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.

How a physical therapist will help you conquer knee pain

Decoding the Subtle Signs of Knee Pain: When to Seek Help

Knee pain often begins as a subtle, almost mysterious discomfort that doesn’t always require immediate attention from a professional. Many instances of knee pain develop gradually, remain mild, or appear after exercise, only to fade away with some at-home care. Simple remedies like rest, ice, compression, elevation, and careful use of anti-inflammatory medications are often the first line of defense against these occasional knee aches.

But how do you know when knee pain has escalated from a minor issue to something that requires professional intervention? The answer lies with skilled sports physical therapists. Their expertise, developed through rigorous training, allows them to determine whether knee pain can be managed with physical therapy or if it requires a physician’s care. Since physical therapy is usually more accessible and cost-effective than a doctor’s visit, it’s wise to consider a physical therapist as your first option for knee pain that persists beyond a week. If your symptoms last longer than this, it’s time to schedule an evaluation.

Understanding Knee Conditions That Physical Therapy Can Treat

Knee pain isn’t a one-size-fits-all problem; it encompasses a variety of conditions that physical therapy can effectively address. These range from sudden injuries to chronic issues, each requiring a specific treatment approach.

Meniscus Tear

The meniscus, which serves as the knee’s natural shock absorber, can suffer tears, but physical therapy is often a strong alternative to arthroscopic surgery. Recent studies show that physical therapy can provide results similar to surgery in improving knee function, even two years after the injury. The physical therapy approach combines muscle strengthening with stretching, focusing on enhancing the muscles around the knee to better absorb shocks and fine-tuning daily movements to reduce pain during activities like walking and squatting. This progression eventually leads to more advanced, sport-specific movements.

Knee Ligament Sprain

Similar to the treatment for a meniscus tear, a knee ligament sprain may initially require bracing or taping to support the knee, reduce swelling, and alleviate pain. The physical therapy plan for this condition includes strengthening exercises, improving range of motion, balance training, and gradually returning to pre-injury activities.

Osteoarthritis (OA)

For chronic conditions like knee osteoarthritis (OA), physical therapy focuses on strengthening the muscles around the knee, much like the supports of a building, to help them absorb daily impacts with ease. Stretching is essential to maintain the knee’s range of motion and protect it from further injury. Physical therapy may also involve modifying daily activities or refining movement patterns to reduce pain during routine tasks, such as standing up from a chair. A home exercise program, designed by a physical therapist, can serve as a long-term strategy for managing knee OA.

Patellofemoral Pain Syndrome

Patellofemoral pain syndrome is a complex condition that requires a thorough physical therapy evaluation. The cause could be anything from your footwear to the strength of your hips. Whether the solution involves foot orthotics to realign the patella or hip-strengthening exercises to correct knee alignment, physical therapy is tailored to address the specific factors contributing to this type of knee pain.

Physical therapists also play a crucial role in the rehabilitation of knee fractures, helping patients regain strength, flexibility, and the ability to perform everyday activities like walking and climbing stairs.

When to Seek Immediate Medical Attention

While many forms of knee pain can be managed with physical therapy, certain symptoms signal the need for immediate medical care:

– Inability to bear weight on your knee or bend it past a right angle
– Visible deformities in your leg or knee
– A feeling of instability, as if your knee might give way
– Persistent pain that doesn’t improve with home care
– Swelling and redness that don’t respond to elevation
– Severe tenderness in the calf, which could indicate deep vein thrombosis
– Swelling, redness, general malaise, and/or fever, which may suggest an infection

Choosing the Right Physical Therapist for Knee Pain

When seeking a physical therapist for knee pain, look for someone who specializes in sports and orthopedic injuries and has extensive experience with these conditions.

Physical therapy for knee pain is a blend of science and art, requiring a keen eye and a skilled practitioner. It combines expert knowledge, personalized care, and evidence-based practices—all aimed at restoring harmony to your knees and getting you back to your normal activities.

If you’ve read this far, you know there’s no better team than ours at CHP. Contact us today to schedule your physical therapy evaluation at our McLean or Bethesda facility!

Physical therapy for Swimmers part 3-Backstroke

Up next in our 4-part physical therapy for swimmers series is a crowd favorite, backstroke!

Backstroke is often the first or second stroke that a swimmer masters. It appeals to many swimmers by allowing them to breath through the entirety of the stroke and keep their face out of the water.

But, this does not mean that the backstroke is simple (we see many backstrokers as physical therapy clients in our McLean facility). Backstroke involves asymmetrical arm and leg motions, requiring coordination of upper and lower rotation around a fixed neck and head. This stroke requires strong shoulder external rotation, adduction, and a powerful kick to keep the swimmer afloat on their back.

If you’re curious about the differences in muscle groups between this stroke and the other’s we’ve already covered, here they are below!

1. Latissimus Dorsi and Rotator Cuff: These two upper-body muscles play a crucial role in backstroke by providing the primary propulsion during the arm pull phase. As you extend your arms outwards and sweep them in a circular motion, the rotator cuff initiates the “catch” and the lats engage to follow through, generating forward momentum.

2. Deltoids and Pectorals: Situated at the top of the shoulders, the deltoid muscles assist in raising the arm during the recovery phase. The pec major and pec minor are responsible for an efficient recovery out of the water to complete the propulsion phase. They help the rotator cuff in stabilizing the shoulder joint and contribute to the overall power and efficiency of each stroke.

3. Erector Spinae: Found along the length of the spine, the erector spinae muscles provide support and stability, especially during the kicking phase of backstroke. They help maintain proper body position and alignment in the water.

4. Quadriceps and Hip Flexors: While the arms perform the pulling motion, the legs play a crucial role in propulsion through the flutter kick. The quadriceps, located on the front of the thigh, and the hip flexors, situated at the front of the hip, contract and extend with each kick, driving the body forward.

5. Gluteal Muscles: The glutes, comprising the gluteus maximus, medius, and minimus, provide power and stability during the kick. They work in tandem with the quadriceps and hip flexors to generate propulsion and maintain body position.

6. Core Muscles: Last but certainly not least, the core muscles— including the abdominals, obliques, and lower back—play a vital role in backstroke. They provide stability and rotational control, allowing for efficient transfer of power from the upper body to the lower body and ensuring a streamlined position in the water.

Due to the heavy demand and unique position of the arm during the catch position of pull, the rotator cuff is the muscle group susceptible to overuse and injury with high volumes of backstroke swimming (the most common swimming injuries that we see in physical therapy with swimmers). Injuries to the chest and pectoral muscles are also common.

These muscles must be strong to prevent overuse injuries. Additionally, the hips and thoracic spine must be mobile so that the rotational movement of each stroke cycle can be done correctly.

Below are some exercises that help increase strength of the rotator cuff and pecs, as well as mobility drills that directly correlate to the movements required for backstroke!

1. External rotation focused shoulder strength: Targets the initial catch
– Rotator cuff screwdriver
– Kettlebell windmill

2. Adduction focused chest strength: Targets the final catch and recovery phase
– Standing chest fly

3. Thoracic spine rotational mobility: Important for efficient shoulder rotation to maximize the depth of the catch phase
– Wall thoracic rotations

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

CHP Spotlight Interview: Dr. Garry Ho

In the ever-evolving sphere of health and fitness, the quest to sidestep the scalpel in favor of less invasive approaches has directed us towards physical therapy and regenerative medicine.

I recently sat down with Dr. Garry Ho, a sports medicine specialist at OrthoVirginia. Dr. Ho doesn’t just see patients; he sees potential athletes in everyone, regardless of age. This perspective is refreshing, as recreational athletes search for the high quality of care, typically only reserved for the professionals. Dr. Ho’s collaboration with our physical therapy team at Cohen Health and Performance underscores a synergy that is pushing boundaries and redefining injury recovery, physical therapy, and fitness.

Why is it, you might ask, that burgeoning athletes—still green behind the ears—are succumbing to afflictions once reserved for adults? Dr. Ho sheds light on this conundrum, attributing it to a modern paradox: the pursuit of fitness through sport versus the foundational necessity of being fit to engage in sport. It’s a chicken-or-the-egg scenario that has far-reaching implications for our approach to physical therapy and training.

Physical therapy, in this narrative, is not just a reactive measure but a proactive toolkit. It’s about recalibrating our bodies, ensuring they are primed and ready for the demands we place on them, whether that’s chasing a soccer ball, sprinting down a track, or even just keeping up with our kids. The magic of physical therapy lies in its ability to tailor rehabilitation and conditioning to the individual.

In the vast expanse of information that is the internet, finding credible, actionable advice on physical therapy—or any health-related topic—can feel like searching for a needle in a haystack.

The mission of the CHP Spotlight Interview Series is to share information with you from local experts in the fields of sports medicine, physical therapy, personal training, and sports performance. Now, more than ever, a seemingly infinite amount of information is available, and finding credible information is challenging. But we have good news. We are here to help you find the best information about physical therapy, personal training, and sports medicine from experts in Bethesda, Chevy Chase, DC, McLean, and Northern Virginia.

To learn more about Dr. Ho, click here and check out our interview!

Couch to 5k and Beyond: Role of Physical Therapy in your running journey

Incorporating physical therapy into the regimen of a runner offers a comprehensive approach to not only mitigate the risk of injury but also to enhance performance, ensure proper rehabilitation post-injury, and maintain overall physical well-being. The expertise of physical therapists in movement science makes them indispensable in guiding runners through the complexities of training, recovery, and performance optimization. Here’s an expanded look at why physical therapy for runners is pivotal at every level.

Comprehensive Injury Prevention

The foundation of a successful running career, regardless of one’s goals, is the ability to stay injury-free. Physical therapists play a crucial role in this aspect by offering:

1. Preventative Assessments: Through detailed evaluations, physical therapists identify potential risk factors for injuries. These assessments delve into a runner’s biomechanics, including stride analysis, foot strike patterns, and overall body alignment. By pinpointing inefficiencies and imbalances, therapists can prescribe targeted interventions to correct these issues before they lead to injury.

2. Strength and Conditioning Advice: Runners benefit from tailored strength and conditioning programs designed by physical therapists to address specific weaknesses or imbalances. Strengthening the muscles used in running and those that offer stabilization can significantly reduce the risk of common injuries like IT band syndrome, Achilles tendinitis, and runner’s knee.

Effective Rehabilitation Strategies

When injuries do occur, physical therapy offers a path to recovery that is both efficient and focused on preventing future issues.

1. Personalized Rehabilitation Programs: Each runner’s injury and physical condition are unique, necessitating a customized approach to rehabilitation. Physical therapists design these programs to target the specific needs of the runner, employing a variety of techniques to accelerate recovery and ensure the injury heals properly.

2. Technique Modification and Education: Beyond addressing the immediate injury, physical therapists educate runners on proper running techniques and modifications to prevent re-injury. This education often includes adjustments to running form, strategies for effective warm-up and cool-down routines, and guidance on how to increase training load safely.

Performance Enhancement

Physical therapy isn’t just for recovering from injuries; it’s also about achieving peak performance.

1. Efficiency Improvements: By analyzing a runner’s biomechanics, physical therapists can identify areas for improvement that can lead to more efficient running mechanics. Enhancements in stride length, cadence, and posture can help runners use their energy more effectively, translating into better performance.

2. Customized Training Plans: Understanding the fine balance between training and recovery is vital for any runner looking to improve. Physical therapists can outline training plans that incorporate adequate rest, cross-training, and targeted exercises to build strength and endurance without overtraining.

Holistic Approach to Runner’s Health

Physical therapists look beyond the mechanical aspects of running, considering the whole person to foster optimal health and performance.

1. Nutrition and Lifestyle Counseling: Proper nutrition, hydration, and sleep are paramount for runners. Physical therapists can offer guidance on these aspects, ensuring that runners are not only training effectively but also supporting their bodies with the right fuel and rest.

2. Stress and Mental Health Management: The mental aspect of running and recovery from injury is often as challenging as the physical. Physical therapists provide support and strategies to manage stress, enhance mental resilience, and maintain motivation—key components for long-term success in running.

3. Longevity in Running: By addressing issues early, providing targeted interventions, and educating runners on proper self-care, physical therapists help ensure a long and healthy running career. This includes adapting training and recovery strategies as runners age or as their goals and physical condition change.

Building a Supportive Community

1. Ongoing Support and Motivation: The journey of a runner is filled with highs and lows. Physical therapists stand as a constant source of professional advice, encouragement, and support. They celebrate the victories and provide perspective and solutions when challenges arise, making them invaluable partners in achieving running goals.

The Bottom Line

The role of physical therapy in running extends far beyond mere injury recovery. It encompasses a holistic approach to the runner’s health, aiming not only for the immediate resolution of injuries but also for the long-term prevention of issues, performance enhancement, and overall well-being. Physical therapists employ a multifaceted strategy that includes biomechanical analysis, personalized training and rehabilitation plans, lifestyle adjustments, and mental health support to help runners achieve their goals.

For runners, investing in physical therapy is investing in their passion, ensuring they can pursue it safely, effectively, and joyfully for years to come. Whether you’re just starting out, looking to smash personal bests, or aiming to run well into the future, physical therapy offers the tools, knowledge, and support to make those goals a reality. In the world of running, where every step counts, physical therapy ensures those steps are taken with confidence, strength, and resilience.

A more scientific approach to back pain physical therapy

In today’s fast-paced society, where the norm often involves juggling work, personal commitments, and social obligations, finding moments to relax can seem like a luxury.

Relaxation not only recharges our batteries but also plays a crucial role in enhancing outcomes in various areas, including physical therapy. However, this shift to a more sedentary lifestyle during breaks can have unintended consequences, particularly for those accustomed to being on the move. One common issue arising from extended periods of inactivity is back discomfort, a symptom familiar to many.

Research indicates a clear link between reduced daily movement and an increased risk of lower back pain. The human spine is engineered for movement, with the structures in our lower backs, especially our discs, relying on regular motion to receive proper nutrition and maintain blood flow. Being sedentary disrupts this essential process, potentially leading to discomfort and pain, especially for individuals with a history of lower back issues. During holiday seasons or any prolonged period of inactivity, the risk of experiencing lower back pain can significantly increase.

Given the increased risk of back pain associated with decreased activity, incorporating specific movements into one’s daily routine becomes paramount. These activities are not only designed to mitigate discomfort but also aim to activate the spine’s stabilizing mechanisms, fostering a healthier back. As a part of a “movement break,” the following exercises can offer significant benefits:

Spinal Segmentation: This involves performing spinal waves in each direction, aiming for three waves. The exercise promotes flexibility and mobility in the spine, encouraging each vertebra to move independently. This can help alleviate stiffness and improve circulation throughout the back

Kettlebell Windmill (do not use a kettlebell if you don’t have one available):

Physioball Rollouts: Complete 2-3 sets of five rollouts, incorporating a breath at the top of each repetition. This activity strengthens the core and lower back muscles, supporting spinal health and reducing the risk of pain.

For those who find themselves struggling with chronic back pain, it may be time to consider a more structured approach to recovery. Back pain physical therapy offers a tailored solution to address the root causes of pain, employing a variety of techniques to improve mobility, strengthen the back, and ultimately enhance one’s quality of life.

Physical therapy for back pain encompasses a comprehensive evaluation to determine the specific needs of each individual, followed by the creation of a personalized treatment plan.

This plan may include manual therapy, targeted exercises, education on proper body mechanics, and strategies for pain management. Physical therapists specialize in understanding the complexities of back pain and work closely with patients to develop effective strategies for relief and recovery.

If you’re looking to address your back pain effectively, consider reaching out to a physical therapy clinic. For residents in the McLean or Bethesda areas, our clinics are equipped with the expertise and resources needed to tackle chronic back pain head-on. By setting up an evaluation for back pain physical therapy, you’ll be taking a crucial step towards regaining comfort and mobility, allowing you to return to the activities you enjoy without being held back by pain.

Remember, back health is vital for overall well-being. Taking proactive steps through physical therapy can not only alleviate current discomfort but also prevent future episodes of back pain. As we continue to navigate the demands of modern life, let’s not forget the importance of movement and the significant impact it has on our physical health, especially when it comes to maintaining a strong and healthy back.

A physical therapist’s role in performance training

Physical therapy plays an integral role in the world of sports, particularly for young athletes navigating the challenges of high school sports.

After opening our new facility in Bethesda, my return to treating patients has once again shown me the critical role that physical therapy and physical therapists play in the health, recovery, and performance enhancement of these young individuals.

Our afternoons are bustling with the energy of high school athletes, many of whom bring a fervor and intensity to their training that, while commendable, often needs a more informed approach to be sustainable and beneficial in the long term.

The Role of Physical Therapists in Youth Sports

Physical therapists specialize in understanding the complex dynamics of the human body, especially how it heals, adapts, and improves with proper training and rehab. In the context of high school athletics, a physical therapist’s role transcends mere rehabilitation; it encompasses prevention, education, and performance optimization. We see a common thread among young athletes: a passion for their sport that sometimes leads to overzealous training habits.

Overtraining: The Pitfall of Youthful Exuberance

The notion of overtraining is not new, yet it remains a prevalent issue among high school athletes. The invincibility felt by the youth can often lead to pushing their limits, participating in multiple teams, and juggling a demanding academic schedule. This relentless pursuit of excellence, while admirable, can lead to compromised techniques and an elevated risk of injuries. Herein lies the importance of physical therapy – guiding these athletes towards more mindful, strategic approaches to training that emphasize recovery, technique, and balanced physical development.

The Overlooked Aspects of Performance Training

In the age of social media, the allure of “exciting” training routines is undeniable. Yet, it is the foundational aspects of youth sports performance training – such as mobility, stability, and foundational movement skills – that often go overlooked. The basics don’t get a lot of likes on Instagram!

Physical therapists are adept at identifying these gaps and implementing training regimens that address these vital components. Exercises like Forward Bounds and Forward Hops are examples of specific drills that we use to teach essential skills, highlighting the need for a nuanced approach to training that balances the exciting with the essential.

The Need for Individualized Training Programs

Another critical area where physical therapists make a significant impact is in the development of individualized training programs. High school athletes, particularly those recovering from injuries, require tailored programs that consider their unique needs, strengths, and weaknesses. Generic training programs often do not address these nuances, potentially hampering an athlete’s recovery and performance enhancement. A physical therapist’s expertise in creating customized training plans is invaluable, ensuring each athlete’s journey towards optimal performance is both efficient and safe.

Encouraging a Holistic Approach

For athletes motivated to excel, the guidance of a physical therapist can be transformative. It is not merely about correcting mistakes but fostering a holistic approach to training that integrates physical wellness, injury prevention, and performance optimization. Our training programs embody this philosophy, offering young athletes a comprehensive foundation upon which to build their sporting endeavors. To learn more about our training programs, click here!

Physical therapy and physical therapists occupy a central role in the health and performance of high school athletes. Through their expertise in rehabilitation, injury prevention, and performance training, they guide young athletes towards more sustainable, effective training practices. The lessons learned extend beyond the gym or field, instilling a mindset that prioritizes overall health, well-rounded development, and the long-term enjoyment of sports. As we continue to support these young athletes at our Bethesda and McLean facility, the value of physical therapy remains abundantly clear – it is not just about rehabilitation but about fostering a generation of athletes who are as healthy as they are talented.