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.

X-Rays and MRIs don’t tell sports physical therapists the whole story

Medical images like X-Rays and MRIs are awesome and a helpful part of the sports physical therapy process. It’s like peering into the secret life of our bones and tissues, but sometimes what we see can be a bit startling.

Picture this: You’ve just got your X-Ray or MRI results. There’s a moment of truth, where you feel like your body’s betrayed you. Maybe you’re staring at an image that seems to scream ‘surgery!’ or ‘pain for life!’

But hold on – it’s not all doom and gloom.

X-Rays provide physical therapists with more general information, especially with bones. They show us the spacing between vertebrae in your back or if there’s a sneaky fracture hiding in there. But when it comes to the softer stuff – muscles, tendons, ligaments – they’re a bit out of their depth.

This is where the MRI comes in, providing more detailed information about our intervertebral discs and soft tissues. It’s high-resolution and insightful, but sometimes all this detail doesn’t help us.

Research has shown that many of us are walking around with meniscal tears in our knees or disc issues in our backs, completely unaware because we feel fine. Then there are times when we’re in pain, get scanned, and the images come back with a shrug – nothing significant.

When it comes to back pain, about 90% of it is ‘non-specific’. Translation: even with all our tech, we can’t pinpoint the exact cause in most cases. So, do these images really matter?

Well, yes and no.

They’re super valuable when they align with what you’re feeling – when the story your body is telling matches the tale spun by the images. But if you’re holding an X-Ray or MRI report that’s making you second-guess your body’s capabilities, take a step back. It’s just one piece of a much larger puzzle.

Even if an image shows something that looks bad, it doesn’t mean you’re destined for surgery, or a life of pain or inactivity. Our bodies are incredible at adapting and healing. As physical therapists and sports performance coaches, we’re detectives in a way. We look for the root cause of the damage and focus on fixing it, not just the symptoms.

If you’ve got an X-Ray or MRI that’s got you worried, it is important to understand why these issues popped up in the first place and discover what you can do about them.

It’s not just about getting out of pain; it’s about getting back to living your life and doing the things you love, regardless of what the images say. So, keep moving, keep exploring, and remember, your body’s story is much more than a snapshot on a screen.

Is sitting the new smoking? Probably not. Physical therapist guest post!

Check out this awesome guest post by one of our amazing sports physical therapists, Dr. Samuel Kinney. Sam is a Doctor of Physical Therapy at our McLean, Virginia location. Enjoy!

-Zac

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Many of our physical therapy patients grappling with lower back pain and hip discomfort find themselves stuck due to prolonged hours chained to their desks.

While some have experimented with sit-to-stand desks to break up static positions, this approach isn’t always effective. This strategy is rooted in the belief that sitting is a primary contributor to back pain, and standing will alleviate it.

However, scientific evidence doesn’t fully support sitting as a clear cause of back pain and an effective physical therapy recommendation. Claims circulating on the internet linking sitting to cardiovascular disease, diabetes, and cancer also lack conclusive backing.

If sitting isn’t the main culprit, what is? Scientific research suggests that a primary factor in back pain and related health issues isn’t excessive sitting but rather insufficient physical activity and exercise.

Those spending long hours seated at a desk without incorporating regular exercise tend to attribute their discomfort solely to sitting.

Let’s reframe the discussion. Sitting itself is not the problem, and it’s not equivalent to smoking. The real issue lies in the lack of activity and exercise during an 8-hour workday.

The solution I recommend is incorporating microbreaks or “movement snacks,” as I often mention to my patients. Many people adopt the Pomodoro Technique to enhance productivity. Essentially, you work for 25 minutes and then take a 5 minute break. Utilize those 5-minute breaks every 30 minutes or hour to move your body instead of staring at an Excel sheet.

These microbreaks should extend beyond merely stepping away from your workstation or engaging in casual conversations with your coworkers. They should involve activities that elevate your heart rate and promote joint mobility.

Here are some examples of microbreaks that we recommend to our physical therapy patients:

Boost your heart rate:

1) Climb 3-5 flights of stairs.
2) Perform 5 reps of body weight squats, toe touches, and glute bridges.

Get your joints moving:

1) Hip CARs (Controlled Articular Rotations).
2) Thread the Needle

By incorporating these short, targeted breaks into your day, you can reduce the impact of extended periods of sitting and promote overall well-being. Remember, it’s not about demonizing sitting but about maintaining a balance between sedentary work and physical activity.

This is why my physical therapy clients are tight

Are you one of those people have always had tight hamstrings, stiff hips, or struggled with your overhead shoulder mobility?

My sports physical therapy and performance training clients in McLean and Bethesda often report issues like this in addition to all the stretches they have tried to address them.

The problem with this approach is that the root cause of tightness often lies within the nervous systems response to our physical activities.

One extreme example comes from my interactions with NFL athletes. I observed a trend of mobility limitations, especially in ankle dorsiflexion (ability to bring the knees over the toes).

These top-tier athletes, whose routines predominantly involve sprinting and dynamic movements, rarely place their heels on the ground to fully lengthen the muscles on the backside of the lower leg. This continuous action results in a natural shortening of the calf muscles and Achilles tendons.

Here’s where the brain’s adaptive genius kicks in. To optimize performance, it creates stiffness in these muscles, producing a spring-like effect. This is a brilliant move for energy conservation and speed on the field. However, this adaptation, beneficial in high-intensity sports, can lead to an imbalance, pushing the body towards an extreme “all or nothing” movement pattern.

This, in turn, heightens the risk of injuries and reduces the body’s ability to perform a range of movements, outside their sport.

This principle isn’t just confined to athletes. Our brains adapt our mobility based on our routine activities. If we train repetitively in the same movement patterns, our mobility gets restricted in certain areas.

It’s crucial to train our bodies to be versatile, not just powerful, or efficient in a singular style.

In physical therapy, I emphasize the importance of integrating exercises that foster fluidity and ease of movement, rather than pushing the body to its limits constantly. Straining excessively or forcing every muscle to engage at once defeats the purpose of efficient movement.

Stretching alone isn’t the answer. The nervous system, a key player in movement patterns, can’t be simply overridden. The solution lies in addressing the root causes of these mobility restrictions.

Incorporating diverse, less strenuous exercises can retrain the brain and the body, allowing for a more balanced, injury-free physical state. Examples include single leg drills like a posterior tap down or step ups.
It’s about teaching our bodies to move in multiple ways, not just the way we’re conditioned for a specific sport or activity. This holistic approach to sports physical therapy and performance training is essential for sustained, optimal performance, both on and off the field.

If you have a long history of tightness or injury, schedule an evaluation to determine how you can incorporate these principles into your training routine!

2023: A Year of Growth and Reflection

This past year has been nothing short of transformative—both personally and for our physical therapy and sports performance practice.

In December 2022 (close enough to count!), we opened a new physical therapy clinic in McLean, led by our Clinic Director, Dr. Kelly Henry. As we continued to expand our presence in Northern Virginia, Dr. Samuel Kinney joined our team later in the year, further strengthening our ability to make an impact in the community.

November marked another milestone with the relocation of CHP Bethesda to a larger, more advanced facility, under the leadership of Clinic Director, Dr. Sebastian Bellitto. This cutting-edge space not only allowed us to grow our physical therapy offerings but also launched CHP Performance U, directed by Dr. Ethan Lennox. Performance U is our latest initiative, providing small-group sports performance training designed specifically for elite high school athletes aspiring to compete at the collegiate level. You can check out their festive, holiday-themed training session in the video below.

While 2023 was a year of expansion and progress for CHP, it was also a year of personal growth for me. I embraced discomfort and learned the importance of trusting our exceptional team to guide the ship forward.

However, my most valuable lesson from this year wasn’t about growth—it was about reflection.

I’ve often struggled with reflection, constantly focused on what comes next. While forward-thinking is essential, this single-minded focus has sometimes taken a toll on my mental well-being. This year, I made a conscious effort to slow down and reflect.

Looking ahead is crucial, but what’s the point if we don’t pause to appreciate the positive things we’ve accomplished along the way? As I reflect on this past year, I’m filled with gratitude for everything we’ve achieved at CHP and in my personal life. This includes our beloved pup, Reina, who has bravely battled cancer all year and continues to show incredible resilience.

As we step into 2024, I encourage you to take a moment to reflect on the wonderful experiences and accomplishments of 2023.

Here’s to a bright and fulfilling New Year!

Cheers!

Conquer the slopes: physical therapy for skiers

The air is crisp, morning frost is on the car windshield and the skin on my hands are cracking.

Winter is officially here and instead of just “surviving” winter, why not embrace and enjoy it?

It’s a fantastic time to embrace the great outdoors and stay active, especially when chilly weather tends to encourage a more sedentary lifestyle.

In McLean and Bethesda, several of our physical therapy clients have been preparing for the ski season. Their goals vary, from recovering from past injuries to simply wanting to be in top physical shape to handle the rigors of skiing.

It’s important to recognize that skiing is a demanding sport due to the unique constraints it places on the body.

Ski boots, while providing necessary support, significantly limit the movement of the ankle and calf muscles, unlike activities that involve running or jumping. These limitations shift more demand onto the knees and hips to control movement. This is reflected in the common ski-related injuries, with ACL and MCL injuries in the knee being particularly prevalent.

Beyond improving your skiing skills and avoiding falls, preparing your lower body for skiing is an effective strategy for injury prevention. As part of your physical therapy and exercise regime, consider incorporating the following exercises into a warm up before hitting the slopes:

Wall Squat Hold: Find a challenging position and perform 2-3 sets of 30-second holds. This exercise strengthens your thighs and glutes, crucial for maintaining stability while skiing.

Single Leg Drop: Execute 2-3 sets of 6 reps on each side. This exercise not only improves balance but also targets the muscles around the knees and hips, areas that bear the brunt of the workload while skiing.

Whether you’re an avid skier coming back from an injury or someone looking to enhance your physical fitness for skiing, incorporating these physical therapy exercises into your routine can make a significant difference.

Stay safe, enjoy the slopes, and make the most of this winter season!

This increases your groin injury risk by 17 times!

This week, we’re excited to feature another guest post by Dr. Samuel Kinney. Dr. Kinney is a performance physical therapist at our McLean location. You can learn more about Dr. Sam here.

As a sports physical therapist and someone who is passionate about maximizing human performance, I’m constantly intrigued by the unique challenges athletes face in different sports. Field sport athletes and hockey players, in particular, encounter distinct movement demands due to the dynamic, multi-directional nature of their sports.

Unlike athletes who primarily run in straight lines, such as sprinters, field sport athletes and hockey players rely heavily on their hip muscles. This continuous, varied use of the hips puts them at a higher risk of injury, especially in the hip and surrounding muscles. Gaining a deep understanding of the anatomy and demands of these sports is essential for both injury prevention and achieving peak performance.

The hips are driven by four primary muscle groups. The glutes and hip flexors manage forward and backward movement, while the abductors (located on the outside of the hip) and adductors (found in the groin or inner thigh) control lateral or side-to-side movements. Sports involving a lot of lateral movement, like skating, place extra stress on the abductors and adductors, making them more prone to overuse or strain injuries.

Maintaining a balance in muscle strength is crucial. Ideally, we aim for a 1:1 strength ratio between these muscle groups. If an athlete’s adductor-to-abductor strength ratio drops below 0.8, their risk of suffering a groin strain skyrockets by 17 times.

To reduce the risk of hip injuries, it’s essential for athletes to focus on strengthening both the adductors and abductors equally. Keep in mind that hip strength can fluctuate throughout the season, so it’s vital to work on these muscles beyond regular practice sessions.

Wondering about the strength ratio of your hips? I suggest scheduling an appointment with one of our sports physical therapy specialists to assess your hip strength. This proactive step could significantly reduce your risk of groin injuries during the season.

For those eager to start strengthening their adductors and abductors, here are two exercises to include in your routine:

1. Copenhagen Plank for Adductor Strength: Aim for 3 sets of 30-45 second holds. This exercise is excellent for building up your inner thigh muscles.

2. DNS Side Plank for Hip Abductor Strength: Try 3 sets of 12 reps. This exercise helps strengthen the outer hip muscles, which are essential for lateral movements.

Remember, whether in sports, physical therapy, performance training, or life, balance is key. By maintaining a balanced strength ratio in your hips, you’re not only preventing injuries but also optimizing your performance on the field or rink.