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.

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.

Cold plunges in physical therapy; worth it?

A few months ago, while on vacation, I was surprised and excited to find that our hotel had a cold plunge. Every morning, I would brave the cold temperatures for 10 minutes, feeling refreshed and ready for the day as soon as I got out. The invigorating chill seemed to shake off any lingering drowsiness, leaving me energized and mentally clear.

The Search for a Home Cold Plunge

When I got home, I found myself researching how I could have a cold plunge at home. I was determined to recreate that sense of vitality and well-being I experienced during my vacation. My initial search led me to various options, from high-end cold plunge tubs to DIY solutions involving stock tanks and ice. However, amidst this enthusiasm, I felt it was essential to investigate whether cold plunging genuinely works or if the benefits I felt were simply a result of the placebo effect.

Cold Plunges in Physical Therapy and Performance Training

If you follow any athletes, fitness influencers, or people in the health/wellness space, you have likely heard someone touting the benefits of cold-water immersion. Ice baths are often claimed to aid recovery by reducing inflammation, relieving sore muscles, and supporting immunity and mental health. These assertions intrigued me, prompting a deeper dive into the science behind cold plunging and its role in physical therapy and performance training.

The Theories Behind Cold Plunging

There are a variety of theories to support why cold plunging might be beneficial. Here are three of the more common ones:

1. Fluid Shifts: When the body is immersed in cold water, fluid moves away from muscles and inflamed or sore tissues into the circulatory system to be pumped away. This shift can potentially reduce swelling and speed up recovery, making it a valuable tool in physical therapy.

2. Cardiac Assistance: As fluid moves from inflamed tissues into the bloodstream, more blood is pumped into the heart. This increased blood volume helps the heart pump more efficiently, moving nutrients throughout the body faster and aiding in muscle repair and recovery, which is crucial for performance training.

3. Psychological Benefits: The soothing effect of cold water immersion can reduce the perception of fatigue, helping the mind stay sharp. The shock of cold water may also trigger the release of endorphins, improving mood and overall mental health, which can enhance both physical therapy and performance training outcomes.

The Evidence: Placebo Effect or Real Benefits?

On the surface, scientific theories such as these make sense, and recent trends suggest potential benefits. However, the research surrounding ice plunges remains inconclusive and has yet to prove that it provides notable benefits beyond the placebo effect. Studies show mixed results, with some indicating minor benefits in recovery and mental clarity, while others find no significant difference compared to other recovery methods used in physical therapy and performance training.

My Decision

So, what did I end up doing? I did not get a cold plunge. As the husband of a scientist, I would have had a hard time justifying an ugly tub sitting in the backyard without any solid evidence to back it up! My wife’s scientific rigor rubbed off on me, and I decided that more evidence was needed before making such an investment.

This isn’t to say you shouldn’t do an ice plunge. If you feel better after, and don’t have cardiovascular or other risk factors, go for it! Anecdotal evidence from athletes and wellness advocates can’t be completely dismissed, especially if you experience tangible benefits in your physical therapy and performance training routines.

Final Thoughts

Reflecting on my cold plunge journey, I realize that personal experiences and scientific evidence both play crucial roles in health and wellness decisions. While science provides a foundation of understanding, individual responses can vary. If cold plunges make you feel invigorated and aid your recovery, they might be worth incorporating into your physical therapy and performance training routine. Just remember to listen to your body and consult with a healthcare professional if you have any underlying health conditions.

For now, I’ll stick to other proven recovery methods like proper hydration, nutrition, and sleep. But who knows? If future research provides more conclusive evidence, I might just reconsider and take the plunge once more.

Common Myths About Physical Therapy – Debunked

Many people have misconceptions about physical therapy and those who have never experienced treatment often misinterpret what physical therapists can offer. The expertise of the physical therapy team at Cohen Health and Performance goes far beyond simple stretching routines. Here are 4 common myths about physical therapy that we hear at our Bethesda and McLean facilities.

Myth 1: “I Need a Doctor’s Referral to Go to Physical Therapy”

At least once a week I hear this one and I am always happy to shine a light on the most common physical therapy myth that we see. Thanks to legislation known as Direct Access, you can schedule an appointment with a physical therapist without needing a referral. The benefits of Direct Access are significant: faster treatment and less hoops to jump through. Instead of taking the extra time to see a physician, you can visit a physical therapy clinic and start receiving care immediately. This streamlined approach not only saves you time but also helps you address your pain or injury more swiftly.

Myth 2: “I can see another healthcare provider for physical therapy”

This is a dangerous misconception. Only licensed physical therapists are qualified to provide the specific care required in physical therapy. According to Move Forward PT, approximately 37 percent of people believe that any healthcare professional can perform physical therapy methods on patients. It’s crucial to understand that physical therapy requires specialized training and knowledge that other healthcare professionals do not possess.

Myth 3: “Physical Therapy Is Only for Injuries”

It’s a common misconception that physical therapy is solely for treating injuries. While treating injuries is a significant part of what physical therapists do, our scope of practice is much broader. Physical therapy can benefit a wide range of conditions and goals, from enhancing athletic performance to managing bone loss associated with aging. For example, at Cohen Health and Performance, we provide customized running analysis and training recommendations for runners looking to improve their performance or reduce future injury risk. Physical therapy is about improving overall well-being, not just recovering from injuries.

Myth 4: “Surgery Is More Effective”

Many people believe that surgery is the most effective treatment for pain relief. While, surgery is necessary in many situations, that is not always the case. Depending on the injury or health condition, physical therapy can be a more effective and less invasive option. For instance, conditions like low back pain or meniscus tears may respond better to physical therapy than surgery. Before opting for surgery, consulting with a physical therapist can help you explore all available treatment options. Physical therapy might offer a less risky and more holistic approach to pain management and recovery.

Unseen Benefits of Physical Therapy

Now that we’ve debunked these common myths, let’s explore the real benefits of physical therapy that often go unnoticed.

Enhanced Quality of Life

Physical therapists aim to improve your overall quality of life. This involves not just treating pain or injury, but also enhancing your physical function, mobility, and overall health. For athletes, physical therapy can optimize performance and prevent injuries, allowing them to excel in their sports.

Preventive Care

Physical therapy isn’t just reactive; it’s also proactive. Physical therapists work with patients to prevent injuries before they occur. Preventive care at Cohen Health and Performance often includes educating patients on proper body mechanics, developing strength and conditioning programs for sport, and providing ergonomic advice for work or daily activities. By addressing potential issues early, physical therapy helps you avoid future pain and injury.

Holistic Approach

Physical therapy takes a holistic approach to health and wellness. Physical therapists consider all aspects of a patient’s life, including their physical, emotional, and social well-being. This comprehensive approach ensures that the treatment plan addresses the root cause of the problem, not just the symptoms. For example, a physical therapist might recommend stress-reduction techniques or lifestyle modifications into a treatment plan to support overall health and recovery.

Personalized Treatment Plans

Each patient is unique, and physical therapists create personalized treatment plans tailored to individual needs and goals. This personalized approach ensures that the treatment is effective and aligns with the patient’s lifestyle and goals. Whether you’re an athlete looking to return to your sport, a senior aiming to maintain independence, or someone managing a chronic condition, your physical therapist will design a program that’s right for you.

Physical therapy is a dynamic and essential field that offers much more than most people realize. Physical therapists are highly trained professionals who provide comprehensive care that can improve your quality of life, prevent future injuries, and offer effective alternatives to surgery. By debunking these myths, we hope to shed light on the true value of physical therapy and encourage more people to take advantage of its many benefits.

So, the next time you’re dealing with pain, recovering from an injury, or looking to improve your overall health, consider seeing a physical therapist. You might be surprised at how much they can help.