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.

Is Aging Really the Reason Injuries Increase in Your 40s and beyond? A Sports Physical Therapy Perspective

One of the most common things we hear from patients in our McLean and Bethesda clinics goes something like this:

“I guess I’m just getting old.”

People come in with back pain, knee pain, or shoulder pain and immediately attribute it to aging. While age does play a role, it is often given far more credit than it deserves. In our experience providing sports physical therapy to active adults, aging is rarely the main reason injuries begin to pile up in your 40s and beyond.

More often, the real issue is how lifestyle changes affect your body over time.

How Aging Actually Affects the Body

There is no denying that the body changes as we get older. From a sports physical therapy standpoint, some of the most common age-related changes include slower tissue recovery, gradual declines in muscle mass and power if those qualities are not trained, and a reduced tolerance for sudden spikes in activity.

However, these changes are gradual. They do not suddenly appear when you turn 40. Chronological age alone does not determine how resilient or capable your body is. What matters far more is how consistently you prepare your body for the demands you place on it.

The Bigger Factor: Lifestyle Changes in Middle Age

For most active adults in McLean and Bethesda, the biggest shift is not physical aging but lifestyle.

Careers become more demanding. Family responsibilities increase. Time to get to the gym becomes limited. Sleep is often shorter and more interrupted. Nutrition can take a back seat to convenience.

Over time, these factors reduce how well the body is prepared for physical stress. Yet many people still expect their body to perform the same way it did years ago. This gap between preparation and demand is where injuries tend to occur.

In sports physical therapy, we often describe this as a capacity problem. Your body adapts to what you do consistently. If strength training, mobility work, and recovery are inconsistent, your capacity gradually decreases, even if you still consider yourself active.

Why Injuries Feel Sudden in Your 40s

Many injuries in middle age seem to come out of nowhere. A weekend pickup basketball game leads to a calf strain. The first ski trip of the season triggers knee pain. A return to running causes persistent Achilles or hip discomfort.

In most cases, these injuries are not random and they are not simply the result of aging. They occur because the body was not adequately prepared for a sudden increase in intensity.

As we get older, we tend to tolerate these spikes in activity less effectively. That does not mean you should avoid high-level activities. It means you need a more intentional approach to preparation.

How Sports Physical Therapy Helps Active Adults Stay Resilient

The goal of sports physical therapy is not to tell you to slow down or stop doing what you enjoy. The goal is to help you build and maintain the physical capacity needed to keep doing it safely.

For active adults in McLean and Bethesda, this often means consistent strength training two to three days per week, gradual progression instead of an all-or-nothing approach, and prioritizing recovery, especially sleep.

Addressing small aches and pains early is another critical component. Minor discomfort that is ignored often becomes a bigger issue over time. In sports physical therapy, intervening early can mean the difference between missing a few days and missing several weeks or months.

Aging Matters, But It Is Rarely the Main Problem

Aging does matter. But it is rarely the primary driver of injury. More often, injuries reflect a mismatch between what the body is prepared for and what it is being asked to do.

With the right plan, many of these issues are preventable and reversible. Sports physical therapy focuses on rebuilding strength, improving movement quality, and restoring confidence so you can continue to train, compete, and stay active well into middle age and beyond.

If you are an active adult in McLean or Bethesda dealing with recurring injuries, nagging pain, or the sense that your body is not responding the way it used to, sports physical therapy can help. A personalized approach that accounts for your lifestyle, goals, and physical demands can make a meaningful difference.

Your body is not broken. It may simply need the right inputs to perform at a high level again.

Back Pain Got You Regretting Yesterday’s Workout?

Back pain is one of the most common reasons active adults seek out physical therapy in Bethesda and McLean. A pattern we hear repeatedly sounds like this:

“My back feels great while I’m working out, but the next day it’s killing me.”

For many people, this is confusing and frustrating. If you felt strong and pain-free during the workout, why does your back feel stiff, sore, or even painful the following day? More importantly, does this mean you hurt yourself?

In most cases, the answer is no. What you’re experiencing is usually not an injury. It is a capacity and load tolerance issue, and understanding this distinction is critical to managing back pain effectively.

How Adrenaline Masks Back Pain During Exercise

During exercise, your body is flooded with adrenaline and other stress hormones. These chemicals temporarily increase pain tolerance, improve performance, and blunt symptoms. That is why you can lift heavy weights, move explosively, or push through intense workouts feeling strong and capable.

In the short term, your nervous system essentially turns down the volume on pain signals.

The problem shows up later.

Once the workout is over and those chemicals wear off, the tissues that were stressed beyond their current tolerance start to respond. This often happens hours later or the next morning, when you suddenly notice stiffness, soreness, or pain with simple movements like bending over or putting on socks.

This delayed response is one of the most misunderstood aspects of back pain physical therapy.

Why Next-Day Back Pain Does Not Automatically Mean Injury

Many active adults assume that pain equals damage. This belief leads people to panic, stop exercising, or avoid movements they enjoy. In reality, pain after activity is often your body’s way of signaling that the demand exceeded your current capacity, not that something was torn or broken.

Think of it like sun exposure. You might feel fine while you’re outside, but later that evening you realize you stayed out longer than your skin could tolerate. The solution is not to avoid the sun forever. It is to build tolerance gradually and dose exposure more intelligently.

Your back works the same way.

Load Tolerance and Why It Matters in Back Pain Physical Therapy

Load tolerance refers to how much stress your tissues can handle before symptoms appear. Your spine and surrounding muscles adapt positively to load when it is introduced progressively. Problems arise when demand increases faster than adaptation.

This is especially common when people:

Increase workout intensity too quickly
Add more weight or volume without adequate progression
Increase training frequency without adjusting recovery
Combine hard training with high life stress and poor sleep

High-intensity training performed for long durations can amplify this effect. Even if your technique is solid, your back may not yet be prepared to tolerate the cumulative stress.

Back pain physical therapy focuses on identifying these mismatches and correcting them, not simply chasing symptoms.

Why Avoiding the Gym Is Usually the Wrong Answer

After experiencing next-day back pain, many people respond by avoiding the gym altogether. While rest can calm symptoms temporarily, prolonged avoidance often leads to decreased strength, reduced tissue tolerance, and greater sensitivity to future stress.

This creates a cycle where the back becomes less resilient over time.

The goal of effective back pain physical therapy is not to remove load, but to apply the right load at the right time in the right amount. That is how long-term improvements happen.

Training Smarter Instead of Training Less

If your back pain consistently shows up after workouts but settles within a day or two, that is often a sign that your program needs refinement, not elimination.

Smarter training may involve:

Adjusting exercise selection
Modifying volume or intensity
Improving recovery strategies
Progressively loading the spine and surrounding musculature

A well-designed plan gradually increases your back’s ability to tolerate stress so that the same workouts no longer trigger symptoms.

This is one of the core principles of back pain physical therapy for active adults.

How Back Pain Physical Therapy Helps Active Adults

A comprehensive back pain physical therapy approach looks beyond where you feel pain and examines:

Strength and endurance of the trunk and hips
Movement strategies during loaded tasks
Training history and recent changes
Recovery capacity and overall workload

Rather than telling you to stop doing what you love, the goal is to help you return to lifting, training, skiing, snowboarding, and daily life with confidence and consistency.

If your back feels great during workouts but hurts the next day, that does not mean you are broken or that you should stop being active. In most cases, it means your current capacity does not yet match the demands of your training.

With the right progression, guidance, and strategy, your back can become more resilient over time.

That is exactly what high-quality back pain physical therapy is designed to do.

Performance Training for Young Athletes in Bethesda and McLean: What Parents Need to Know

Parents in Bethesda and McLean frequently ask us when their child should start performance training and whether it’s safe, age-appropriate, or even necessary. These are important questions, and ones we hear daily from families with active kids and young athletes.

As physical therapists and strength & conditioning coaches serving the Bethesda and McLean communities, our focus is not on lifting heavy weights early. The goal of performance training for young athletes is to build strong fundamentals, healthy movement patterns, and a positive relationship with exercise that supports long-term athletic development.

Is Performance Training Safe for Kids?

One of the most common concerns parents raise is whether performance training can stunt growth. Fortunately, there is no strong evidence to support this belief.

In fact, when you consider the forces kids experience during normal play. Running, sprinting, jumping, cutting, and landing, those forces often exceed what they experience in a properly supervised performance training environment.

Safe performance training in Bethesda and McLean comes down to:

Appropriate coaching and supervision
Smart exercise selection
Gradual progressions
Emphasis on movement quality over load

No responsible program is placing a young athlete under heavy weights. Instead, performance training focuses on control, coordination, and proper mechanics.

What Performance Training Should Look Like for Younger Athletes

For pre-pubertal athletes (roughly ages 9–12), performance training should prioritize learning how to move well. At our Bethesda and McLean locations, this includes:

Teaching proper movement patterns and technique
Improving balance, coordination, and body awareness
Building strength through safe, controlled exercises
Developing running mechanics, agility, mobility, and overall athleticism

Performance training is not just weightlifting. It’s a comprehensive approach to helping young athletes move efficiently and confidently, both in sports and daily activities.

Why Consistency Matters More Than Intensity

One of the biggest mistakes we see is treating training as a short-term season rather than a long-term process. For most young athletes in Bethesda and McLean, one to two performance training sessions per week, done consistently, produces far better results than training heavily for a few months and then stopping.

Equally important, training needs to be fun. Younger athletes benefit most from sessions that are engaging, playful, and appropriately challenging. When kids enjoy performance training, they are far more likely to stay consistent, and consistency is what drives long-term success.

Long-Term Benefits of Performance Training for Young Athletes

Athletes who begin performance training early often experience:

Better movement quality as they grow
Improved strength and coordination during adolescence
Fewer injuries over time
Increased confidence in the weight room during high school

We regularly see athletes from Bethesda and McLean who started training young enter high school, and even college, with a strong foundation already in place. This allows them to progress faster and train more effectively as demands increase.

Performance Training: The Big Picture

Performance training isn’t about pushing kids too hard or specializing too early. It’s about teaching young athletes how to move well, training consistently, and creating a positive environment around exercise.

When these foundations are built early, sport-specific and higher-intensity training can be layered in safely and effectively later on.

If you’re a parent in Bethesda or McLean looking for performance training that prioritizes safety, fundamentals, and long-term athletic development, our team would be happy to help guide your athlete in the right direction.

The Most Overlooked Reason Runners Keep Getting Injured

Repetitive soft tissue injuries are one of the most frustrating issues runners face. Calf strains, hamstring pulls, hip flexor pain, and lingering tendon problems often seem to appear out of nowhere, especially in runners who are otherwise consistent and motivated in their training.

One of the most overlooked causes of these injuries has nothing to do with mileage alone. Instead, it comes down to how close your body is operating to its maximum capacity during your runs.

Why Running Pace Matters More Than You Think

Imagine a car that can technically reach highway speed, but doing so requires maximum effort. Pushing it that hard, day after day, eventually causes things to break. Not because the distance is too long, but because the system is constantly operating near its limit.

The same principle applies to running.

If you are running close to your maximum sustainable speed just to hit your target training pace, your body is under significantly more strain. That strain is absorbed primarily by your soft tissues such as your calves, hamstrings, hip flexors, Achilles tendon, and connective tissue. Over time, this accumulated stress often leads to overuse injuries.

Two runners may complete the same 5-mile run at the same pace, but if one runner is operating at 80% of their maximum effort while the other is closer to 60%, the internal load on their bodies is very different.

This difference matters.

Why Faster Runners Often Stay Healthier

Elite and highly trained runners are fast, but more importantly, their speed ceiling is high. Because of this, moderate and long-distance paces require less relative effort. Their muscles and tendons are conditioned to tolerate higher forces, which makes everyday training less stressful on their bodies.

For recreational runners, this is where many training programs fall short.

A common assumption is that preparing for longer races simply means running more miles. While mileage is important, it is only one part of the equation. One of the most underutilized tools in injury prevention is strategic speed training.

How Speed Training Reduces Injury Risk

Speed training isn’t just about racing faster, it’s about raising the maximum speed your body can safely handle.

Incorporating interval-style workouts helps:

Improve force tolerance in muscles and tendons
Reduce strain during slower, longer runs
Improve running efficiency and resilience

A simple and effective example includes:

400-meter intervals on a track or measured flat surface
Running at a high effort (roughly 80–90%)
Taking longer rest periods to ensure quality movement and speed

The goal is not exhaustion. The goal is adaptation, teaching your body to handle higher forces so that everyday running feels easier and places less stress on vulnerable tissues.

Even runners training for half marathons or marathons benefit from this approach, particularly during the off-season or early build-up phases. As race day approaches, speed work often becomes less frequent while mileage increases, but having already raised your speed ceiling can dramatically reduce injury risk.

How Physical Therapy for Runners Helps

This is where physical therapy for runners becomes especially valuable.

At Cohen Health & Performance, we work with runners to:

Identify strength, mobility, and load-management limitations
Assess running mechanics and tissue tolerance
Design training strategies that reduce injury risk
Integrate speed work safely and progressively
Treat recurring soft tissue injuries at the root cause

Rather than simply addressing pain after it appears, our approach focuses on helping runners train smarter so injuries are less likely to occur in the first place.

Serving Runners in McLean and Bethesda

We provide specialized physical therapy for runners at our clinics in McLean, VA and Bethesda, MD, working with runners of all levels, from recreational athletes to competitive endurance runners.

If you’ve been dealing with recurring calf strains, hamstring tightness, hip flexor pain, or feel like your body breaks down whenever you increase training intensity, it may be time to take a closer look at how you’re training, not just how far you’re running.

Our team helps runners stay healthy, improve performance, and continue progressing toward their goals without constantly being set back by injury.

If you’re looking for expert physical therapy for runners in McLean or Bethesda, we’re here to help.

Why Being Pain-Free Does Not Mean You Are Ready to Return to Sport

A Sports Physical Therapist’s Perspective in McLean and Bethesda

One of the biggest mistakes athletes make during recovery is assuming that being pain-free means they are ready to return to sport. In reality, relying on pain alone as your return-to-play criteria is one of the primary reasons athletes suffer re-injuries or fail to perform at the level they expect once they return.

As a sports physical therapist serving McLean and Bethesda, this is something we see every week.

Pain-Free Does Not Mean Problem-Free

Think of your body like a car.

If the check engine light is on, something is clearly wrong. But when the light turns off, that does not automatically mean the underlying problem has been fixed. It simply means the warning signal is no longer active.

Pain works the same way.

Pain is an important early indicator that something needs attention, but the absence of pain does not mean your body is fully prepared to handle the demands of sport, training, or high-level activity.

Why Pain Is a Poor Standalone Return-to-Sport Metric

Pain is inherently subjective.

Everyone experiences and processes pain differently
Athletes are exceptionally good at masking symptoms
Many athletes underreport pain because they want to return to play quickly

More importantly, pain often resolves before true readiness returns.

What frequently lags behind pain relief includes:

Strength
Power
Neuromuscular control
Tissue tolerance
Fatigue resistance

This gap between how you feel and what your body can actually handle is where re-injuries occur.

What a Sports Physical Therapist Looks at Instead of Pain

At our physical therapy McLean clinic, we rely on objective criteria, not guesswork, to determine when an athlete or active adult is ready to return to sport or high-level activity.

Pain still matters but it is only one piece of the puzzle.

Objective Return-to-Play Measures We Use

A comprehensive return-to-sport process includes assessing:

Strength symmetry between sides
Power output, not just max strength
Rate of force development (how quickly strength can be produced)
Sport-specific movement capacity
Multi-directional control, not just straight-line movement
Repeated effort under fatigue, similar to game or practice demands

Athletes must demonstrate the ability to perform these tasks consistently, efficiently, and under conditions that resemble real sport, including fatigue and chaotic environments. Check out an article that we wrote here about the technology that we use at Cohen Health and Performance to ensure that we are assessing these criteria as objectively as possible.

Feeling good in a controlled rehab setting is not the same as being prepared for competition.

Why Stopping Rehab at “Pain-Free” Leads to Re-Injury

Being pain-free is a milestone, and an important one but it is not the finish line.

When rehab stops too early:

Athletes return with unresolved asymmetries
Performance expectations are not met
Injury risk increases dramatically
Confidence may exceed physical preparedness

This mismatch is what leads to setbacks, frustration, and prolonged time away from sport.

A More Complete Approach to Physical Therapy in McLean

If you are looking for physical therapy in McLean and Bethesda that goes beyond symptom relief and focuses on long-term performance, injury prevention, and confident return to activity, a comprehensive approach matters.

A qualified sports physical therapist should guide you through a process that:

Starts with pain reduction
Progresses through strength and control
Builds power and fatigue tolerance
Prepares you for real-world sport demands

This is how athletes return not just safely, but successfully.

Ready for a Smarter Return to Sport?

If you are currently injured, coming back from an injury, or unsure whether you are truly ready to return to sport or high-level activity, working with a sports physical therapist who uses objective decision-making can make all the difference.

At Cohen Health & Performance, this comprehensive approach is exactly what we do.

Contact us today to learn how we help athletes and active adults in McLean return to the activities they love, stronger, more confident, and better prepared than before.

Therapy For Knee Pain: How to Prepare Your Body for Ski and Snowboard Season

Winter is here, and with it comes ski and snowboard season. After a fresh snowfall and a morning spent shoveling the driveway, I was reminded how quickly winter sports sneak up on us. I also thought back to a trip I took out west last year. It was an amazing experience, but I remember feeling more sore afterward than I had in years past.

As I approach 40, I have realized something many skiers and snowboarders experience. You cannot get away with the same preparation you once did.

If you ski or snowboard and deal with knee pain, or want to avoid it altogether, a little intentional preparation can make a significant difference. This is where knee pain physical therapy becomes especially valuable.

Why Skiing and Snowboarding Stress the Knees

Both skiing and snowboarding place repeated, high-load demands on the knees. Every turn, landing, edge change, and deceleration sends force through the knee joint. By the end of the day, fatigue sets in, technique changes, and the risk of pain or injury rises.

For snowboarders, rotational forces through the hips and knees are constant. Controlling the board requires the knees to tolerate twisting forces while staying stable. Skiers face repeated knee flexion and extension under load, especially when carving or navigating uneven terrain.

If you have ever noticed your knees becoming sore late in the day, struggling to carve clean turns, or feeling stiff after a trip, those are signs your body may not be fully prepared for the demands of the sport.

Our team sees this every winter, which is why knee pain physical therapy is one of the most common reasons skiers and snowboarders come into our clinics.

You can learn more about common causes of knee pain we treat here:
Knee Pain Physical Therapy in Bethesda and McLean

The Role of Strength, Endurance, and Control

One of the biggest misconceptions is that knee pain is only about weakness. In reality, skiing and snowboarding demand a combination of strength, muscular endurance, and control.

Most gym exercises are performed in mid-range positions for short sets. On the mountain, however, your knees live in deeper positions for long periods of time. This means your muscles must sustain force, not just produce it briefly.

In knee pain physical therapy, we often shift training to better match sport demands. This may include:

Longer sets with moderate loads to build endurance
Hinge-based exercises such as RDL and deadlift variations
Controlled rotational drills to improve knee and hip stability
Landing and deceleration training to prepare for jumps and terrain changes

Small programming changes like increasing reps from 5 to 10 or 12 can significantly improve how your knees tolerate a full day on the slopes.

Why Falls Matter for Knee and Joint Health

Falls are part of skiing and snowboarding. When they happen, the body often ends up in vulnerable positions. Knees, shoulders, wrists, and elbows are commonly exposed to sudden forces.

Most people train strength with their arms and legs close to their body. Injuries, however, tend to occur when limbs are farther away. Part of effective knee pain physical therapy includes preparing the body to tolerate force in these vulnerable positions.

This means incorporating drills that teach the body how to absorb force quickly and safely, helping protect the knees and surrounding joints when things do not go as planned.

If you have had a previous knee injury, this type of preparation becomes even more important. You can read more about how we approach post-injury knee rehab here:
Sports Physical Therapy for Knee Injuries

Do Not Forget About Ankles and Feet

Knee pain is often influenced by what is happening above and below the joint. Boots and bindings limit ankle mobility, which changes how force is transferred through the legs.

Snowboarders, in particular, know the burning sensation in the shins that can build up when riding the toe edge or getting stuck on flats. If the ankles and shins fatigue, the knees often compensate.

A comprehensive knee pain physical therapy program will address ankle strength, endurance, and control to reduce unnecessary stress on the knees.

Skill Level Matters

The demands on your knees vary depending on how you ski or ride. Higher-level skiers and snowboarders who ride steeper terrain or hit jumps experience much higher forces through the knees.

In these cases, plyometric training and controlled jumping drills are often incorporated to prepare the knees for rapid deceleration and landing forces. These drills are progressive and tailored to the individual, not random high-impact exercises.

This is a core principle of how we approach knee pain physical therapy for active adults and athletes.

Keep It Simple and Consistent

Preparing for ski and snowboard season does not require an overhaul of your workouts. In fact, simpler is usually better.

Choose two or three drills that closely match the demands of your sport. Spend five to ten minutes incorporating them into your warm up two to three times per week. This approach is often more effective than long, exhausting workouts that are difficult to sustain.

Consistency matters more than complexity.

When Knee Pain Physical Therapy Can Help

If you already have knee pain, a history of injury, or want a personalized plan to prepare for ski or snowboard season, knee pain physical therapy can help you address the root cause rather than just managing symptoms.

This is something we see consistently every winter at our Bethesda and McLean clinics. Our goal is to help you enjoy longer days on the mountain with fewer setbacks.

If you would like to learn more or schedule an evaluation, visit:
Schedule a Physical Therapy Evaluation

Skiing and Snowboarding Physical Therapy FAQs

Q: Why do skiers and snowboarders commonly experience knee pain?
A: Skiing and snowboarding place repeated rotational and impact forces on the knees. Fatigue, poor muscular endurance, limited mobility, or prior injuries can increase stress on the knee joint, leading to pain during or after time on the slopes.

Q: How can knee pain physical therapy help before ski season?
A: Knee pain physical therapy helps identify strength, mobility, and control deficits that increase injury risk. A targeted program improves knee stability, muscular endurance, and force absorption to better prepare the body for skiing and snowboarding demands.

Q: Should I do physical therapy even if I don’t currently have knee pain?
A: Yes. Preventive knee pain physical therapy can reduce injury risk, improve performance, and help you tolerate longer days on the mountain by preparing your joints and muscles for winter sport demands.

Q: What exercises help prevent knee pain for skiing and snowboarding?
A: Common exercises include hinge-based strength work, controlled rotational drills, landing mechanics training, and muscular endurance exercises. These movements better match the real demands placed on the knees during skiing and snowboarding.

Q: How often should I train to prepare my knees for ski season?
A: Incorporating 5 to 10 minutes of targeted knee-focused drills into your warm-up two to three times per week is often sufficient to build resilience and reduce knee pain risk.