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.

3 exercises I don’t do anymore

A few weeks ago, I was catching up with a former physical therapy colleague from our time working with professional athletes.

We laughed about how we used to work out every day at 5:30 am before the athletes got to the facility. We took turns designing the training programs that we used to torture ourselves with so early in the morning.

After our conversation, I thought that looking at our old training programs would be interesting. I noticed three popular exercises that I don’t do anymore both personally and professionally with my patients as a sports physical therapist in Bethesda and McLean.

Planks: Other exercises do a better job of strengthening the core and working the abs. Planks are typically performed with straight legs, which helps support the body with the legs, not the abs. It is also an easy exercise to cheat by allowing the belly to sag slightly toward the ground. As this occurs, the body is supported by the hip flexor musculature and the lower back instead of the abs. Try performing a bear variation instead!
Barbell Back Squats: This exercise can be done effectively but requires many qualities to perform correctly. Minor limitations in shoulder range of motion, thoracic spine extension, hip mobility, and ankle flexibility result in much strain to the lower back and other areas. I’ve found that I can strengthen my lower body very effectively with exercises that have a lower risk. Goblet, Zercher, or SafetySquats are usually better options unless you are a powerlifter or a collegiate athlete.
Upright Rows: The upright row fails the risk vs. reward equation. You can create the benefits of this exercise with other, lower-risk exercises. The upright row forces the shoulder into combined flexion and internal rotation as it lifts a weight. Doing so is stressful to the shoulder and isn’t worth the risk. Dumbbell pressing variations like this are a better option.

What is the goal of this exercise? That is the question I ask myself as I design training and physical therapy programs for my patients/clients. Typically, the goal is to increase strength, build muscle, or prevent injury. If a different exercise is more effective at reaching those goals or can deliver the same result with less risk, that is the better option.

Maybe I Do Hate Stretching…

Zac, why do you hate stretching?

I received this question during a physical therapy session recently, which admittedly made me chuckle. I don’t hate stretching, but we overrate its importance (physical therapists included).

Like most people, when you think of stretching, you think of static stretching. This type of stretching involves holding a stretch for an extended period.

Come to gyms like the one I train at, and you will see most people doing this form of stretching before they exercise.

Research has shown that static stretching performed before physical activity may negatively affect performance and does nothing to reduce injury risk. It temporarily decreases muscle strength and power and reduces muscle stiffness, essential for joint control and protection.

But stretching feels good. I agree, so I recommend that you perform your favorite stretches when you are done with your workout.

So, what should I do to warm up before exercise?

Dynamic stretching and drills specific to the activity you are about to perform.

This type of warmup involves moving your body through its full range of motion, mimicking the movements of the activity you are about to perform. This helps increase heart rate and body temperature and improves coordination, balance, and neuromuscular control.

Below are 2 drills I often use on my upper body days, followed by 2 more that I commonly use on lower body days with both physical therapy and personal training clients.

Upper Body

Lower Body

Interested in receiving a custom-designed warmup routine from our Doctors of Physical Therapy to help you reduce your injury risk while preparing you to perform at your best? Contact us to learn more!

My jaw pops, is that bad?

Have you noticed joints making more noise as you have gotten older? One of the strangest ones is the random popping I get in my jaw.

Does that ever happen to you? If so, and if it is painful, you may want to investigate it (our physical therapy team in McLean and Bethesda treats this!).

Open and close your mouth while feeling in front of your ears. Search until you feel the joint moving, called your temporomandibular joint (TMJ). This joint allows you to open and close your mouth and move your jaw from side to side.

The TMJ has a small shock-absorbing cartilage disc between the jawbone and your skull. If this disc moves out of alignment or there is arthritis in the joint, clicking, popping, and pain can occur.

The alignment of the TMJ is a product of everything below it. When I see physical therapy patients experiencing TMJ pain, I first check the position of the head, neck, and rib cage and look at posture. Check out this article to learn more about how to get your head, rib cage, and pelvis in the proper position.

This sometimes corrects TMJ pain, but we can’t stop here. Here are some factors that may also need to be addressed.

Malocclusion: Malocclusion is when the teeth do not fit together correctly, resulting in jaw misalignment. This is when your dentist needs to work with your physical therapist as part of the healthcare team!
Stress: Teeth clenching is associated with stress. Caring for your mental health is essential to helping TMJ issues. Many dentists also suggest nightguards for those of us that clench when sleeping.
Chewing gum: stay away!
Posture, especially while working: What posture is best? Does that even exist? Check out an article I wrote on that here.

Popping, clicking, and jaw pain is most likely a result of several different factors. TMJ issues usually require a healthcare team such as a physician, physical therapist, and dentist. Popping and clicking without pain likely isn’t much to worry about. Still, please see a healthcare provider if pain is associated with it.

At CHP, our physical therapists we evaluate patients with TMJ discomfort. If you or anyone you know would like help solving these challenging problems, contact us today!

Most People Forget This Part of Their Recovery

Recovery is a buzzword nowadays, and entire industries (outside of just sports physical therapy) have sprouted up to help athletes and weekend warriors improve their recovery from sports, challenging workouts, and injury. Foam rolling, compression garments, Theraguns, supplements, and cryotherapy (see a previous article I wrote here) are just some of what you may find.

Professional athletes like Tom Brady have gotten in on the action as well. He created his company, TB12, which focuses on “facilitating muscle recovery, injury prevention, and improved performance for anyone with an active lifestyle.”

Like many other approaches to recovery and health improvement, Tom emphasizes the importance of nutrition and sleep. People have argued about the finer details of how he approaches nutrition, but I’ll leave that to the internet to discuss.

One major factor is commonly forgotten despite all this information about optimizing recovery and performance.

Our environment.

The environment is critical to our overall well-being and can significantly impact our body’s ability to heal itself. Our bodies are very complex and constantly respond to their surroundings. Research has shown that environmental factors such as temperature, noise, and light affect our mood, stress levels, and immune systems.

Physical therapy and dealing with an injury is a stressful and anxiety-inducing experience, and a calming environment can help to reduce these negative emotions. Studies have shown that exposure to nature, such as greenery and natural light, helps to reduce stress levels and improve overall well-being. Exposure to sunlight and fresh air has also been shown to boost the immune system and help the body heal faster.

Tips for Creating a Healing Environment

Choose the proper lighting.

Natural light is the best option, so try working or relaxing in an area near a window. If natural light is not possible, consider investing in full-spectrum lighting to mimic natural light.

Incorporate nature.

Consider incorporating plants, flowers, and other natural elements into your office or areas you relax.

Rest in organized places.

This is especially true when recovering from an injury. So much is out of our control as we wait for the body to heal, and research suggests that a clean and organized space reduces anxiety and promotes a sense of control. Keep your recovery area free of clutter!

Looking for ways to speed up your recovery from training or injury? Contact us to learn more!

What is blood flow restriction training? Should I try it?

Think of the last time that you injured your arm or leg or needed physical therapy. If you haven’t had an extremity injury, or needed sports physical therapy, congratulations, and I guess you must use your imagination.

You saw your doctor for help, and they told you to rest your injured limb for at least 4 weeks. You have no choice but to relax and allow your injured limb to get small and weak.

This is where blood flow restriction (BFR) training is a helpful part of the physical therapy process. A cuff or strap is placed tightly around a limb to reduce blood flow but not entirely block it. Exercise is then performed in this state.

This allows you to exercise at a lower intensity but enjoy many benefits of high-intensity training, such as muscle growth and improved strength.

While BFR can’t replace regular training, it is an excellent option for people that want to speed up their return from injury or are searching for ways to exercise without beating up their joints.

But restricting blood flow sounds sketchy. Is it safe?

Yes. Research has shown that BFR is safe when used with patients with no contraindications to it. As with all things, it can be unsafe when misused or placed in the wrong hands.

At Cohen Health and Performance, we use BFR both in McLean and Bethesda to limit weakness and muscle atrophy after surgery. Our patients recovering from knee surgery, such as an ACL reconstruction, have seen great results. When more strength is preserved, people have a faster recovery.

But the benefits extend far beyond people recovering from surgery. People struggling with chronic and overuse injuries can use BFR to maintain their strength without interrupting recovery. This helps people to return to the entirety of their active lifestyles much quicker.

Interested in using BFR to speed up your recovery from an injury or help you with your training? Contact us!

The Best Sitting Posture

This is the best sitting posture.

Many physical therapy articles and rehab blogs discuss the importance of sitting posture and how perfect sitting posture is essential to avoid neck and back pain. Here are a few examples of what I found in several articles online.

Sit with your feet flat on the floor. This position helps to distribute your weight evenly and reduces pressure on your lower back.
Support your lower back. If your chair doesn’t provide enough support for your lower back, consider using a lumbar roll or cushion. This can help maintain the natural curve of your spine and prevent low back pain.
Sit up straight. Sitting up straight helps to maintain good posture and reduce strain on your back. Avoid slouching or leaning forward.

While these may be helpful recommendations as part of the physical therapy process, they miss the most important thing.

There is no perfect sitting posture, and the “best” posture is the one that is constantly changing.

When standing, we naturally sway and shift our weight forward and back or from one foot to another. Unfortunately, this goes away as we sit and concentrate on something…like this blog I’m writing!

The longer we concentrate on something, muscular tension increases. This keeps us still and helps us focus better on what is in front of us. Unfortunately, too much muscular tension leads to discomfort.

Does this mean you must get up every 10-15 minutes and move around? In a perfect world, sure, but there may be better solutions if you try to get stuff done.

As I am writing this article, I am fidgeting. My sitting posture is changing, and I am shifting my weight from one side to the other. I sometimes cross one leg under the other and raise or lower my chair.

But one more part of sitting posture may be most impactful.

Give your eyes a break.

Research shows a connection between high levels of focus on a screen and discomfort in the upper body.

Optometrists recommend the 20/20/20 rule to help with this. The 20/20/20 rule states that for every 20 minutes of focus-intensive work, you should take a 20-second break and look 20 feet away.

This helps to reduce your focus on a single point and, as a result, reduces tension in your upper body.

Our bodies typically don’t respond well when we ask them to be still for long periods. A more active approach to sitting helps us avoid the discomfort that may come with it.

If you are interested in learning other strategies that can be used to sit comfortably throughout your day, contact us!