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.

What do I do if my athlete got injured?

What Should My Athlete Do After an Injury? How Can They Safely and Quickly Get Back on the Field?

To answer these questions, let’s explore the sports physical therapy process for one of the most common soft tissue injuries in soccer: a quad strain. For more details on soft tissue injuries and the differences between strains and sprains, check out last week’s article here.

Soccer players are prone to soft tissue injuries due to the sport’s high demands of sprinting, kicking, and sharp directional changes. Kicking injuries are particularly common, with the rectus femoris muscle, part of the quadriceps group, being the most frequently injured.

The rectus femoris muscle spans both the hip and knee. When an athlete winds up to kick a soccer ball, this muscle quickly stretches and contracts to execute the kick. Any muscle that repeatedly lengthens and shortens rapidly, especially across multiple joints like the hip and knee, is at a higher risk of injury.

Immediately following an injury, the athlete should be evaluated by a physical therapist or sports medicine physician to assess the severity and determine the appropriate course of action. While imaging can be useful, it’s not always necessary.

The rehabilitation process for a muscle strain can be broken down into three distinct phases:

1. Injury Management Phase

The goals of this phase are to reduce pain and inflammation, restore the muscle’s range of motion, and reintroduce pain-free functional movements. While the injured tissues need time to heal, complete rest isn’t the answer. Light strengthening exercises and mobility drills are essential to stimulate the healing process, making early physical therapy crucial.

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

– Isometric knee extension with hip extended

– Split squat isometric

– Single-leg bear hold

Once athletes regain a full range of motion without pain and can perform basic bodyweight movements, they move on to the next phase of rehabilitation. Unfortunately, traditional physical therapy often stops here, leaving many athletes struggling to bridge the gap between rehab and full performance.

2. Strength Training Phase

At the beginning of this phase, many athletes still face significant strength deficits.

Strength training is vital for improving the quality of the injured tissue and reducing the risk of reinjury. This is the time to hit the weight room.

Strength training exercises for an athlete recovering from a rectus femoris or quad strain might include:

– Reverse Nordic curls

– Lateral step downs

– Safety squat bar step-ups

3. Sport-Specific Training

What must the injured tissue be able to do for a safe return to sport?

This phase of rehab demands a deep understanding of the athlete’s sport, ensuring the injured area is prepared for the challenges ahead.

Since the rectus femoris is often injured due to continuous, rapid lengthening and shortening, this movement pattern must be replicated and trained during rehab to prepare the athlete for the demands of soccer.

Some examples of exercises used in this phase might include:

– Alternating split squat jumps

– Banded deceleration drills

While these three phases apply to all muscle strains, the recovery timeline varies based on factors such as the injured body part, the severity of the injury, and other individual factors.

If your athlete is dealing with a muscle strain, it’s essential to schedule an appointment with a physical therapist or sports medicine physician as soon as possible. Early treatment has been shown to get athletes back on the field faster and more effectively. If you suspect that you or your child has a muscle strain, schedule an evaluation with us right away.

The fall injuries we see in physical therapy

Are you the parent of a high school athlete? If so, you may have noticed an increase in injuries lately. At Cohen Health and Performance in McLean and Bethesda, we see many of these athletes for sports physical therapy.

While some injuries, like ACL tears, are traumatic, the most common injuries our physical therapists encounter are soft tissue strains and sprains.

Though these terms might sound similar, they refer to different types of injuries.

A strain is an injury to the muscle itself. Muscle strains often occur in the lower body during high-velocity activities like sprinting, cutting, and kicking. They can also happen in the upper body, typically from contact or a fall, though this is less common. Common lower-body muscle strains involve the hamstrings, calves, quadriceps (especially the rectus femoris muscle), and adductors.

If your athlete has strained a muscle, they will likely feel immediate pain in the affected area and describe a sensation of tearing or pulling in the muscle. Lower-body strains usually occur without contact and happen when an athlete is moving at high speed or decelerating.

A muscle strain can often be self-diagnosed at the time of injury using a few simple assessments:

– Pain when touching the injured area
– Pain when stretching the affected muscle
– Pain and/or weakness when contracting the affected muscle
– Possible bruising or discoloration of the skin over the injured area

A sprain, on the other hand, is an injury to a ligament. Common sites for sprains include the ankle and knee. A sprain occurs when a ligament is overstretched, leading to potential partial or full tears. Sprains often happen when an athlete lands awkwardly, steps on another player’s foot, or twists a limb into an unnatural position.

Similar to strains, sprains can also be self-diagnosed using these assessments:

– Pain when palpating the injured area
– Pain when moving or bearing weight on the affected joint
– Bruising and swelling in the affected area

The key difference between these two injuries is their location. Sprains are localized to joints, while strains are specific to muscles.

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

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

It’s an athlete’s right of passage

The first time may have happened as you landed from a jump playing basketball or making a cut while playing soccer. And since that first time, it has happened several more times.

What should you do the next time you sprain your ankle? Should you go to an athletic physical therapy clinic like ours in McLean and Bethesda?

Most likely, it will be swollen and painful, but you should be able to put some weight through it.

If you cannot put any bodyweight through your ankle, see a physical therapist or doctor immediately.

Assuming a fracture has been ruled out, it is time to start the physical therapy process immediately. The sooner you get started, the quicker you recover!

Initial goals are to reduce swelling, restore the range of motion to the ankle, and get back to walking pain-free, without a limp.

Range of motion is often restricted by joint swelling, and below are a few tips to help.

Move the injured ankle through a comfortable range of motion. This can be drawing circles with your ankle, drawing out the ABCs with your ankle, or pumping your ankle up and down. The important thing is that the joint is being moved.
Elevate the limb above the heart as much as possible.
Perform aerobic exercise that elevates your heart rate to increase blood flow to the area, which will help clear out extra fluid in the joint. An exercise bike is recommended so that weight bearing is not an issue.

Next is strengthening.

Once you have restored the normal range of motion and can comfortably bear weight through the injured joint, it is time to start building up the ankle’s tolerance to higher loads and the demands of life/sport. This will be a combination of strengthening and balance exercises.

Here are a few exercises to help you work on strengthening and balance.

Single leg stance with rotation
Front foot elevated heel raise
Multidirectional RDL

Finally, the fun phase. Sport-specific movements! Movements during this phase are tailored to your sport, often involving change of direction/cutting drills. Various jumping and hopping movements, called plyometrics, are also included.

Below are 2 examples of plyometrics drills we have used with our athletes.

Alternating split stance leaps
Lateral bounds

It is important that you feel 100% confident in your ankle before you are finished with rehab.

If you or someone you know recently sprained their ankle, reply to this email and accelerate your return to the field!

Nagging injury? Don’t miss this interview!

In this very special edition of the CHP Spotlight Interview Series, I chatted with my physical therapy colleague, Dr. Kelly Henry.

Her recent article about dry needling created a lot of interest and several questions (check that out here). What better way to answer them than to ask the expert herself?

As many of you know, Dr. Kelly is the Clinic Director of our McLean location and an amazing sports physical therapist and strength coach.

In this interview, we tackled many of your questions such as:
-Does dry needling actually work? If so, how?
-Can dry needling help me with my injury?
-Does it hurt?!

If you have a frustrating injury that just won’t go away and/or are considering physical therapy, don’t miss this interview!

To learn more about Dr. Kelly, click here.

Hidden injury risks in youth sports

Today’s article is from Dr. Samuel Kinney! Dr. Sam is a Performance Physical Therapist at our McLean location. In addition to being an amazing sports physical therapist and strength coach, Sam was a successful collegiate athlete. Learn more about Dr. Sam here. Enjoy!

What a great time of year to be a physical therapist! Our summer athletes that were injured or training with us are healthy and starting their fall sports seasons.

One of the most rewarding parts of being a sports physical therapist is seeing the athletes I helped return to the field and benefit from all their hard work from the summer.

But I can’t help but be a little nervous sometimes. There is always a risk of injury, and one of the greatest risks for a young athlete is specializing in one sport too early.

Sports specialization is defined as:

“intentional and focused participation in a single sport for most of the year that restricts opportunities for engagement in other sports and activities.”

Many athletes strongly desire to participate in their sport year-round and are pressured to do so. They have been led to believe that this will enhance their athletic success and potential to play “at the next level.” Yet, there is very little data to support this idea. On the contrary, there is strong support in the medical community for athletes to diversify their sporting activities during the off-season.

The main problem with sport specialization at a young age is that it increases an athlete’s risk for an overuse injury, and overuse injuries account for over 50% of injuries in young athletes. Common overuse injuries at CHP include back injuries like spondylolysis, foot and ankle problems, anterior knee pain, and muscle strains. Year-round play of one sport places continued stress through the same joints and tissues without the opportunity to recover.

How can we solve this problem?

First, a well-rounded strength and conditioning program with sport-specific considerations reduces injury risk by increasing the amount of work that the body can handle. As a result, athletes become more resilient to the stresses placed on them in sports. For example, improving the strength and stress-tolerance of a baseball pitcher’s rotator cuff protects against the high forces involved in pitching.

Second, participate in a secondary sport during the off-season of the main sport. This provides a break from the repetitive movements of the primary sport (e.g., repetitive throwing, hitting, jumping) and allows the athlete to explore different movement patterns. This can also improve performance in their primary sport by improving sporting decision-making and problem-solving and giving them a wider range of movements to utilize.

Finally, use the athlete’s age to guide the training load. A simple formula to use is:

Workload hours/week < age.

For example, a 12-year-old athlete should participate in their sport (including practices) less than 12 hours per week.

The topic of injury reduction is complex, and this is just scratching the surface of how we can reduce the risk of injury for youth athletes. If you are looking for ways to reduce the risk of injury for yourself or your child, contact us schedule an evaluation. We will consider all the factors at play and devise an individualized plan to keep you or your child in action!

Runners: Here is a quick workout for you

I get it. Running is a lot easier than going to the gym. Just throw on your running shoes, walk out the front door, and you are good to go! Meanwhile, the gym requires you to leave the house, get in the car, drive there, and fight for equipment and space with others. Not to mention that the traffic in McLean and Bethesda is no joke!

By now, you probably know that cross-training is essential to improving running performance and avoiding physical therapy. But many runners find it hard to make time for anything besides running. It is easy to fall into the trap that we have seen many runners fall victim to. This is the mindset that the only thing that counts towards training is the miles they log. But this is not true!

Cross-training is essential for runners because it helps prevent injury, build/maintain strength, and improve your run times and muscular endurance! Lifting weights and moving your body in varied ways from your typical movement patterns (running is repetitive!) builds resilience to injury. A typical cross-training program for a runner should include strength training of not only your lower body, but upper body and core as well. Lower body strength is important for power production and single leg control during your run. Core and upper body strength will help you maintain efficient running posture and overall muscular conditioning. Cross-training doesn’t have to be long and daunting. 2 sessions per week of 30 minutes of strength training is a great place to start! Below is an easy full-body template and example workout to try at the gym or home!

Step 1: 5-10 minutes warm-up

Get your muscles warm
This can include jogging, biking, or dynamic stretches

Step 2: Full Body Circuit

Choose 1-2 exercises for your lower body, and 1-2 exercises for your upper body
Include compound movements! This includes exercises that use your lower body, upper body, and core to work together
Perform each exercise for 8-10 repetitions, and repeat the circuit for 3-4 total rounds

Step 3: Core and Plyometric Finish

Choose 2-3 core exercises and 1-2 plyometric exercises
Perform each exercise for 20-30 seconds, and repeat the circuit for 3-4 rounds

Example:
1. Jog on the treadmill at 5-6 MPH for 5 minutes

2. Perform 3 rounds of the following circuit:
A. Reverse Lunge x10 reps on each leg
B. Dumbbell Bench Press x10 reps
C. Goblet Squat x10 reps
D. Shoulder press x10 reps
*Choose a weight that is challenging for you, but you can complete all 3 circuits

3. Perform 3 rounds of the following circuit:
A. Sprinter Step Up x 30 seconds
B. Side plank x 30 seconds on each side
C. Russian twists x 30 seconds

If you are a serious runner that is looking to step up your performance or avoid injury, contact us for a customized cross-training program designed by our resident triathlete, Dr. Kelly Henry!