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.

Physical therapy for swimmers part 2-butterfly

Up next in our four-part series of physical therapy and performance training articles for swimmers is what most deem the most physically demanding stroke – the butterfly!

Mastering this stroke requires a blend of technique, endurance, and mental focus. Like breaststroke, the butterfly is another bilateral stroke, requiring a cyclical pull, recovery, and body undulation. The timing of the stroke is often what tricks new swimmers and the upper body strength required to get both arms above the plane of the water simultaneously. Butterfly requires strong and powerful shoulder extension and adduction and enough lumbar and thoracic spine extension to power through each stroke.

If you’re a physical therapy or performance training nerd like us and want to know all of the muscles primarily used in butterfly…here, they are! But, if you just wish to know what you should do to improve your performance in the water or address an injury, skip this section to see the videos below!

Upper body:

Deltoids and Pectorals: As swimmers extend their arms forward and outward, the deltoids initiate the motion, while the pectorals provide additional power during the pull phase. These muscles work in tandem to initiate the pull-through.
Latissimus Dorsi: During the butterfly stroke, the lats play a crucial role in the pull phase, generating power as the arms sweep downward and outward. Strong lats provide the driving force behind each stroke, allowing swimmers to maintain momentum and glide through the water with fluidity.
Upper traps and Rotator Cuff: To start the butterfly pull, the arms must recover over the head. The upper traps and supraspinatus are responsible for the shrugging motion that brings your arms over the water for the proper starting position. The rotator cuff muscles also play a crucial role in maintaining shoulder stability when overhead.

Lower body:

Quadriceps and Hamstrings: The quadriceps at the front of the thighs and the hamstrings at the back work together to execute the simultaneous kicking motion characteristic of the dolphin kick. As swimmers kick from the hips, these muscles generate force, driving the legs up and down in a coordinated rhythm. The hamstrings work in the opposite direction, enabling swimmers to maintain a steady kick throughout the stroke, maximizing speed and efficiency in the water. Both muscles are responsible for an effective “up beat” AND “down beat” kick.
Gluteal Muscles: The gluteal muscles, including the gluteus maximus, medius, and minimus, provide additional power and stability during butterfly swimming. These muscles support the hips and pelvis, allowing for a smooth and controlled kicking motion and appropriate amounts of hip extension for a powerful kick up-beat.
Core Muscles: The core muscles, including the rectus abdominis, obliques, and transverse abdominis, provide stability and balance as swimmers move through the water. These muscles engage to maintain a streamlined body position and facilitate the undulating motion characteristic of the butterfly stroke. A strong core also helps transfer power from the upper body to the lower body, maximizing propulsion with each stroke.

Due to the heavy demand on the upper body and upper back, shoulder injuries are commonly seen in physical therapy for butterfliers. Ensuring proper strength of the rotator cuff, back, and chest muscles is crucial to prevent overuse injuries and appropriately manage the force required to swim an effective butterfly. Additionally, mobility through the cervical and thoracic spine is essential to avoid the need to compensate and put more stress elsewhere.

To target or prevent shoulder and back pain caused by swimming butterfly, implement the following exercises into your strengthening program:

1. Rotator cuff stabilizing drills: targets overhead strength

2. Plank variations: targets dynamic shoulder stability and core strength

If you are a swimmer looking for ways to optimize your performance in the water or address an injury in physical therapy, contact us to learn how much more you can do to step up your game!

Understanding and Managing Shoulder Pain in Physical Therapy

The Anatomy of Shoulder Pain: A Widespread Issue

Shoulder pain is far from rare, affecting an estimated 18% to 26% of adults. This statistic highlights the vast number of individuals who suffer from discomfort or limited mobility daily. The shoulder, with its remarkable range of motion, is a complex joint, but its flexibility also makes it particularly vulnerable to injury.

Physical therapy is often a lifeline in these situations. Think of a physical therapist as a skilled architect for the body, understanding the intricate relationships between the bones (humerus, clavicle, scapula) and the web of muscles, tendons, and ligaments that support them. Their expertise allows them to guide patients from pain to recovery, restoring both function and strength.

The Role of Physical Therapy: A Comprehensive Approach

Physical therapy is more than just exercises and treatments. It’s a comprehensive discipline that blends education, injury prevention, and rehabilitation into one. The goal is not only to alleviate pain but to equip patients with the tools to avoid future injuries. Physical therapy is as much about building awareness and adapting habits as it is about healing.

Acute vs. Overuse Injuries: Two Common Causes of Shoulder Pain

Shoulder injuries typically fall into two categories: acute and overuse. Acute injuries result from sudden, unexpected incidents that cause immediate pain, such as a fall or strain. Overuse injuries, however, develop gradually over time due to repetitive stress on the shoulder. Physical therapy addresses both types with a range of strategies designed to promote healing and prevent future harm.

Physical Therapy Techniques: A Toolkit for Shoulder Recovery

Physical therapists have an array of techniques to aid in the recovery and strengthening of the shoulder. These methods are carefully selected based on the specific nature of the injury:

– Ice and Heat Therapy: By applying cold or heat, physical therapists can control inflammation and promote healing. Ice is used to reduce swelling in the initial stages of injury, while heat helps relax tight muscles and increase blood flow after inflammation subsides.

– Manual Therapy: Using hands-on techniques, therapists can manipulate the shoulder to break up scar tissue, improve mobility, and reduce pain. This method enhances the joint’s overall function.

– Strengthening Exercises: Core to any recovery program, strengthening exercises are designed to target the muscles surrounding the shoulder. Building muscle support helps reduce the risk of future injuries. Here are three common exercises used to enhance shoulder strength.

– Joint Mobilization: Physical therapists use specific movements to increase the shoulder’s range of motion, ensuring that the joints work as they should.

– Electrical Stimulation: By using electrical currents to stimulate muscles, therapists can prevent muscle atrophy, manage pain, and accelerate muscle recovery.

– Taping: Techniques like athletic or kinesiology taping offer support to the injured area, promoting proper movement and aiding in the healing process.

Ergonomics and Activity Modification: Preventing Future Injury

A key aspect of physical therapy is prevention. Physical therapists assess patients’ daily activities and ergonomics, recommending adjustments that can significantly lower the risk of re-injury. Whether it’s modifying a workstation or changing posture habits, these small changes can make a big difference in shoulder health.

Customized Physical Therapy Plans: A Tailored Approach to Wellness

Physical therapy is not a one-size-fits-all solution. It’s a personalized process where the therapist collaborates with the patient to create a program tailored to their specific needs. The regimen is based on the severity of the injury, pain levels, and individual recovery goals, ensuring a precise and thoughtful path to restored function and resilience.

Taking the First Step: When to Seek Physical Therapy

Recognizing the right time to seek physical therapy is essential. If shoulder pain persists for more than a few days or interferes with daily activities, it’s important to consult a physical therapist. Early intervention can prevent minor issues from escalating into more severe problems.

What to Expect from Physical Therapy

Your first session with a physical therapist is a crucial step toward recovery. During this initial evaluation, the therapist will gather detailed information about your condition, assess the shoulder’s functionality, and develop a treatment plan designed to meet your specific goals.

Interested in scheduling an evaluation with one of our experts? Don’t wait—contact us today to take the first step toward relief and recovery!

A missing piece of a runners training program

In the world of running and endurance sports, the integration of strength training into a regular fitness routine is not just beneficial; it’s essential. This article delves into the importance of strength training for runners, exploring how it enhances performance, the most effective approaches to take, and specific methods that yield the best results.

The Significance of Strength Training for Runners

Strength training goes beyond merely increasing muscle mass; for runners, it’s a critical component in improving overall performance, efficiency, and reducing injury risk. By focusing on core strength, lower body power, single-leg stability, and explosiveness, runners can significantly enhance their running mechanics. This not only leads to faster and more efficient running but also plays a vital role in injury prevention by ensuring the body can handle the repetitive impact of running.

Triple Extension: A Key Focus

A particularly effective method within strength training for runners is the emphasis on triple extension. This concept mirrors a critical moment in running – the propulsion phase, where the back leg pushes off the ground. Triple extension involves the simultaneous extension of the ankle, knee, and hip joints. This action is fundamental to creating a powerful stride transition, thereby enhancing the force generated with each step.

Practical Applications of Triple Extension

Incorporating triple extension into your strength training regimen can be transformative. Here are some practical exercises that focus on this concept:

Wall Load and Lift

This exercise is incredibly versatile, making it suitable for warm-ups, strength sessions, or even as a drill to refine triple extension coordination. It helps in reinforcing the proper alignment and mechanics needed for an effective push-off in running.

Explosive Deadlifts

By incorporating speed and explosiveness into traditional deadlifts, this exercise bridges the gap between standard weightlifting and running mechanics. It emphasizes the power generation aspect of the triple extension, crucial for improving running speed.

Kettlebell Swings

A staple in many strength training programs, kettlebell swings can be particularly beneficial for runners when modified to mimic the running dynamics. By using lighter weights and focusing on swift extension at the hips, knees, and ankles, this exercise directly translates to improved running performance.

Why Strength Training Matters

The benefits of strength training for runners are multifaceted. It’s not just about running faster; it’s about running smarter. Strength training:

Improves Running Economy: By increasing muscle strength and power, runners can achieve greater efficiency, meaning they use less energy to maintain the same pace.
Enhances Endurance: Stronger muscles can handle the demands of long-distance running more effectively, delaying the onset of fatigue.
Reduces Injury Risk: A well-rounded strength training program increases muscle and joint resilience, making runners less susceptible to common running injuries.

Conclusion

Incorporating strength training into a runner’s regimen is crucial for enhancing performance, efficiency, and injury prevention. Focusing on exercises that promote triple extension can significantly improve the power and mechanics of a runner’s stride. By embracing a comprehensive strength program that includes exercises like wall loads and lifts, explosive deadlifts, and kettlebell swings, runners can unlock their full potential. Ultimately, strength training is not just a supplement to running; it’s a cornerstone of a well-rounded running program.

Why swimming doesn’t help you avoid physical therapy

“I kept getting injured, so I started swimming.”

Dr. Kelly Henry here!

My physical therapy patient was frustrated when she saw me for her first physical therapy appointment. She ran recreationally and loved her group exercise classes consisting of various strength exercises.

But she had been struggling through several different injuries for months and was looking for a safer exercise alternative.

She started swimming, thinking that she found her solution. Unfortunately, her optimism was short lived.

Although it is less impactful on our joints, swimming isn’t without its fair share of injuries and I see many in McLean as physical therapy clients.

In fact, the repetitive nature of swimming strokes can lead to a variety of overuse injuries, particularly among competitive athletes. Recognizing the unique demands of each stroke and tailoring rehabilitation and strength training exercises accordingly is crucial for optimizing performance and preventing injury recurrence.

Competitive swimming comprises four primary strokes: freestyle, backstroke, breaststroke, and butterfly. Each stroke involves different biomechanics and engages specific muscle groups. Just as different positions on a football team require specialized training, swimmers specializing in different strokes benefit from individualized approaches to injury management and prevention.

Today, let’s start with breaststroke.

Part 1: Breaststroke

Among the four competitive strokes, breaststroke stands out for its complexity and technical demands, making it challenging to master (but my favorite stroke!). Central to the breaststroke technique is a bilateral coordination of arm and leg movements, executed in a rhythmic, cyclical pattern. However, it is the intricacies of the kick that often pose the greatest hurdle for novice swimmers. To achieve a legal breaststroke kick, swimmers must be able to access positions of simultaneous hip external rotation, knee flexion, and ankle flexion. This culminates in a rapid hip internal rotation moment “whip kick”, and a powerful propulsion forward.

Muscles Engaged in Breaststroke:

Upper Body:

Pectoralis Major and Deltoids: Initiate the arm pull, driving the circular motion that propels the body forward.

Lower Body:

Quadriceps and Adductors: Power the kick, providing significant forward propulsion.
Hip Flexors: Facilitate the kicking motion, aiding in lifting and extending the legs.
Core and Lower Back: Essential for maintaining stability and body position throughout the stroke cycle.

Despite its elegance, breaststroke is not without its risks. Medial knee pain and patellofemoral pain are common complaints among breaststrokers, stemming from the substantial demands placed on the knee, adductors, and quadriceps during the kick phase. Strengthening the hip rotators and hamstrings is crucial for mitigating these forces and promoting a strong internal rotation moment at the hips. Additionally, compensatory movements, such as excessive lumbar extension, can contribute to low back pain if left unaddressed.

To address and prevent knee pain, incorporating targeted exercises to strengthen the glutes, hamstrings, and adductors is essential. Consider integrating the following exercises into your training regimen:

Side plank variations: Targets core/abductors

Easier:

Harder:

RDL variations: Targets hip extension/hamstring strength

Easier:

Harder:

Bridging progressions: Helps address low back and hip positioning with the knees bent

Easier:

Harder:

By addressing muscular imbalances and improving functional strength, swimmers can enhance performance, reduce the risk of injury, and optimize their experience in the water. Stay tuned for the next installment of our series, where we will explore the biomechanics and injury considerations of another iconic swimming stroke.

Low Back Pain Physical Therapy

Physical therapy stands as a cornerstone treatment for most variations of lower back pain.

Our approach involves specialized exercises aimed at improving the body’s ability to control intra-abdominal pressure (the pressure we use to stabilize our low back), the lower back’s muscular endurance/loading capacity and conditioning the spine’s supportive structures.

Objectives for Therapeutic Intervention

The primary and secondary objectives for engaging in physical therapy for back discomfort are multi-tiered:

Alleviate pain in the lumbar region and any referred symptoms into the legs.
Improve functional capacity for day-to-day independence.
Improve dynamic spinal mobility.
Develop an exercise program designed to improve the low back’s stress tolerance

Don’t forget, the back often takes the brunt of the stress when other areas aren’t doing their job. These exercises are not isolated to the back but target the entire kinetic chain—interlinked segments of the body that collaborate for movement.

Therapeutic Outcomes

Patients in physical therapy first must get out of pain and return to their previous level of function. Comprehensive studies reveal that physical therapy can improve symptoms of lower back pain by up to 60%.

Exercise for Low Back Pain Management

Core Muscle Fortification

Central to mitigating lower back pain is the strengthening of core muscles, enveloping the abdomen, back, and the base of the lungs. A robust core ensures even weight distribution across the spine and optimal control of the intra-abdominal pressure that we use to stabilize the pain, thus mitigating pain. Targeted exercises like 90/90 hip lifts and bear positions are integral to this strengthening process.

Dynamic Lumbar Stability

Mobility and strength in the lumbar region and legs are crucial for spinal support. Specific stretching exercises that teach the spine to move at each of its segments helps to strengthen pivotal muscles, fostering stability, control and pain alleviation.

Cardiovascular Conditioning

Cardio exercises go beyond heart health—they rejuvenate spinal muscles, enhancing flexibility and mobility, essential for managing back pain. Activities such as walking and swimming are particularly effective.

Postural Help

Optimal posture can significantly reduce strain, with exercises designed to teach patients how to “stack” their head, rib cage and pelvis over one another help to reduce strain on the spine and contributes to spinal stability.

A Collaborative Therapeutic Journey

A physical therapist’s role is vital in creating a program that educates and trains patients in the execution of these exercises.

Physical Therapy’s Applicability to Different Types of Back Pain

Most lower back conditions are amenable to physical therapy, barring urgent medical scenarios. The specifics of the pain and injury determine the therapy regimen, catering to conditions ranging from axial back pain to sciatica and postoperative recovery.

Program Duration and Complementary Therapies

The length of therapy depends on pain severity, often commencing with an eight-week guided program, followed by a home-based continuation. Back pain physical therapy might be augmented with other treatments such as massage, manual therapy, acupuncture, and in some cases, injections or medications, alongside self-treatments like heat and cold therapy for pain mitigation and tissue healing.

Physical Therapy FAQs: I’m Sore. Can I Still Train?

Today we have a special guest post from Dr. Kelly Henry. Dr. Henry is the clinic director and a sports physical therapist in our McLean facility. Enjoy!

“I’m sore – I shouldn’t train, right?”

As sports physical therapists and performance coaches, we frequently encounter this question, especially when people begin a new exercise regimen or return to activity after a break. Delayed Onset Muscle Soreness (DOMS) often accompanies these transitions, typically appearing 24-48 hours after activity.

Muscles ache, movement becomes uncomfortable, and tightness sets in. Despite the discomfort, DOMS is usually not a cause for concern. It’s simply a side effect of the muscle breakdown and the repair process that facilitates adaptation to exercise.

You obviously shouldn’t be training if you are sore right? Wrong! Training through DOMS offers several benefits:

Improved adaptation: Exercising in a fatigued state prompts muscles to adapt, leading to enhanced strength and endurance over time.
Temporary symptom relief: Exercise often temporarily alleviates DOMS symptoms as muscles warm up and blood flow increases, aiding in the repair process.
Enhanced recovery: Regular training can make muscles more resilient, reducing the frequency and duration of soreness and allowing for better adaptation to increased workloads.

However, rest days remain crucial. How sore is too sore? Here are some guidelines:

Does soreness diminish after your typical warm-up?

- If yes, proceed with your planned workout.

- If no, consider Active Recovery (low-intensity aerobic activity) or reducing training intensity.

If soreness persists after 10 minutes of Active Recovery, take a rest day.

If soreness is severe or persistent, or if you struggle to exercise without experiencing significant discomfort, it may be wise to seek additional assessment. Your sports physical therapist can evaluate your level of soreness to determine its root cause, adjust your exercise program to minimize discomfort, and ensure it aligns with your goals and capabilities.