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.

Winter Running Tips from a Performance Physical Therapist

Running through the winter months can be a challenge, especially when cold temperatures, ice, and wind threaten to derail your training. But with the right strategy, runners can stay consistent, healthy, and injury-free all season long.

Today, we’re excited to share insights from Dr. Elizabeth Farmer, a Performance Physical Therapist at our Bethesda location and an avid runner herself. After logging miles in recent frigid DC conditions, Dr. Farmer combined her personal experience with her clinical expertise in physical therapy for runners to share practical tips that help runners safely train outdoors during the winter.

If you hate the treadmill but feel stuck indoors every time the temperature drops, these tips are for you.

1. Dress Smart with Thin, Layered Clothing

When it comes to winter running, layering is key. Instead of bulky clothing that restricts movement, opt for multiple thin layers that trap warmth while allowing sweat to escape.

Dr. Farmer recommends:

Tucking shirts into leggings or tights
Wearing wool socks tucked into leggings
Using merino wool base layers for temperature regulation and moisture control

On a recent easy run in 7°F temperatures (with a 2°F windchill), Dr. Farmer wore two pairs of leggings (one fleece-lined), a merino wool long-sleeve shirt, a lightweight sweatshirt, a windbreaker, gloves, a beanie, and tall wool socks and was warm enough to break a sweat within the first mile.

Proper layering helps runners maintain performance while reducing the risk of muscle tightness and cold-related injury.

2. Keep Your Pace Easy on Icy Surfaces

Winter running requires flexibility. If you’re unsure whether your route is icy or clear, prioritize safety over speed.

Running at an easy pace allows you to:

Adjust to unpredictable footing
Reduce fall risk
Avoid compensations that lead to overuse injuries

For runners in Bethesda, the Maryland portion of the Capital Crescent Trail has been plowed and is often more ice-free than neighborhood roads. Regardless of location, always assess conditions before attempting speed work.

From a physical therapy for runners perspective, slips and sudden muscle guarding are common causes of winter injuries, especially to the calves, hamstrings, and low back.

3. Warm Up Indoors Before Heading Out

Cold weather works against your body’s natural ability to warm up. That’s why an indoor warm-up is even more important in winter.

Dr. Farmer recommends completing your entire warm-up inside so you’re already warm before stepping outdoors. This helps:

Improve mobility
Reduce stiffness
Lower injury risk during the first mile

A proper warm-up is one of the simplest ways runners can protect themselves during winter training and a key component of injury prevention we emphasize in performance physical therapy for runners at our Bethesda and McLean clinics.

4. Use Warm Pre- and Post-Run Nutrition

Fueling properly in winter isn’t just about performance, it’s also about staying warm.

Try these simple swaps:

Replace cold juice with warm apple cider before your run
Swap chocolate milk for hot chocolate post-run to get carbs and protein while warming up

Adequate pre- and post-run nutrition supports recovery, energy levels, and muscle health, especially during high-volume winter training blocks.

5. Consider Winter-Specific Running Shoes

Many running shoe brands offer winter models that include:

Waterproof materials
Increased warmth
Improved traction for icy conditions

Cold temperatures can also affect how shoe foam responds. If your regular running shoes feel stiffer in winter, it doesn’t necessarily mean they’re worn out, they may simply be reacting to the cold.

For runners experiencing foot, ankle, or knee discomfort, footwear choice is a frequent topic we address during physical therapy for runners sessions at our McLean and Bethesda locations.

Physical Therapy for Runners in Bethesda & McLean

Winter is one of the most common times we see runners develop nagging aches, stiffness, or overuse injuries. The combination of cold weather, altered mechanics, and reduced recovery can add up quickly.

If you have questions about winter running, are dealing with pain, or want help optimizing your training, our team specializes in physical therapy for runners. We work with runners of all levels—from recreational runners to competitive athletes, helping them stay healthy, strong, and consistent year-round.

📍 Locations: Bethesda, MD & McLean, VA
📞 Reach out to schedule an evaluation or ask a question. We’re happy to help support your running goals.

Snow Shoveling and Back Pain: What You Need to Know to Stay Safe This Winter

The recent snowstorm in the DC area was different than what we usually see. Not only did we get a much larger volume of snow, but the sleet that followed packed everything down, making the snow significantly heavier than expected. For many people, that meant long hours of shoveling driveways and sidewalks under cold, challenging conditions.

Unfortunately, events like this often lead to a spike in injuries and back pain is one of the most common reasons people seek physical therapy after heavy snowfall.

Why Snow Shoveling Is a Common Cause of Back Pain

Snow shoveling places a unique and often underestimated load on the body. Snow can weigh two to three times more than most people expect, especially when it’s wet or compacted by sleet. Combine that with cold temperatures and repetitive movements, and the risk of injury rises quickly.

Cold weather causes muscles, tendons, and joints to feel stiffer and less responsive. Unlike a typical workout, most people don’t warm up before shoveling. That means the body is suddenly asked to lift, bend, and twist repeatedly while tissues are at their least prepared state.

From a biomechanics standpoint, shoveling is especially demanding on the spine. The weight of the snow is held far out in front of the body, increasing stress on the lower back. Unlike lifting a weight close to your body, something we coach regularly in back pain physical therapy. Shoveling often involves reaching forward, rounding, and then twisting to throw the snow. Repeating this pattern over and over can overload the spine and surrounding muscles.

Cardiac Risks During Heavy Snowfall

While back pain is the most common complaint we see after snowstorms, it’s also important to acknowledge the cardiovascular risks. Many cardiac events occur during snow shoveling due to the combination of cold temperatures and sudden, intense physical exertion.

If you are over the age of 45 or have risk factors such as high blood pressure, high cholesterol, or diabetes, it’s especially important to pace yourself, take breaks, and avoid overexertion during heavy snowfall.

How to Reduce Back Pain Risk When Shoveling Snow

The best way to approach snow shoveling is to think of it like a workout rather than a household chore.

Before heading outside, take a few minutes to warm up with light, dynamic movements. The goal is to get your body warm enough that you’re almost sweating before you start lifting heavy snow. This can significantly reduce strain on the lower back and shoulders.

Staying hydrated is also important. Cold, dry air increases fluid loss, even if you don’t feel thirsty. Proper hydration supports muscle function and recovery and can help reduce stiffness.

During shoveling, try to minimize excessive twisting and avoid lifting more snow than necessary at once. Smaller loads and frequent breaks go a long way in protecting your back.

What to Do If You’re Feeling Back Pain After Shoveling

It’s very common to feel sore or stiff after shoveling, especially in the lower back, shoulders, and neck. Gentle movement, relaxed breathing, and light mobility exercises can help calm irritated tissues and reduce next-day soreness.

However, if your back pain lingers, worsens, or limits your ability to move normally, it may be time to seek back pain physical therapy. Many snow-shoveling injuries are very treatable with the right approach, and addressing them early can prevent the issue from becoming chronic.

How Back Pain Physical Therapy Can Help

Back pain physical therapy focuses on more than just pain relief. The goal is to identify why your back was overloaded in the first place, whether that’s poor movement mechanics, limited mobility, or insufficient strength and address those factors directly.

Through targeted mobility work, strength training, and education, physical therapy can help you recover faster, move more confidently, and reduce your risk of future injuries, whether from snow shoveling or everyday activities.

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.