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.

Nails on a chalkboard to me

“It Will Hurt Your Knees if They Go Past Your Toes”—Debunking the Myth

Recently, while working out at the gym, I overheard two young men discussing their barbell squats. One of them mentioned that he had just finished physical therapy, and I hope the following advice didn’t come from his therapist…

After completing a set, one of the lifters (let’s call him Lifter 1) was chatting with his friend (Lifter 2). Lifter 2 advised him not to let his knees go past his toes during squats, claiming it would be bad for them.

This belief is widespread in fitness circles, the personal training industry, and was even common in physical therapy. However, it’s simply not true.

Your knees naturally go over your toes when you walk or run. In fact, proper squat technique requires your knees to move well past your toes.

Attempting to prevent this by pushing your hips back and arching your lower back only shifts more stress onto your lower back, increasing the risk of back pain.

But you might wonder: does allowing your knees to move past your toes increase stress on them?

The answer is no! In fact, research shows that training your knees to comfortably move past your toes helps build healthier knees and reduces the strain on your back.

Check out the squat tutorial below to retrain your squat technique and get your knees accustomed to moving over your toes as they naturally should!

Remember, there’s no such thing as a “bad” or “good” exercise. The suitability of an exercise depends on various factors, including your fitness goals, injury history (consult your physical therapist), unique body traits, and movement capabilities. Keep this in mind whenever you hear generalized or “one size fits all” advice about exercise.

Runners, Stop Making This Mistake in Your Training

According to the research, the chances of having a knee injury increase significantly after running for 1000 hours.

Most serious runners pass the 1000-hour mark within 1 year and end up in performance physical therapy clinics like CHP!

Does this mean that “bad knees” are inevitable once you choose to run? No, but it does mean that you must learn how to take care of them.

Running consists of thousands of strides repeated over and over. As a result, any problems with your running technique will add up, potentially contributing to injury.

Even if you are not a serious runner, you are likely approaching the 1000-hour running mark.

Does this mean that you are a ticking time bomb, ready to explode? Probably not if you are strength training and working on improving your running technique.

Strength Training

Implementing strength training into a consistent exercise routine has been shown to make you a more efficient runner. This means that you use less energy to run a given amount of time and as a result, are less fatigued. Less fatigue=less risk of injury. For this reason, becoming a more efficient runner is an essential part of the sports physical therapy process.

Research also shows that regular strength training improves a runner’s speed and VO2 max. VO2 max is a measure of the amount of oxygen that you can use during exercise. When you can use more oxygen as you run, you will run farther, faster!

Just remember, every runner is unique. Even if you have a running partner with the same routine, you both have unique characteristics and needs to address in a strength training program. Your strength training program must be unique to you. Cookie cutter programs don’t cut it!

Running Technique

Think of the last time that you went out for a run. Were you thinking about every stride you took? Were you aware of your foot strike? I highly doubt it!

Running is an automatic pattern that does not require conscious thought to perform. Most people listen to music or podcasts. We couldn’t do that if we needed to focus on how to run.

Unfortunately, this also means that you may be repeating the same bad pattern over and over without realizing your mistake, until it is too late. One of the most common mistakes occurs with a runners foot strike position. Runners often contact the ground in front of the body which puts more stress on the body.

Foot strike position is dependent on your body dimensions (such as limb length).

We can’t change your anatomy, but we can change the position, aka the posture, of our bodies. This is often the first step of the physical therapy process for a runner!

A “stacked” posture will change your foot strike so that it occurs directly underneath the body. This results in a more efficient stride and less stress to the body. To learn about the stack, check out a previous article that I wrote on Learn to Stack Like a Snowman.

Attempt the drill below to feel what it is like to have a stacked posture while running.

Grab a partner and ask him/her/they to stand behind you (you are also standing)
Have your partner press down on your shoulders with a moderate amount of force and do not let them squish you
As you resist them you should feel your abs engage and feel as if you are standing tall
Next, attempt to shift your weight onto 1 leg and pick up your opposite foot while resisting the force of your partner
Try the other leg

For a video on this drill, click here.

After performing this drill, you should have a better sense of your optimal running posture. Try to replicate this feeling the next time you go on a run!

This Made Me Roll My Eyes

The medical profession, sports physical therapy included, is good at giving out bandaids.

To illustrate this point, let me tell you a story about my best friend. He lives in LA and takes advantage of all it has to offer. The guy can’t sit still. He hops in the ocean to go open water swimming in the morning and goes on hikes or trail runs in the evenings/weekends. 75 degrees and sunny every day must be nice…

On another beautiful, 75-degree day, he was running on a dirt trail to the top of Runyon Canyon and suddenly felt a sharp pain in the inside of his right knee. As he kept running, the pain increased. He decided to turn around, limp down the trail, and make an appointment with his Doctor. He saw his Doctor the next week and was told to take Advil and “take it easy”. This was when he called his favorite performance physical therapist…

My friend has known me since I was 10 years old and could feel me rolling my eyes.

Have you ever been told only to rest as a solution to an injury? This isn’t bad advice but it is a band-aid. It stops the bleeding without solving the reason the bleeding is occurring in the first place!

Pain occurs when the amount of stress placed upon the body exceeds the body’s tolerance of it.

So what is causing this stress to accumulate? It could be over-training, insufficient sleep, poor nutrition or a variety of other factors. Most likely it is a combination of many different things.

The root cause of pain must be addressed if you hope to feel better, stay better, and exercise consistently.

It is essential for your Doctor or Performance Physical Therapist to answer these questions and provide a plan to address them. If you are ready to finally solve the root causes of your pain and injury, contact us now!

What a Runny Nose and Your Pain Have in Common

Do you remember the last time that you caught a cold, the flu, or had Covid? If you are like me, you build a mountain of dirty tissues to keep your snot under control. Meanwhile, the little bug causing it runs around your body, creating chaos.

The pain you feel when exercising is a lot like your runny nose. Pain is a symptom of a larger issue and the key to finally fixing it is to correct that root cause.

Unfortunately, I find that most athletic physical therapy treatment for focuses on the symptoms, rather than the reasons the symptoms started in the first place. We wouldn’t blow our nose all day without taking medicine to kill the bug causing it, would we?!

At Cohen Health and Performance, the goal of every patient’s first performance physical therapy appointment at our Bethesda or McLean location is to discover the root cause of their symptoms. Once this has been identified, our physical therapists create a rehabilitation plan that is customized for every person that we see. Every person is different, with different reasons for an injury and different goals. If your physical therapist has a cookie cutter plan that they use for every patient with low back pain, for example, find another physical therapist!

How do you know if your physical therapy plan is a good one?

The end goals of the rehabilitation plan should be YOUR goals, not the goals of the physical therapist. The physical therapist should clearly describe how your plan is going to get you back to the activities that are most important to you, not what the insurance company wants to see.

For example, we help many runners overcome injury. Their first physical therapy appointment includes a running analysis if they are able to do so. Their rehabilitation plan then includes drills that will help them get back running ASAP. Below is an example of an exercise that we may give a runner with knee pain to prepare them for the stress of their training.

It is easy for physical therapy to become focused on outcomes that insurance companies want to see because that is what is required to get paid. This is why we advise our patients to look for a physical therapy clinic that works for their patients, not insurance companies!

3 Easy Exercises for Happy Knees

I can’t stand doing warmups. There I said it. Even though I’m a sports physical therapist both in Bethesda and McLean (yup, we opened our new location in McLean, Virginia!), and I know better, I just want to get into my workout without spending 15 minutes doing boring drills.

If you are anything like me, you want to spend the least amount of time warming up without increasing your risk of injury.

One way to reduce the amount of time that you need to warmup your knees are with home exercises that prepare your knees to handle more stress. Our athletic physical therapy patients (both youth athletes and active adults) see us in Bethesda and McLean for help with knee pain that limits them in the gym and/or out on the field. We commonly recommend that people perform drills that build the capacity of what the knees can handle. This means that the knees will be capable of handling more stress and be ready to go as soon as you walk into the gym.

Check out the videos below where I breakdown 3 drills that you can do at home for happy, healthy, and strong knees!

These are just a few examples of drills that help you with knee pain. If you are serious about finally solving the knee pain that is forcing you to modify your favorite workouts, don’t hesitate and contact us today to schedule an appointment in McLean or Bethesda. The root cause of your knee pain is unique and it is unlikely that the cookie cutter program you found online will do the job. We will show you exactly where your knee pain is coming from and provide a customized performance physical therapy plan to address it!

For Weekend Warriors Wanting to Avoid Knee Surgery

I probably don’t need to tell you this, but the best surgery is the one that is avoided. Disclaimer, as a sports physical therapist, I am a bit biased!

After knee surgery, your knee is not the same. Tissue may have been removed or artificial parts/pieces may have been put in. Regardless of the procedure, the skin was cut open, scar tissue formed, and time is needed time to heal.

This impacts the function of your knee and your ability to run and exercise as you had previously.

Now, I am not saying that surgery should never happen. What I’m saying is that it should be a last resort.

In my 12+ years working as a sports physical therapist, I have learned that people commonly have knee surgeries when there are things they can do to delay or avoid them altogether.

In many situations, the knee cannot handle the stress required of it for sports or your active lifestyle. As physical therapists, we commonly prescribe exercises that train the knee to handle all of that stress. In other instances, the knees are dealing with too much stress because another area isn’t doing its job. A thorough sports physical therapy assessment will determine what these areas are so that a comprehensive plan can be prescribed to fix it.

Whatever the reason is, a sports physical therapy assessment may be the secret sauce to finally solving your knee pain and avoiding the surgery you have been worried about! To schedule that, contact us today!