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 there one physical therapy intervention for running related foot injuries?

Ice baths, massage, compression socks, orthotics, rolling your feet out on tennis balls…

Have you tried one or more of these without much help?

This is Dr. Kelly, and as a passionate runner, sports physical therapist in McLean, and someone who doesn’t want to be interrupted by injury, I’ve learned foot pain is complex- there’s usually not “just one thing” contributing to it.

Here are a few things I’ve found to be most important in physical therapy when diagnosing foot injuries:

Foot Type, Biomechanics, and Shoe Type: Each runner has a unique foot structure and biomechanics. High arches, flat feet, overpronation, and supination can affect how your foot strikes the ground. It’s crucial to understand your foot type to choose appropriate footwear and support. Here is a link that better explains foot type. Ensure that your shoes provide adequate cushioning, arch support, and fit your foot shape properly. Regularly replacing of worn-out shoes is essential for injury prevention (recommended replacement after 400 miles of running).
Running Surface: The type of surface you run on can impact foot pain. Hard surfaces like concrete can be harsh on your feet, while softer surfaces like grass or trails offer more cushioning. Varying your running terrain can help reduce the risk of repetitive strain injuries.
Running Form and Mechanics: Variations in running form can strain muscles and joints differently. Understanding your form and what muscles are dominating during your run is important to building strength and endurance as well as overall mechanical balance. A Marching, Skipping, and Single leg hopping are great drills that help enforce foot strike directly under your center of mass and tendon elasticity while running.
Training Intensity and Volume: Overtraining or increasing your running intensity too quickly can stress your feet. Gradual progression and adequate rest are essential for preventing overuse injuries. In general, the best guideline to follow is to increase your volume by 10% per week.

Remember that everyone’s body is unique, and what works for one person may not work for another.

If you would like to finally solve the lower body injuries that are interrupting your ability to run successfully, don’t miss this FREE workshop..
“CHP’s Running Performance Lab”
Saturday, October 21st at 9am
Cohen Health and Performance
1401 Chain Bridge Rd, Suite 203
McLean, VA 22101

In this workshop, you will discover the root cause of your injuries and learn exercises to solve them.

We only have 5 slots left, so don’t miss your chance to sign up here.

New Bethesda location coming soon!

CHP-Bethesda is getting bigger and better!

I am so excited to finally tell you about our new physical therapy and sports performance facility in Bethesda. We are moving 2 miles down the road to 5272 River Road.

You may wonder why we moved so soon after opening our McLean facility.

Our new 3100-square-foot, state-of-the-art facility will allow us to have a sports performance center and physical therapy clinic. This will help us to continue our mission of helping active people like you conquer injury while providing opportunities to train in a setting like none other.

This amazing new facility is being built and is expected to open in mid-November.

Stay tuned for updates on our grand opening and all of the new services we will be providing at the new and improved CHP Bethesda!

P.S – If you need help with something now, we have openings available!

Fitness watches: what stats should you care about?

Dr. Kelly Henry here. I work with lots of runners in McLean as physical therapy and performance training clients. We all know a runner who is obsessed with their watch, and with all the technology these days, your fitness watch can tell you just about anything.

This is informative and overwhelming at the same time.

So many statistics are provided, but how many of them are relevant? And if they are relevant, what do they mean? After doing a deep dive into my own watch (a Garmin Venu Square), and some market research on other running watches’ statistics, here is what you should care about:

Resting heart rate

What this means: How fast your heart beats when you are not doing any activity.

Why you should care: A normal heart rate ranges from 50-100 beats per minute, but more importantly, your watch is learning what is normal for you. Fitness watches usually do a good job of tracking this. Knowing your resting heart rate is a good indicator for helping you determine what your heart rate should be when you’re exercising. A raised heart rate can indicate a number of things, but regarding your training, it can indicate overtraining and a lack of recovery.

Heart rate zones

What this means: Most fitness trackers divide your heart rate into Zones 1-5. These are determined based on your resting heart rate and a hypothetical maximum heart rate derived from a standard calculation.

Why you should care: You can use your heart rate zones to guide the intensity of your training. Most of your workouts should be performed in Zones 2-4. If you are performing cardiovascular exercise, exercising in Zones 1-3 will provide more of an aerobic benefit (lower intensity, longer duration), whereas Zones 4-5 should focus more on anaerobic systems and power development (fast runs, sprints, or interval training). If you aim to address certain improvements (speed vs. endurance), using heart rate zones can be a great objective way to determine how to adjust your perceived effort. Keep in mind heart rate can be impacted by other factors, including heat and time of training.

Cadence

What this means: Simply put, cadence is how many steps you are taking in one minute. Aka, how fast your feet are moving.

Why you should care: Measuring cadence helps to make you aware of your stride length and energy expenditure while running. A longer stride often results in a lower cadence and vice versa. Research has shown that patients with knee pain after running often benefit from a shortened stride by increasing stride length. An ideal cadence for most people is 170-180bpm (beats per minute).

Distance

What this means: How far you ran/walked/moved.

Why you should care: Tracking distance ensures that you are progressing your exercise appropriately and is one of the main things runners care about. While some people prefer time-based exercise, distance may be easier to track if you are working on maintaining a consistent pace. Tracking distance over time is important to ensure there is adequate training volume and can prevent over or under-training. Generally, you should aim for a ratio between 0.80-1.20 when comparing month-to-month averages. This means that the weekly average of this month’s distance is not less than 80% or more than 120% of the weekly average of last month’s distance. Your watch should calculate your weekly mileage for you! Use this mileage in the following formula:

(Week 1 distance + Week 2 distance + Week 3 distance + Week 4 distance) / 4 = Average Workload)
Then divide this number by the average workload from the previous month. This is more accurate for more experienced runners, while less experienced runners or those who run shorter distances may be able to increase their distance more liberally.

Heart Rate Variability (HRV)

What this means: The variation in time between heartbeats. Although our heartbeat is often described as a metronome, it is not. There are small differences in the intervals between each of your heartbeats, which are impacted by your sympathetic nervous system. HRV depends on multiple readings, including core body temperature, circadian rhythm, metabolism, and sleep cycle, to make the best estimate.

Why you should care: In a broad scope, increased HRV can be correlated with better aerobic fitness (if there is no underlying pathology). While it’s difficult to properly measure HRV strictly from a wearable, it can indicate training adaptations and improvements in cardiovascular health. HRV is good supplemental data but shouldn’t be the basis for any training changes since the sensitivity of this measurement is limited, and the most accurate HRV reading will come from a controlled clinical setting. Multiple comorbidities can impact HRV, including chronic pain, inflammation, insomnia, concussions, depression and anxiety, and other stress.

These 5 statistics only scratch the surface of what your fitness watch can do for you. If you are a runner searching for an advantage over your competition, schedule a consultation by replying to this email. In this consultation, she will help you determine how to use technology to your advantage and other ways to improve your performance.

What is that pinch in my hip?

Have you ever felt a pinching sensation in the front of your hip? This is one of the most common symptoms that our sports physical therapy hears from people with hip problems.

We hear about it from all ages and populations – field athletes, powerlifters, weekend warriors, etc.

Our physical therapy patients in Bethesda and McLean note that they feel an uncomfortable sensation in the front of their hip whenever they flex their leg, squat, or bear lots of weight on one side. This may happen during running, lifting weights, or getting on and off the floor.

The hip is a big, complex joint with lots of moving (and not moving) parts! “Pinching” symptoms often involve a few structures. Some to note are the hip labrum, the hip flexors, and the shape of your hip ball and socket itself. While it may be difficult to diagnose the exact cause of those symptoms, your physical therapist can perform a physical exam to differentiate what is giving you problems and how we can address this in physical therapy.

Often, it is a combination of the 3 factors above. Muscle testing, range of motion, and a deep dive into your symptoms and history inform us about the cause of your pain. Findings we see include:

1. Decreased hip flexion or internal rotation range of motion
2. Discomfort and difficulty with deep squatting or lunging
3. Weakness of the hip flexors, abdominals, or hip abductors/adductors

But why does this happen?

As mentioned, the hip is a big, complex joint supporting much of your body weight. As we move throughout the day, from walking to running to sitting to standing, our hips and pelvis adapt to the changes in the load being placed on them. Our joints are lined with cartilage that helps absorb shock and protect the joint. The muscles around our joints help to manage additional stress and decrease the amount of pressure on the joint. If one of these three pieces is affected – the hip labrum (cartilage), the hip muscles/tendons, or the bony structure of the joint itself, the other pieces will be affected as well. This can progress to labral tears, hip flexor tendinopathy, and chronic hip impingement symptoms.

In simple terms (although none of this is simple!), there is too much pressure in one spot. As physical therapists, our job is to teach you how to manage this pressure better, protect the structures that are giving you problems, and gradually progress you back to the activities that you want to do while respecting the healing process. A few interventions we use to do this are:

1. Hip range of motion drills

Hip flexor/adductor isometric strengthening

Dynamic hip flexion progressions

If you have been experiencing a consistent pinching sensation in the front of your hip, see a healthcare professional, preferably a sports physical therapist. These symptoms commonly become more intense and limiting over time. Contact us now for help solving your chronic hip discomfort!

My athlete got injured. Now what?

What should my athlete do after an injury? How can they get back on the field as quickly and safely as possible?

Let’s answer these questions by examining the sports physical therapy process for the most common soft tissue injury in soccer, a quad strain. For more information on soft tissue injuries and the difference between strains and sprains, check out last week’s article, here.

Soccer players risk having soft tissue injuries due to the sport’s high volume of sprinting, kicking, and cutting. Kicking-related injuries represent the largest portion, with the rectus femoris muscle, part of the quadriceps group, being the most commonly injured muscle.

The rectus femoris muscle crosses both the hip and the knee. As an athlete winds up to kick a soccer ball, the rectus femoris muscle quickly stretches and rapidly contracts to kick the ball. Any muscle that quickly and continuously lengthens and shortens is at an increased risk of injury, especially across multiple areas like the hip and knee.

Immediately after the injury occurs, the athlete should be examined by a physical therapist or sports medicine physician to determine the severity of the injury and course of action. Imaging may be helpful in some cases but is not always necessary.

The physical therapy/rehab process for a muscle strain can be divided into 3 distinct phases .

Injury Management Phase
The goals of this phase are to reduce pain and inflammation, restore the range of motion of the muscle, and re-introduce pain-free functional movements. Injured tissues need this time to recover and heal, but that does not mean complete rest. Light strengthening exercises and mobility drills help to stimulate healing, which is why immediately starting physical therapy is so important.

Examples of early-phase exercises for a quad strain may include:

Once athletes demonstrate full range of motion without pain and perform basic bodyweight movements, they progress to the next rehabilitation phase. Unfortunately, this is where traditional PT stops, and many athletes struggle to bridge the gap from rehab to performance.

Strength Training Phase
Many athletes still have significant strength deficits at the start of this phase.

Strength training improves the quality of the injured tissue and reduces the risk of reinjuring the muscle. This is when it is time to get in the weight room.

Examples of strength training exercises for an athlete recovering from a rectus femoris or quad strain include:

Sport Specific Training
What must the injured tissue be capable of to safely return to sport?

This phase of rehab requires a strong understanding of an athlete’s sport as the injured area must be ready for everything that is about to be thrown at them.

The rectus femoris is injured because of continuous, rapid lengthening and shortening. This must be replicated and trained as a part of the rehab process, preparing the athlete for the demands of soccer.

Here are some examples of movements that may be used during this phase.

These 3 phases apply to all muscle strains, but each muscle strain recovers at a different rate. The area of the body that is injured, severity of the injury, and several other factors impact how quickly an athlete will return to the field.

If you have an athlete with a muscle strain, schedule an appointment with a physical therapist or sports medicine physician right away. Early treatment has been proven to get athletes back on the field sooner, and more successfully. If you are suspicious that you or your child has a muscle strain, schedule an evaluation with us right away.

Fall injuries are piling up

Are you the parent of a high school athlete? If so, you may have noticed that injuries are piling up. We have seen many of them here at Cohen Health and Performance in McLean and Bethesda for sports physical therapy.

Some of these injuries are traumatic, like an ACL tear, but soft tissue strains and sprains are the most common injuries that our physical therapists see.

While these words are nearly identical, they are not the same.

A strain is an injury to the muscle itself. Muscle strains often occur in the lower body with high-velocity movements like sprinting, cutting, and kicking. They also occur in the upper body with contact or a fall, although less common. Common lower-body muscle strains occur in the hamstrings, calves, quadriceps (particularly the rectus femoris muscle), and adductors.

If you athlete has strained a muscle, they will feel pain in the affected muscle right away. They are likely to describe a sensation of tearing or pulling of the muscle. Strains of the lower body usually do not happen with contact and occur when an athlete moves at a high speed or decelerates.

A muscle can be self-diagnosed at the time of the injury with a few simple assessments.

Pain with touching the injured area
Pain with stretching the affected muscle
Pain and/or weakness with contraction of the affected muscle
Possible bruising or discoloration of the skin over the injured area

A sprain is an injury to a ligament. Common sites for sprains are the ankle and knee. A sprain occurs when an area is overstretched, the ligament is injured, and potentially partially or fully torn. Sprains commonly occur as an athlete lands or steps on an opponent’s foot, or their limb gets twisted into an awkward position.

A sprain can also be self-diagnosed following using similar assessments to a muscle strain.

Pain with palpating the injured area
Pain with moving and bearing weight through the affected joint
Bruising and swelling of the affected area

The key difference in distinguishing between these two injuries is the location. Sprains will be localized to a joint and a strain is localized to a muscle.

Future blog posts will include examples of how you or your athlete can manage each of these injuries.

If you are suspicious that you or your athlete has sustained a soft tissue injury, it is important to have it examined by a physical therapist as soon as possible. We will assess the injury’s severity and provide detailed guidance on how to get back in the game as quickly as possible!