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.

5 Mistakes Athletes Make Returning to Sport After a Shoulder Injury

Navigating the path through physical therapy and back to training after a shoulder injury is like threading a needle. It’s tricky and demanding, and if not done right, it can lead to setbacks. At Cohen Health and Performance, our experiences in McLean and Bethesda have given us invaluable insights into what works and what doesn’t. Here are five common errors that can derail your recovery journey in physical therapy.

Jumping the Gun: Increasing Workload Too Quickly

This is the big one. When athletes feel no pain or get the green light from their doctor, they often rush back to their previous training levels. But this excitement can quickly turn into a setback.

It’s crucial to educate early to prevent this. Feeling better doesn’t mean you are back to your pre-injury levels.

Progressive loading is critical. Develop a detailed plan that helps you slowly and progressively increase activity. This gives your shoulder a chance to acclimate to more stress and loading over time. Include physical therapy exercises to care for your rotator cuff and improve the movement capabilities of your scapula-thoracic joint and rib cage.

Start with 1 arm exercises

Everyone has a dominant arm, but rushing into bilateral exercises like bench presses and pull-ups requires addressing unilateral strength imbalances. After an injury, your body may be experiencing something called protective inhibition when the nervous system prevents you from fully activating the muscles of the injured arm. In addition, you may be experiencing weakness and atrophy from not using your injured arm for a period.

At Cohen Health and Performance, we use tools to measure force output and look for upper extremity strength to be symmetrical before moving to bilateral exercises. Ensuring that your strength is balanced can save a lot of headaches and prevent re-injury.

Treating the Symptom, Not the Cause

It’s easy to focus on the source of the pain, but it’s vital to look at the bigger picture. Ask yourself: What caused this shoulder injury?

There are numerous factors to look at here, but we’ll discuss a couple common issues.

Let’s start by looking assessing an athlete’s overall workload. Many are consumed by games, practices, and workouts without sufficient recovery built in.

In addition, their bodies may not be able to handle all the stress that they are asking of them. Many of our physical therapy patients do not have the movement capabilities and loading tolerance necessary to withstand the rigors of their sports schedules.

Lack of Individualized, Objective Return-to-Sport Programs

A one-size-fits-all approach needs to be revised. Every athlete is an individual with unique traits, strengths, and weaknesses. A personalized, detailed roadmap to recovery is needed.

Your athlete’s personalized program must start with their goals. Next, they must undergo a thorough assessment to determine their current situation.

The athlete’s goals are the destination, and the assessment is the starting point. The program is the roadmap to get them from the start to their destination.

Lack of Communication

Open communication with all parties involved (parents, coaches, physical therapists, trainers, and physicians) is essential for a triumphant return to sport. Everyone needs to be on the same page, which ultimately helps the athlete return to sport faster and safer.

At Cohen Health and Performance, we request to be in touch with an athlete’s coaches, parents, and other healthcare team members.

If you avoid these common mistakes, you’ll be back in the game stronger and more resilient than before your injury.

Are you seeking ways to overcome your shoulder injury and return to the field immediately? Contact us to get back out there ASAP!

2 Performance Training Exercises for Future College Athletes

In 2010, I was a graduate physical therapy student at Northeastern University and an assistant strength and conditioning coach with their varsity athletics program. The summer season was particularly exciting, as it marked the arrival of first-year student-athletes who were eager to begin their team’s rigorous strength and conditioning program.

As the new athletes arrived, our strength and conditioning staff advised me that many freshmen typically had limited sports performance training experience. This often left them lagging behind their more experienced teammates. They were right.

The incoming freshman athletes were noticeably unprepared in the weight room. Their initial performance assessments revealed significant weaknesses compared to their older counterparts. These deficiencies not only increased their risk of injury but also hampered their ability to perform at the high level required for collegiate athletics.

To address these challenges, we implemented a series of targeted exercises designed to build foundational strength and improve movement mechanics. Here are two key exercises we used to help prepare these athletes for the demands of collegiate sports:

Lateral Step Down: This exercise was crucial for developing lower body strength and enhancing single-leg stability. It involved stepping down laterally from a raised platform, which required the athletes to control the descent of their body. This movement is essential for efficient deceleration, a critical component during cutting maneuvers and other sport-specific movements. By mastering the lateral step down, athletes learned to manage their body’s momentum, reducing the risk of injuries such as strains and sprains during dynamic sports actions.

Split Stance Deceleration: Deceleration is a fundamental skill in many sports, and improper technique can lead to severe injuries, such as ACL tears. The split stance deceleration drill was designed to teach athletes how to decelerate effectively. We incorporated resistance bands into this exercise to increase the challenge and more accurately replicate the forces encountered during sports activities. Athletes practiced lowering their center of gravity and maintaining control, which is essential for preventing lower body injuries when stopping or changing direction quickly.

Reflecting on these experiences, I often wonder about the potential benefits if more high school athletes participated in comprehensive strength and conditioning programs before entering college. Such early preparation could significantly enhance their physical capabilities, reduce the risk of injuries, and give them a competitive edge over their peers.

High school athletes who engage in structured training programs are likely to arrive at college with a solid foundation in strength and conditioning. This preparation would not only impress their coaches but also increase their chances of securing playing time in their first year. Early exposure to proper training techniques can foster long-term athletic development, leading to improved performance and longevity in their sports careers.

At Cohen Health and Performance, we’ve recently expanded our Performance Division by launching Performance University (Performance U). In addition to complementing our sports physical therapy services, this small-group performance training program is specifically designed for elite-level high school athletes. Performance U tailors its training to meet each athlete’s unique needs, utilizing the latest advances in sports technology to optimize results.

If your child dreams of playing collegiate sports or if you are seeking the best training option available, Performance U is here to help. We are currently accepting new clients for our summer Performance U group, which begins on May 20th. To learn more about Performance U and how it can benefit your athlete, check out the video below or click here for more information.

How to know your athlete’s sports performance program is any good

Lately, I’ve noticed a nice change.

High school athletes better understand the importance of sports training during their off-season(s), most notably during the summer.

What a relief! In the past, I spent countless hours teaching my physical therapy clients about the importance of participating in a well-designed sports training program after they’ve hit puberty.

But now there is a new challenge.

Choosing the right performance program!

Young athletes have many different options, including different programs, coaches, companies, etc. So, how do you know which option is best?

Start by understanding the design of the sports performance program and who is directing it.

The Coach

When selecting a coach for your athlete, it’s crucial to prioritize experience, qualifications, and expertise. A coach should possess a deep understanding of athletes across various skill levels and abilities. This breadth of experience ensures that they can tailor their approach to meet the unique needs of each individual under their guidance. Moreover, qualifications play a pivotal role in ensuring the efficacy of the training program. Look for coaches who have obtained a college degree in a relevant field such as Kinesiology or exercise science. These degrees provide a solid foundation of knowledge in human movement, physiology, and sports performance.

Furthermore, certifications like the CSCS (Certified Strength and Conditioning Specialist) indicate that the coach has undergone rigorous training and testing in the principles of strength and conditioning. This certification ensures that they are well-equipped to design and implement effective training programs that prioritize safety and performance optimization. Additionally, access to a quality sports physical therapist can be invaluable in preventing injuries and addressing any underlying issues that may impact athletic performance. By prioritizing these qualifications and resources, you can ensure that your athlete receives the highest standard of coaching and support to achieve their goals.

The Program

When considering a training program for your athlete, it’s essential to evaluate its components to ensure comprehensive development and optimal results. Here are key elements that every program should encompass:

Goal Setting: Effective coaching begins with a clear understanding of the athlete’s objectives. Coaches must align training strategies with the athlete’s goals to measure success accurately. Without defined goals, progress evaluation becomes challenging.

Testing: A thorough assessment of the athlete’s current abilities is fundamental. Identifying strengths and weaknesses through objective metrics lays the groundwork for tailored training plans. Quantifiable data provides insights into progress and informs adjustments to optimize performance.

Research-Backed Programming: Cookie-cutter approaches won’t suffice. Each program should be meticulously crafted based on scientific principles and individual assessments. By integrating research-backed methodologies, coaches can design training regimens that address specific needs and sport-related demands effectively.

Facilities and Environment: The training environment significantly impacts motivation and performance. A well-equipped facility with adequate space fosters optimal training conditions. It should promote positivity and motivation, enhancing the athlete’s focus and commitment to improvement.

Re-testing: Continuous evaluation is essential for tracking progress and refining training strategies. Regular re-testing, ideally every 4-6 weeks, allows coaches to gauge advancements and identify areas for adjustment promptly. This iterative approach ensures that athletes stay on the right track towards their goals, with any necessary modifications implemented promptly to maximize results.

By ensuring that these components are integral to the training program, athletes can experience holistic development and tangible progress towards their athletic aspirations.

What options are available in the DMV?

You’re looking at it!

We’ve recently grown the Performance Division of Cohen Health and Performance, starting with Performance University.

Performance U is a small-group performance training program designed for elite-level high school athletes. It is tailored to your athlete’s needs and designed using recent advances in sports technology.

If your child dreams of playing collegiate sports or you’ve been searching for the best training option, we’ve got you!

We are accepting new clients for our summer Performance U group, beginning on May 20th! Learn more about Performance U by checking out the video below or clicking here!

Contact us if you are interested in hopping on a phone call with CHP’s Director of Sports Performance, Dr. Ethan Lennox, to learn more or partake in a free trial session!

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!