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.

Why Wearing a Boot After an Ankle Sprain Can Make Things Worse

If you’ve been active most of your life, chances are you’ve sprained your ankle at some point. Maybe you went to urgent care, saw an orthopedist, or even a physical therapist in McLean, and were told to wear a walking boot.

It sounds logical to protect the injury, reduce swelling, and prevent further damage. But here’s the truth: in most cases, that advice can actually slow down your recovery and make it harder to return to the sports and activities you love.

When Is a Walking Boot Actually Necessary?

There’s a time and place for a walking boot. If you have a severe (grade 3) ankle sprain or a fracture, a short period in a boot may be appropriate to stabilize the joint and protect the tissues while they heal.

But those cases are rare. The majority of ankle sprains we see at our physical therapy clinic in McLean are mild to moderate. In these situations, wearing a boot can do more harm than good.

Why a Boot Can Make Your Ankle Worse

When you immobilize the ankle too soon, the muscles around it stop doing their job. The boot provides a false sense of stability, which causes your stabilizing muscles to become weaker and less responsive.

Over time, this leads to:

Muscle deconditioning and weakness around the ankle and foot
Reduced proprioception (your body’s ability to sense position and balance)
Joint stiffness that alters your walking and running mechanics
Compensations in other joints like your knees, hips, and lower back

All of these issues make it harder to get back to your sport — and increase your risk of re-injury.

What You Should Do Instead

If your sprain isn’t severe, you want to get the ankle moving early — safely and within a pain-free range of motion.

At Cohen Health and Performance in McLean, our physical therapists guide athletes through a structured plan that focuses on:

Restoring range of motion as soon as possible
Rebuilding strength through those ranges
Progressing to weight-bearing activities that retrain balance and coordination
Integrating dynamic drills like single-leg squats and plyometrics
Preparing for sport-specific demands (cutting, sprinting, decelerating, etc.)

Whether you’re a runner, tennis player, or field-sport athlete, this approach ensures your ankle not only heals but becomes stronger and more resilient than before the injury.

The Smart Way to Recover from an Ankle Sprain

Even though ankle sprains are common, they shouldn’t be ignored. Trying to “play through” the pain or relying on a boot too long can lead to chronic instability, recurring injuries, and even new pain elsewhere in the body.

The best thing you can do is get a proper evaluation from a licensed physical therapist who understands the specific demands of your sport or activity.

At Cohen Health and Performance, our team helps athletes and active adults in McLean and Bethesda recover faster, move better, and perform at a higher level, without unnecessary time in a boot.

Ready to Get Back on Your Feet?

If you’ve recently sprained your ankle or are still dealing with stiffness and pain from an old injury, we’d love to help.

👉 Schedule an evaluation today and get a customized plan designed to help you return to what matters most. Pain-free movement, strength, and confidence on your feet.

Surgeon Says “You’re Cleared.” What That Really Means

At Cohen Health and Performance, we see this all the time.

A patient walks in excited because their orthopedic surgeon just told them, “You’re cleared.”

For the athlete or for a parent of a young athlete that sounds like great news. It feels like full steam ahead, time to get back to the field, the court, or the gym.

But being cleared by your surgeon doesn’t necessarily mean your body is ready for the demands of your sport.

That’s where our team at Cohen Health and Performance, providers of expert physical therapy in Bethesda, comes in.

What Your Surgeon Means by “Cleared”

When your surgeon clears you, it’s a medical milestone. It means:

The surgery was successful.
Imaging and MRI results look good.
Your range of motion has returned.
You’ve regained a basic level of strength.

In other words, your surgeon’s focus is on whether the surgical site has healed and whether you’re safe to start progressing again. Their job is to make sure the repair looks good, moves well, and passes basic checks.

But that doesn’t mean your body is fully prepared for the demands of your sport.

Why “Cleared” Doesn’t Always Mean “Ready”

Let’s take a closer look at what happens in those follow-up visits.

Your surgeon might test your strength by asking you to hold your arm or leg in a fixed position while they apply pressure. If you can resist them without pain or weakness, that box gets checked.

The problem? That’s not how sports work.

Sports are dynamic. You’re not holding a static position. You’re cutting, sprinting, jumping, landing, throwing, or reacting at high speed. Your body must not only produce force but also control and absorb it repeatedly and efficiently.

That’s where the real risk lies after surgery. An athlete may appear strong in basic tests, but when it’s time to decelerate from a sprint or land from a jump, their body might not yet have the capacity to handle those forces safely.

Without that preparation, the risk of reinjury or injury elsewhere in the body skyrockets.

How Physical Therapy Bridges the Gap

This is exactly where advanced sports physical therapy in Bethesda plays a critical role.

At CHP, our job isn’t just to make sure your range of motion and strength look good on paper. It’s to determine if your body can handle the high-speed, high-load, fatigue-driven conditions of your sport.

We use a combination of clinical expertise and advanced sports technology, including VALD Force Plates, A-frames, and dynamometers to objectively measure how your body performs.

Some of the key things we assess include:

Force production: How much power can you generate through your repaired side?
Deceleration control: Can you safely slow your body down after a sprint or jump?
Symmetry: Are you unconsciously favoring one side more than the other?
Fatigue performance: Do you maintain good control and power when you’re tired?

These metrics tell us whether your body is actually ready for competition—not just whether your surgery has healed.

Every Sport Has Different Demands

One of the most important things we teach our patients is that every sport has its own movement and performance prerequisites.

A swimmer’s shoulder rehab will look completely different from a soccer player recovering from an ACL surgery.

A tennis player’s shoulder must tolerate explosive, high-velocity end-range movements.

A football player must absorb and redirect massive amounts of force.

That’s why at CHP, no two return-to-sport plans look the same. We build individualized programs that mirror the specific stresses and skills of your sport, helping you return not just healthy, but stronger, faster, and more resilient than before.

Fatigue: The Hidden Factor Behind Re-injury

Another key area we focus on is how your body performs when tired.

It’s easy to look great when you’re fresh but most injuries don’t happen during warm-ups. They happen when fatigue sets in late in the game, when your muscles and nervous system are under stress.

That’s why we test your ability to maintain strength, stability, and control under fatigue.

If your repaired side starts to fail once you’re tired, your risk of reinjury increases dramatically.

By building up work capacity and fatigue tolerance, we help you finish strong, no matter the score or the quarter.

The CHP Difference

At Cohen Health and Performance, our approach to physical therapy in Bethesda is centered on one goal: helping athletes safely and confidently return to the activities they love.

We combine one-on-one care, advanced testing technology, and individualized programming to make sure every athlete we work with is truly ready, not just medically cleared.

If you’ve been cleared by your surgeon but want to be confident that your body is ready for the next step, we’d love to help.

Contact us at Cohen Health and Performance today to learn more about our individualized physical therapy programs in Bethesda and McLean designed to help athletes move, feel, and perform at their best.

Free Weights vs. Machines: What’s Best for Your Training?

When I look back at the things I believed in college, I can’t help but laugh a little, especially when it comes to my views on weight training. At that time, I was all in on free weights and completely against using machines. If it didn’t involve a barbell or dumbbell, I didn’t want anything to do with it.

Fast forward to today, and my perspective has evolved. I still love free weights, but I’ve come to appreciate the value that machines can bring to a well-rounded training program. As a performance-focused physical therapy provider in McLean, I now help patients and athletes combine both methods for stronger, safer, and more effective results.

Why Free Weights Are So Valuable

Free weights will always have a place in great strength training programs. Exercises like squats, lunges, and deadlifts require balance, coordination, and total-body control. These movements train not just strength, but also stability and athleticism.

For example, a lunge closely mimics the way your body moves when you decelerate, cut, or plant during sports. This is one reason our sports physical therapy team in McLean uses these exercises with athletes returning to play after an injury. They have tremendous carryover to real-world movement.

The Case for Machines

That said, machines offer benefits that free weights can’t always match. For one, they’re less intimidating for beginners and have a lower learning curve. If you’re new to training or getting back into the gym after time off, machines allow you to move safely and confidently while you build your foundation.

But even for experienced athletes, machines have a valuable place. They make it possible to isolate specific muscles that may be weaker or underdeveloped. In physical therapy sessions here in McLean, we often see this after injuries.

Take knee injuries, for instance. It’s common for the quadriceps to lag behind the rest of the leg during recovery. A knee extension machine is an excellent way to directly target and rebuild that strength. By improving the muscle’s capacity to handle load, we help ensure that the knee and the athlete can perform at a high level without increased risk of re-injury.

How to Combine Both for Best Results

If you’ve ever walked into a gym where all you see are barbells, dumbbells, and kettlebells, you might think machines are “less effective” or even unnecessary. But the truth is that the most successful training programs use both free weights and machines strategically.

Free weights build functional strength and athleticism. Machines help strengthen weak links and support recovery. Together, they provide a complete approach that promotes performance, resilience, and long-term health.

Work with Our Physical Therapy Team in McLean

At Cohen Health and Performance, our physical therapy team in McLean specializes in helping active adults and athletes recover from injury, rebuild strength, and return to the activities they love. We take a scientific, individualized approach to training, using both free weights and machines when appropriate, to make sure every part of your body is prepared for the demands of your sport or lifestyle.

If you’d like help designing a program that’s customized to your needs, we’d love to help.

Contact us today to schedule an assessment and discover how our McLean physical therapy experts can help you train smarter, recover faster, and perform better.

Why Strength Training is the Missing Piece in Your Running Program

Today we have a special guest post from Dr. Elizabeth Farmer, our newest Performance Physical Therapist at Cohen Health and Performance Bethesda!

As a performance physical therapist and avid long-distance runner, I’m no stranger to the aches and pains that can threaten to derail a training plan or race goal. Over the years, both in my own training and while working with runners at Cohen Health and Performance, a leading provider of physical therapy in Bethesda, I’ve noticed something important: most “overuse injuries” are really under-preparedness injuries.

When aches or pains arise during training, it’s often because the body isn’t fully prepared for the stress of increased mileage or intensity. The good news? With the right guidance, you can build the strength and resilience needed to handle those demands, helping you run stronger and stay injury-free.

The Role of Strength Training in Preventing Running Injuries

Even the best running programs can fall short if they don’t include one key ingredient: strength training.

At Cohen Health and Performance, our Bethesda physical therapy team help runners develop strong, balanced, and durable bodies that can handle the demands of training. Strength training improves muscular endurance, running economy, and speed while significantly lowering the risk of injury.

How to Incorporate Strength Training Into Your Running Plan

Whether you’re a beginner or a seasoned marathoner, here are a few guidelines our performance physical therapists recommend:

1. Start Strength Training in the Off-Season

If you’ve never lifted before, the off-season is the perfect time to begin. It gives your body time to adjust (and recover from that initial soreness!). Studies show that it takes roughly 6–8 weeks to see true strength improvements, so the earlier you start, the better prepared you’ll be when race training ramps up.

Building the habit in your off-season also makes it easier to maintain strength workouts once your running mileage increases, a key principle we teach at Cohen Health and Performance through our Bethesda physical therapy and performance programs.

2. Keep Hard Days Hard, and Easy Days Easy

Your goal should be to complement your running, not compete with it. We recommend stacking your strength workouts after your harder running days (like hills, intervals, or long runs). This allows your easier runs or rest days to stay truly easy and promotes recovery.

A good rule of thumb: always lift after running, not before, so you can perform your key running workouts with fresh legs.

3. Intensity Matters: Choose the Right Rep Range

If you’re short on time, focus on higher-intensity, lower-rep movements. Aim for 2–3 sets of 6–12 reps at a difficulty level that feels like a 6–9 out of 10 on the effort scale. You should only feel capable of 2–3 more reps with good form at the end of each set.

This approach helps you get the most benefit from your workouts without spending hours in the gym, a philosophy we emphasize with our runners seeking sports physical therapy in Bethesda.

4. Essential Strength Exercises for Runners

Here are four lower-body exercises we often prescribe at Cohen Health and Performance to help runners build strength, stability, and resilience:

1️⃣ Single-Leg Depth Drop – Builds resilience when absorbing landing forces.

2️⃣ Bulgarian Split Squat (Front Heel Float) – Improves unilateral quad, glute, and hamstring strength while also challenging calf stability.

3️⃣ Copenhagen Plank – Strengthens the adductors and core to support pelvic control.

4️⃣ Side Plank with Leg Lift – Targets hip stabilizers, crucial for preventing “under-preparedness” injuries.

Looking for Physical Therapy Near You in Bethesda?

If you’re a runner dealing with nagging aches or simply want to improve performance, our team at Cohen Health and Performance in Bethesda can help. We specialize in sports physical therapy, strength training for runners, and performance optimization, all under one roof.

Our Doctors of Physical Therapy provide one-on-one, 60-minute sessions designed to help you move better, recover faster, and perform your best.

Ready to take your training to the next level?

Contact us to schedule your session today and experience why so many athletes searching for physical therapy near them in Bethesda trust us to keep them healthy and strong.

Sports Physical Therapy Tips: How to Bench Press Without Shoulder Pain

The bench press is one of the most popular exercises in the gym. Walk into almost any weight room on a Monday and you’ll see athletes and adults alike lining up to get their reps in. But as common as the bench press is, it’s also one of the leading causes of shoulder pain in athletes and active adults.

At Cohen Health and Performance, we see this all the time in our sports physical therapy practice. Athletes love the bench, but their shoulders don’t always agree. The reason comes down to how the exercise locks the shoulder blades against the bench, reducing natural movement and placing extra stress on the front of the shoulder joint. Over time, this stress can lead to irritation, nagging pain, and even more serious injuries.

Why the Bench Press Can Cause Shoulder Pain

Unlike push-ups, where the shoulder blades are free to move, the bench press pins them down. That restriction limits mobility through the shoulder complex, forcing certain joints and tissues to pick up the slack. For many athletes, that means increased stress on the AC joint or the front of the shoulder. The result? Pain and frustration that keep you from training the way you want.

Sports Physical Therapy Solutions for the Bench Press

The good news is that with a few simple changes, you can still bench press effectively while protecting your shoulders. Here are the modifications we often recommend in sports physical therapy settings:

Narrow Your Grip
A slightly closer grip can take pressure off the AC joint and reduce pain.
Slow Down the Tempo
Adding a pause at the chest helps eliminate the painful “bounce” effect many lifters experience.
Limit Range of Motion
Using a chest pad or switching to a floor press reduces how far you lower the bar, which in turn decreases stress on the shoulders.
Switch Implements
Dumbbells usually allow for a more natural arm path and are often better tolerated than a barbell.
Adjust Angles
Keep your arms closer to a 45-degree angle instead of flaring them out wide, and vary bench positions (incline/decline) to spread out the stress.

When Modifications Aren’t Enough

Sometimes these adjustments aren’t enough. If you have limited shoulder mobility or strength deficits in key stabilizing muscles, the bench press will still feel uncomfortable. That’s where a physical therapist near you plays a critical role. A sports physical therapist can assess movement restrictions, identify weak links, and design a personalized plan to restore pain-free strength.

At Cohen Health and Performance, our team of Doctors of Physical Therapy specializes in helping athletes and active adults get back to training without pain. Whether it’s the bench press, squats, or sport-specific training, our goal is to keep you doing what you love, safely and at your best.

If you love the gym but shoulder pain is holding you back, don’t just push through it. Small changes can make a big difference—and if you need deeper solutions, a physical therapist near you can get you back to pressing stronger, healthier, and pain-free.

ACL Physical Therapy: How We Determine When It’s Safe to Return to Sport

Guest Post by Dr. Ethan Lennox, ACL Rehabilitation Specialist at Cohen Health and Performance (CHP)

One of the toughest challenges athletes face after ACL surgery is knowing whether they are truly ready to return to play. Getting this wrong can have serious consequences, not only a higher risk of re-tearing the repaired ACL, but also the possibility of injuring the other knee or sustaining a completely new lower body injury.

If you’re an athlete, parent, or coach navigating the ACL recovery process, this guide will walk you through the objective criteria that determine readiness for a safe return.

Why Time Alone Isn’t Enough

A safe return to sport after ACL surgery isn’t about simply waiting 6, 9, or 12 months. At CHP, our ACL physical therapy program goes beyond the calendar. We use specific benchmarks for strength, movement quality, knee health, and confidence.

For athletes in cutting or pivoting sports, we typically recommend at least 9–12 months before full competition, as research shows that early return carries a much higher risk of re-injury. Our goal is not just to “clear” an athlete, but to build a durable return that lasts.

What Really Determines Readiness?

1. Strength

Strength is the foundation of ACL physical therapy. But it’s not just about moving heavy weight in the gym. The question is:

Can the athlete produce strength quickly in the chaos of sport?
Can they tolerate the workload of practices and games?

We focus heavily on restoring quadriceps strength to sport-specific demands, not just symmetry between legs. A common benchmark is ≥ 3.0 Nm/kg of knee-extension torque relative to body weight. Symmetry matters, but hitting an absolute strength threshold is what keeps knees safe during high-speed stops and cuts.

2. Force-Plate Testing

Traditional field tests often miss hidden deficits. At CHP, our ACL physical therapy program uses force-plate technology to analyze how each leg produces and absorbs force during jumps, landings, and change-of-direction tasks. To learn more about our forceplates, check out this link.

We track asymmetry (aiming for ≤10%) and test both when athletes are fresh and fatigued. This helps us individualize rehab, catch weaknesses before they become injuries, and make safer clearance decisions.

3. Movement Quality

Numbers matter, but how an athlete moves under fatigue is just as critical. During ACL rehab, we look for:

Controlled deceleration
Proper knee and hip alignment
Strong trunk stability
Quiet, efficient landings at game speed

By combining movement analysis with force-plate data, we ensure athletes are not just strong on paper—but resilient in real game conditions.

4. Knee Health

A successful ACL recovery also depends on the joint’s response to load. Non-negotiables include:

Full, pain-free range of motion
No swelling or irritation after training
Zero “giving way” episodes

If the knee flares up as we increase intensity, we scale back. Just because the calendar says “9 months” doesn’t mean the knee is ready.

5. Confidence

Physical readiness means little without mental readiness. At CHP, our ACL physical therapy program uses validated questionnaires like the ACL-RSI (Return to Sport after Injury) to track confidence. Scores in the mid-60s or higher, paired with strong physical metrics, usually indicate safe readiness.

We also coach mindset—helping athletes rebuild trust in their body is just as important as rebuilding strength.

Clearance Does Not Mean Full Game Readiness

“Cleared” to return to sport means an athlete can begin practicing. It does not mean they’re ready for full minutes or their pre-injury role. Building back to game-day fitness requires another 6–12+ weeks of gradual progression:

Non-contact practice and controlled drills
Controlled contact with planned rest
Increased intensity and practice density, monitoring workload
Gradual introduction of limited game minutes

This measured progression is how we prevent setbacks and ensure long-term success.

How CHP Puts It All Together

At Cohen Health and Performance, our clearance testing includes:

Strength testing with precise benchmarks
Force-plate assessments for braking and propulsion
Movement quality reviews under fatigue
Knee health evaluation for calm, stable joints
Confidence tracking for mental readiness

From there, we design a stepwise return-to-play plan that gradually increases training load and game minutes while monitoring next-day knee response.

Our philosophy is simple: earn the right to do more, then prove you can repeat it.

If you or your athlete is recovering from ACL surgery, don’t settle for a clearance based only on time or basic hop tests. A true ACL physical therapy program should integrate strength, force-plate data, movement analysis, joint health, and confidence.

At CHP, our ACL specialists are committed to helping athletes not only return safely, but come back stronger than before.

If your athlete is working toward a safe, confident return to sport, our ACL rehabilitation team would love to guide the process. Contact us here.