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.

Is there a perfect sitting posture?

The Truth About Sitting Posture: Physical Therapy Tips for Preventing Neck and Back Pain

When it comes to preventing neck and back pain, most people have heard the usual advice: sit up straight, keep your feet flat on the floor, and support your lower back. While these tips can be helpful, they don’t tell the full story of how to sit comfortably for long periods.

The truth is, there’s no such thing as a “perfect” sitting posture, and that’s a key principle in physical therapy. In fact, the best sitting posture is one that constantly changes. Our bodies are designed to move, not remain still for long periods, whether we’re sitting, standing, or lying down. Just as you naturally shift your weight when standing, sitting should involve frequent adjustments to prevent discomfort and long-term issues.

Why Static Sitting Causes Problems

When we sit for long periods—especially while working or focusing on a task—we tend to lock into one position. This prolonged stillness can lead to tension, stiffness, and ultimately pain, particularly in the neck and lower back. This is where physical therapy plays a vital role: teaching us how to adjust our habits and posture to reduce the strain on our bodies.

Sitting in one static posture for too long, even if it’s “perfect,” is not ideal. The key is to introduce small, consistent movements that engage the muscles and reduce pressure on certain parts of your body. It’s not about sitting in one way forever; it’s about finding ways to keep your body active, even while seated.

Physical Therapy-Backed Tips for Comfortable Sitting

Here are two simple yet highly effective tips that can help you sit more comfortably during long periods of work or study:

1. Keep Moving: Small Adjustments Make a Big Difference
While it might seem counterintuitive, fidgeting while sitting can be beneficial. Making small adjustments—such as shifting your weight from side to side, crossing and uncrossing your legs, or adjusting the height of your chair—helps prevent muscle tension from building up.

Physical therapists often recommend this kind of regular movement because it engages different muscle groups, reducing strain on your lower back and neck. The more often you change your posture, the less likely you are to experience discomfort later in the day.

In fact, if you’re experiencing ongoing pain from sitting too long, a consultation with a physical therapist could help you learn more personalized movement strategies to relieve discomfort and prevent future issues.

2. Give Your Eyes a Break: The 20/20/20 Rule
There’s a strong connection between extended screen time and discomfort in the upper body, particularly around the neck, shoulders, and eyes. This is known as visual strain, and it’s a common issue in today’s digital world. When your eyes are fixed on a screen for long periods, it leads to tension that can affect your entire posture.

To alleviate this, optometrists recommend the 20/20/20 rule: every 20 minutes, take a 20-second break and look at something 20 feet away. This helps relax the muscles in your eyes and reduces tension in your upper body.

Incorporating this simple practice into your routine can significantly reduce the risk of neck and shoulder pain, especially if you spend a lot of time in front of a computer.

If you’re experiencing discomfort from long hours of sitting at work or school, I have great news. We’re offering a Low Back Pain Workshop on Saturday, October 5th at 9 AM. This workshop is perfect for anyone struggling with back pain and looking for immediate solutions that can be implemented at home or work.

During the workshop, we’ll cover practical strategies from physical therapy that you can use right away to relieve low back pain, improve your posture, and keep your body active—even when sitting for long periods.

Interested? Click here to sign up and get more information!

The most common sports injury in physical therapy right now

Physical Therapy for Fall Sports: Preventing Soft Tissue Injuries in High School Athletes

As fall sports kick into high gear, it’s no surprise that we’re seeing an increase in soft tissue injuries at our Bethesda and McLean physical therapy clinics. This trend is particularly noticeable among athletes involved in sports like football and soccer, where dynamic, multi-directional movements are essential. These activities often lead to soft tissue injuries, especially in the hip region, making physical therapy a crucial component of an athlete’s recovery and injury prevention strategy.

The Importance of Hip Muscle Balance in Physical Therapy

Field sport athletes rely heavily on their hip muscles to perform the various movements required in their sports. Unlike athletes who primarily run in straight lines, such as sprinters, these athletes need strong and balanced hip muscles to manage the demands of quick lateral movements, sudden stops, and directional changes. This is where physical therapy plays a vital role in maintaining muscle balance and preventing injuries.

The hip is controlled by four primary muscle groups:

– Glutes and Hip Flexors: Manage forward and backward movement.
– Abductors: Located on the outside of the hip, these muscles control side-to-side or lateral movements.
– Adductors: Found in the groin or inner thigh, these muscles also control lateral movement.

Sports that involve significant lateral movements, such as hockey and field sports, place additional stress on the abductors and adductors. If these muscles are not properly conditioned and balanced, overuse or strain injuries can occur, making physical therapy essential for maintaining strength and preventing injuries.

The Critical Strength Ratio in Sports Physical Therapy

One key aspect of physical therapy for athletes is ensuring a balanced strength ratio between the adductors and abductors to reduce the risk of groin injuries. Ideally, athletes should aim for a 1:1 strength ratio between these muscle groups. Research in physical therapy has shown that when the adductor-to-abductor strength ratio drops below 0.8, the risk of sustaining a groin strain increases by 17 times.

Maintaining this balance is crucial because an imbalance can lead to one group of muscles being overworked and more susceptible to injury. For instance, if the adductors are significantly weaker than the abductors, a common issue identified during physical therapy assessments, they may not provide adequate support to the hip during lateral movements, leading to a higher risk of groin injury.

Strengthening Exercises in Physical Therapy to Prevent Groin Injuries

To reduce the risk of groin injuries, athletes should focus on strengthening both the adductors and abductors through targeted exercises in their physical therapy routine.

1. Copenhagen Plank for Adductor Strength

– Objective: Strengthen the inner thigh muscles (adductors).
– How to Perform: Aim for 3 sets of 30-45 second holds.
– Why It Works: This exercise is highly effective at building up the adductor muscles, which are crucial for stability and control during lateral movements, a key focus in physical therapy.

2. DNS Side Plank for Hip Abductor Strength

– Objective: Strengthen the outer hip muscles (abductors).
– How to Perform: Try 3 sets of 12 reps.
– Why It Works: This exercise helps develop the abductor muscles, which are essential for maintaining balance and power during side-to-side movements, a critical part of physical therapy for athletes.

Ongoing Physical Therapy Assessment and Training

It’s important for athletes to regularly assess their hip strength throughout the season as part of their physical therapy routine. Hip strength can fluctuate due to the demands of the sport, making it essential to continually work on these muscles beyond regular practice sessions. Scheduling an assessment with a sports physical therapy specialist can provide valuable insights into an athlete’s hip strength and highlight areas that may need additional focus.

For athletes beginning fall sports, reducing the risk of groin injuries should be a top priority. By maintaining a balanced strength ratio between the adductors and abductors, and by incorporating targeted physical therapy exercises into their training routine, athletes can significantly decrease their risk of injury. This proactive approach not only helps prevent injuries but also enhances overall performance on the field or rink.

Remember, in sports, as in life, balance is key. By focusing on the strength and balance of your hip muscles through physical therapy, you’re setting yourself up for a successful and injury-free season.

If you or your athlete has suffered an injury at the start of this fall season, now is the time to take action. Contact us for a physical therapy assessment to understand the issue, address it effectively, and prevent it from escalating into a bigger problem that may keep you off the field longer.

A physical therapist in the wild! 3 of my personal upper body warmups

Incorporating overhead pressing exercises into my weight training routine is something I really enjoy, but I often find them a bit challenging.

My overhead mobility isn’t as good as I’d like it to be, and a significant reason for that is my stiff chest. I have a mild case of pectus excavatum, commonly known as bowl chest. This condition causes the sternum-the bone at the center of the chest-to remain depressed, creating difficulties during overhead movements.

While this condition varies in severity, it often leads to difficulties during overhead movements due to the restricted ability of the sternum to rise when pressing or reaching overhead. In an ideal scenario, the sternum should lift as you inhale and lower as you exhale. However, for individuals with pectus excavatum or a generally stiff chest, this natural movement is hindered, making overhead exercises more challenging.

It’s not just those with pectus excavatum who face these challenges. Many people develop tight chest walls from modern lifestyle habits such as prolonged sitting, slouching, carrying heavy backpacks, or simply spending too much time hunched over a desk. These habits can cause stiffness in the chest, limiting overhead mobility and increasing the risk of injury during exercises like the overhead press.

Physical therapy offers a comprehensive approach to improving overhead mobility, particularly for those dealing with stiff chests. Traditional stretching methods might not be effective in addressing the underlying issues that restrict movement. Instead, targeted exercises and warm-up drills can be instrumental in loosening the chest, enhancing mobility, and ensuring that the body is well-prepared for the demands of weight training.

Three Effective Warm-Up Drills for Improved Overhead Mobility

To address these challenges, incorporating specific warm-up drills into your routine is crucial. Here are three exercises that can help improve overhead mobility, especially for those struggling with a stiff chest:

1. Crab on Elbows: This exercise is designed to open up the chest and promote better sternum mobility. By supporting yourself on your elbows in a crab-like position, you can stretch the chest and prepare it for the demands of overhead pressing.

2. Hooklying Overhead Reach: In this exercise, you lie on your back with your knees bent and reach overhead. The goal is to enhance the connection between your breathing and your chest movement, encouraging the sternum to rise and fall with each breath. This drill not only improves mobility but also reinforces proper breathing techniques that are essential during overhead movements.

3. Yoga Pushup*: Combining the elements of a traditional pushup with yoga-inspired movements, the yoga pushup is excellent for improving overall shoulder and chest mobility. It helps in engaging the entire upper body while emphasizing the importance of controlled breathing and proper form.

The Importance of a Tailored Warm-Up Routine

A tailored warm-up routine that addresses specific areas of stiffness or weakness can significantly improve your performance and reduce the risk of injury. In physical therapy, we emphasize the importance of being intentional about your warm-ups. By incorporating exercises like the crab on elbows, hooklying overhead reach, and yoga pushup, you can specifically target areas that need improvement, ensuring that your body is fully prepared for the workout ahead.

Moreover, these exercises are not just about getting ready for the workout; they are about making long-term improvements in mobility and strength. Over time, consistent practice of these drills can lead to better overhead mobility, reduced discomfort, and enhanced performance in your weight training routine.

For anyone facing challenges with overhead pressing due to a stiff chest or conditions like pectus excavatum, physical therapy offers a range of solutions that can make a significant difference. By incorporating targeted warm-up drills into your routine, you can improve your overhead mobility, reduce the risk of injury, and enjoy the full benefits of your weight training regimen. Remember, being intentional about your warm-up is not just a preparation—it’s a critical part of your journey toward better physical health and performance.

This made physical therapist, Dr. Sneh, sad

Dr. Sneh, a great sports physical therapist and proud Minnesota native, is an avid Minnesota Vikings fan. This year, the Vikings drafted their quarterback of the future, JJ McCarthy, and the excitement among their fans is palpable. McCarthy has shown promising performance so far in the preseason—a time when rookies often struggle to find their footing.

Unfortunately, following his most recent preseason game, reports emerged that McCarthy had sustained a knee injury that would require surgery to repair a torn meniscus.

I commend the Vikings’ approach to handling McCarthy’s injury, as it offers valuable insights into how we should approach injuries in high school athletes.

The meniscus is a C-shaped piece of cartilage in the knee, acting as a shock absorber between the femur (thigh bone) and the tibia (shin bone). When an athlete suffers a meniscus tear that cannot be rehabilitated, they face three primary options:

Rest and Physical Therapy: This is the preferred option. The best surgery is the one that doesn’t need to happen, and that wisdom extends far beyond knee injuries. A skilled physical therapist, especially one experienced with athletes, begins by reducing pain, inflammation, and swelling, before moving on to restore range of motion and strength. Next, they guide the athlete through normal functional activities like walking and running, eventually progressing to sport-specific exercises.In addition, one of the most overlooked aspects of physical therapy is identifying the root cause of the injury. Why did it happen in the first place? Is there anything that can be done to reduce the risk of it happening again? A truly effective sports physical therapist has not completed their job until these questions are answered and addressed. It’s not just about returning to the “previous level of function”—sometimes, that may not be good enough!
Meniscectomy (Trimming the Torn Parts): In some cases, the meniscus tear cannot be repaired, and the damaged parts must be trimmed away in a procedure known as a meniscectomy. The upside is that recovery from this surgery is relatively quick, with athletes often returning to play in as little as 4-6 weeks, provided they receive proper post-operative physical therapy. However, the downside is that trimming the meniscus means there’s less cartilage left to protect the knee, which can increase the risk of early-stage arthritis and future knee discomfort.
Meniscus Repair (Fixing the Tear): If the meniscus can be repaired, this is generally the preferred option. During a meniscus repair, the torn pieces are stitched together, restoring the knee’s structure as closely as possible to its pre-injury state. This approach reduces the risk of early-stage arthritis and long-term complications but requires a lengthy rehabilitation process. Athletes often do not return to full sports participation until a year after the surgery.

McCarthy and the Vikings’ medical team chose to pursue a meniscus repair for his injury.

While Dr. Sneh was disappointed that he won’t be seeing his team’s promising young quarterback on the field this season, he was heartened by the team’s decision to prioritize McCarthy’s long-term health.

In professional sports, long-term health outcomes for players are often overshadowed by the immediate pressures to get back in the game. Historically, many athletes have opted for a meniscectomy—despite the poor long-term outcomes—because it allowed them to return to play faster.

During my time working with retired professional football players in Texas, I witnessed firsthand the consequences of these rushed decisions. Athletes who were at the peak of their careers just 10-20 years ago are now struggling with basic mobility. Many wake up in constant pain, even though they’re only in their 30s or 40s. I’ll never forget meeting a young man, someone I had watched on TV less than a decade earlier, who had already undergone a knee replacement.

While these are extreme examples, there’s much to learn from the Vikings’ approach to McCarthy’s injury.

The long-term health of young athletes must always be prioritized. It’s easy for a high school game or a college showcase to feel like the Super Bowl, but there will always be another opportunity.

We strive to instill this perspective in our athletes, though it can be challenging when an upcoming game or season feels like the most important thing in their world.

Prioritizing a young athlete’s long-term health may seem like common sense, but the reality can be complex. How can you be sure that an athlete isn’t risking their future by playing now?

That’s where we come in.

Many athletes seek our expertise for an assessment to determine if they’re ready to return to play without jeopardizing their long-term health and goals. If you have concerns about an athlete in your life this upcoming fall season, you know where to find us!

Natural selection and the Olympics

Recently, my wife and I went on a family vacation with the whole crew—my parents, brother, sister-in-law, niece, and nephew. While watching the Olympics, we found ourselves captivated by the swimming events, which brought back memories for my mom of my old swim team days.

I swam competitively until I was about 12, and I decided to retire while I was still on top (in hindsight that may have been a bad choice considering how much time I spent in physical therapy as a result of football injuries!).

Back then, I dominated the competition, but swimming didn’t ignite the same passion in me as other sports did.

My mom always believed I could have excelled in high school swimming and maybe even competed at an elite college level.

I love that she thinks so highly of me, but realistically, that wasn’t in the cards.

As a kid, I hit my growth spurts early, which gave me a physical edge over my peers during my swimming years. However, had I continued, they would have eventually caught up to me.

I’m of average height and don’t have particularly large hands or feet—traits that are significant advantages for elite swimmers.

If you’ve watched the Olympics, you might have noticed how different body types excel in different sports.

Swimmers tend to be tall, with long torsos relative to their legs, and they often have large hands and feet. They also have greater shoulder mobility, which helps them achieve the positions necessary for elite performance.

On the other hand, elite sprinters are usually stiff and springy, with a noticeable amount of muscle mass to generate bursts of power. Distance runners are typically taller, leaner, and have longer legs relative to their torsos—almost the opposite of swimmers.

At the highest levels of competition, natural selection tends to favor those with the ideal physical attributes for the sport. For a stark contrast, just look at the difference between USA Gymnast Suni Lee and USA Basketball Player Kevin Durant (there is a great photo of them together that you can find online).

Of course, physical attributes are just one piece of the puzzle. Becoming an Olympian requires immense talent, hard work, and unwavering commitment.

So, what should an athlete do if they love their sport but don’t have the ideal body type for it?

This is where sports physical therapy comes into play.

At the high school and collegiate levels, many athletes aren’t maximizing their potential. Generic, one-size-fits-all training programs often hold them back from fully utilizing their talents.

Moreover, even the most gifted athletes are liabilities to their teams if they aren’t consistently available to compete. Those who may not have the same physical gifts as their peers can gain an advantage by staying reliably injury-free and always being ready to compete. Sports physical therapy can play a crucial role in this by providing personalized treatment and injury prevention strategies.

A customized, scientifically designed training program, combined with sports physical therapy and injury prevention, can give any athlete the upper hand.

If you or your athlete are looking for that competitive edge, contact us—we can help you get there with a specialized sports physical therapy approach!

What we can learn from polyglots

My wife’s grandfather greeted me in Spanish the first time I met him. Later, he made some comments to my wife, mother-in-law, and father-in-law in Spanish. My in-laws claimed he wasn’t saying anything about me, but my wife thought it was too funny not to tell me what he said. At that moment, I decided that I was going to learn Spanish and wouldn’t stop until I could chat with him.

Sadly, he has since passed, but now my in-laws can’t make jokes in front of me without me knowing anymore!

I thought of this story while reading Dr. Adam Grant’s new book, Hidden Potential.

In it, he talks about how polyglots—people who can speak and think in multiple languages—learn new languages so quickly. The people he references in the book weren’t exceptional students in school, nor did they possess exceptionally high IQs. Their secret is that they seek discomfort. The more uncomfortable they are when learning a new language, the more they are learning. More discomfort equals more mistakes. More mistakes equal more learning opportunities and less chance of repeating them.

The same principle applies to physical therapy and movement. Our bodies continue to move in ways that are most comfortable until we force them to do something different. This stimulates our nervous system to learn new movements and expand our range of skills and strategies. The more movement strategies we have, the less likely we are to overuse a single method, thereby lowering our injury risk.

During my physical therapy evaluations, I assess my patients to determine which movement strategies they predominantly use. I then help by teaching them new ways to move so that the overused tissues or body parts can have a break. Physical therapy is about more than just treating injuries; it’s about preventing them and improving overall movement efficiency. By learning new movement patterns, patients can enhance their physical performance and reduce the likelihood of future injuries.

One of the most fascinating aspects of physical therapy is its ability to adapt to the needs of each individual. No two bodies are the same, and therefore, no two treatment plans should be identical. Physical therapists, like myself, take the time to understand each patient’s unique challenges and goals. This personalized approach ensures that the therapy is effective and relevant to the patient’s life.

For example, someone recovering from a sports injury might need a different set of exercises and strategies than someone dealing with chronic pain. Physical therapy addresses these differences by creating tailored treatment plans. These plans often include a combination of exercises, manual therapy, and education to help patients understand their bodies and how to care for them properly.

Another crucial aspect of physical therapy is the emphasis on patient education. Many people are unaware of how their daily habits and movements can contribute to pain and injury. By educating patients about proper body mechanics and movement strategies, physical therapists empower them to take control of their health. This knowledge not only aids in recovery but also helps prevent future problems.

Physical therapy is also deeply rooted in evidence-based practice. This means that the techniques and methods used are supported by scientific research and have been proven to be effective. Physical therapists continually update their knowledge and skills to provide the best possible care for their patients. This commitment to ongoing education ensures that patients receive the most current and effective treatments available.

Moreover, physical therapy is not just for those who are injured. It is also beneficial for individuals looking to improve their overall fitness and performance. Athletes, in particular, can benefit greatly from physical therapy. By identifying and addressing any movement dysfunctions, physical therapists can help athletes optimize their performance and reduce the risk of injury. This proactive approach allows athletes to stay at the top of their game and achieve their goals.

Naturally, these new movements feel foreign and may be uncomfortable to the ego, but they are necessary. When was the last time you had a movement assessment to determine how you can expand your movement capabilities and reduce your injury risk? If it has been more than a year, it may be time for a movement check-up!

If this is something you are interested in scheduling, contact us!