbalances and promoting overall wellness.

However, this doesn’t mean that specializing in a sport is inherently bad. Every athlete eventually reaches a point where they need to focus on “their sport.” Whether they’re on a recreational team or competing at a state level, life gets busy juggling multiple sports and activities.

When to Specialize and How Physical Therapy Can Help

The critical question is: when is the right time to specialize, and what are the dangers of doing so too early or too late? Is it possible to excel in a sport while preventing injuries and avoiding burnout?

Guidelines for Healthy Athletic Development and Physical Therapy

Here are some essential guidelines to help maintain a healthy balance:

1. Avoid Over-Specialization: Encourage participation in multiple sports throughout the year. Repetitive stress from a single activity can increase injury risk. Staying active across various sports can help maintain overall fitness and prevent burnout. Physical therapy can help address and correct any emerging issues.

2. The “Hours per Age” Rule: Ensure your child does not train more hours per week in one sport than their age in years. For instance, a 14-year-old swimmer should swim less than 14 hours per week.

3. Practice and Competition Limits: Limit practice sessions to 1.5 hours per day and competitions to 3 hours per week.

4. Rest Days: Ensure 1-2 rest days per week from sport practice or competition.

5. Seasonal Breaks: Young athletes should have up to 3 months off from organized sports per year, ideally in 1-month increments.

6. Focus on Form: Emphasize proper form and technique over intensity to reduce injury risk. Physical therapists can provide valuable guidance on form and technique.

Communication and Fun: Essential Elements

Managing activity levels and recognizing when an injury needs attention is challenging. Regular communication with a physical therapist when something feels off can help ensure a successful season and address potential issues early.

Above all, remember that sports should be fun! Keeping enjoyment at the forefront will help maintain a healthy, balanced approach to athletics.

By integrating physical therapy into their routine, young athletes can not only enhance their performance but also prevent injuries and ensure long-term success.

Don’t do what the pros do

As a passionate Boston Celtics fan, I’m thrilled to share that our team is up 2-0 in the NBA Finals! Just two more wins, and the Celtics will secure their 17th Championship. However, the excitement is tempered by the news that one of our star players, Kristaps Porzingis, recently suffered a rare foot/ankle injury towards the end of the latest game.

Porzingis had already been sidelined for over a month due to a calf injury, and he admitted he wasn’t entirely sure he was 100% healthy before the Finals began. This highlights a critical issue in professional sports: the risks associated with returning to play before fully recovering from an injury. Physical therapy plays a pivotal role in ensuring athletes like Porzingis can return to peak performance safely.

The Risks of Premature Return to Play

Returning to play before fully recovering can significantly increase the risk of re-injury or new injuries. When one part of the body is not operating at 100%, compensatory movements can stress other areas, leading to additional injuries. This scenario isn’t uncommon in professional sports, where athletes often face the difficult decision of whether to return to play early.

In the 2019 NBA Finals, former Golden State Warriors superstar Kevin Durant ruptured his Achilles tendon when he quickly returned to play after a calf injury. This tragic incident underscores the importance of proper injury management and the role of physical therapy in the recovery process. NBA medical staffs and the amazing athletes they work with are acutely aware of these risks.

Kristaps Porzingis: A Case Study in Risk Versus Reward

In Porzingis’ case, he deemed the risk worthwhile, having reached the pinnacle of professional basketball. This risk versus reward decision is one every athlete faces, but it’s crucial to manage it wisely. Physical therapy provides the tools and guidance needed to navigate this challenging landscape.

If you’re dealing with a nagging injury or planning to return to training post-injury, it’s essential to assess your risk versus reward scenario carefully. Unlike Porzingis, you might not have a championship at stake, and avoiding further injury is paramount. This is where physical therapy becomes indispensable.

The Role of Physical Therapy in Injury Recovery

Physical therapy is not just about addressing the injury itself but also about ensuring a comprehensive recovery that minimizes the risk of future injuries. A qualified sports physical therapist can assess your injury, identify any compensatory movements, and develop a personalized recovery plan. This plan will not only address the injury but also strengthen the affected area and improve overall body mechanics.

By consulting a physical therapist, you can ensure that your recovery is complete and that you’re fully prepared to return to your favorite activities safely. Physical therapy also educates you on injury prevention strategies, helping you maintain peak physical condition and avoid setbacks.

Take the First Step Towards Safe Recovery

To lower your risk and safely return to your beloved activities, consult a qualified sports physical therapist. They can assess your injury and guide you through a safe recovery process. Physical therapy is a critical component of sports medicine, providing the expertise and support needed for athletes and active individuals alike to recover fully and perform at their best.

If you’re managing your own nagging injury or returning to training after being hurt, don’t take unnecessary risks. Physical therapy can help you achieve a safe and effective recovery, ensuring that you can enjoy your activities without the fear of re-injury.

Schedule Your Physical Therapy Evaluation Today

Don’t let an injury hold you back. Contact us to schedule a sports physical therapy evaluation with our expert team. We’re here to help you get back in the game safely and effectively.

Sleep and Physical Therapy

The Crucial Role of Sleep in Injury Recovery

Recovery may not always be the most thrilling topic, especially when compared to the countless “recovery hacks” circulating on social media. A quick glance at Instagram or Twitter reveals a flood of advice, from specialized supplements to elaborate workout routines. While some of these tips can be helpful, they often overlook the most essential aspect of recovery.

For instance, many supplements are marketed with promises of speeding up recovery between workouts. Yet, there is one recovery tool so vital that, without it, all other efforts may fall short: sleep.

The Science Behind Sleep and Recovery

Understanding why sleep is so crucial for recovery requires a dive into the science. Sleep isn’t just a passive state; it’s a dynamic process during which the body undergoes critical repair and regeneration. Here’s a link to an article from the National Institutes of Health if you want to learn more!

Tissue Repair and Growth

During deep sleep, the body releases growth hormone, essential for tissue repair and muscle growth. This process enhances protein synthesis and cell division, both of which are vital for healing injuries and building strength. Research shows that those who get enough sleep experience better muscle repair and growth compared to those who don’t, highlighting the importance of sufficient rest in both physical therapy and performance training.

Inflammation Reduction

While inflammation is a natural response to injury, chronic inflammation can hinder recovery. Studies indicate that sleep helps lower inflammation markers in the body. On the other hand, poor sleep can raise these markers, prolonging recovery times. By prioritizing quality sleep, you can help your body better manage and reduce inflammation, a key factor in both physical therapy and performance training.

Immune System Support

A strong immune system is crucial for warding off infections and speeding up the healing process. A good night’s sleep bolsters the immune system, making it more effective at combating pathogens. Research shows that sleep deprivation can impair immune function by up to 70%, significantly slowing down recovery from injuries. This immune support is particularly important for those undergoing physical therapy or performance training.

Pain Management

Adequate sleep also plays a significant role in pain management. Studies have shown that people who get enough sleep report lower pain levels and faster healing. Conversely, just one night of poor sleep can reduce pain tolerance by 15-30%. By making sleep a priority, you can lower pain sensitivity and improve your body’s ability to manage pain, which is crucial in physical therapy and performance training.

Mental Health and Recovery

Mental health is often an overlooked component of physical recovery. Sleep is vital for maintaining mental well-being, which directly affects physical healing. Good sleep enhances mood, reduces anxiety, and helps sustain motivation throughout the recovery process. By ensuring adequate rest, you equip both your mind and body to be in the best condition for healing, essential for anyone involved in physical therapy or performance training.

Key Statistics on Sleep and Recovery

The benefits of sleep for recovery are supported by compelling data:

– Athletes who sleep 8+ hours a night have a 68% lower risk of injury, illustrating the protective effects of sleep in performance training.
– Chronic sleep deprivation can delay wound healing by up to 20%, underscoring the critical role of sleep in timely recovery during physical therapy.
– Just one night of poor sleep can lower pain tolerance by 15-30%, making injuries feel more severe and prolonging the recovery process, impacting both physical therapy and performance training.

These statistics highlight the necessity of prioritizing sleep, especially when recovering from injuries.

Prioritizing Sleep for Optimal Recovery

Given the critical role that sleep plays in recovery, it’s essential to prioritize it. Here are some practical tips to help improve your sleep quality:

1. Establish a Routine: Try to maintain a consistent bedtime and wake-up time every day, even on weekends. This consistency helps regulate your body’s internal clock.
2. Create a Sleep-Friendly Environment: Ensure your bedroom is cool, dark, and quiet. Consider blackout curtains and a white noise machine if necessary.
3. Limit Screen Time Before Bed: The blue light from phones and computers can interfere with your sleep. Aim to avoid screens for at least an hour before bedtime.
4. Watch Your Diet: Avoid heavy meals, caffeine, and alcohol close to bedtime, as these can disrupt your sleep cycle.
5. Stay Active: Regular physical activity can help you fall asleep faster and enjoy deeper sleep. Just be careful not to exercise too close to bedtime.

Sleep is the cornerstone of recovery. While supplements and other recovery hacks can be helpful, they cannot replace the fundamental need for quality rest. By prioritizing sleep, you can create the optimal conditions for your body to repair, regenerate, and recover from injuries. Whether you’re in physical therapy or focused on performance training, sleep is your best ally. Make it a priority and witness the transformation in your recovery journey.