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.

How land training improves swimming performance

Dryland Training: A Swimmer’s Love-Hate Relationship

Dryland training is something every swimmer has a complicated relationship with. However, building strength and power on land is just as vital for enhancing race performance as clocking laps in the pool. Shoulder pain and overuse injuries are the most common issues swimmers face, often limiting their ability to maintain high-level training. So, how can we strengthen our shoulders on land before returning to the water?

Building Shoulder Strength and Resilience

For swimmers, it’s crucial to develop sufficient strength and range of motion in the shoulders to withstand the repetitive demands of a two-hour swim practice. The rotator cuff is key to stabilizing the shoulder during overhead movements and generating power during the pull-down phase. Lift-off drills like this one focus on activating the rotator cuff muscles and building tolerance at the end range of motion. Once comfortable with this drill, incorporating overhead pressing variations and kettlebell stabilization exercises will help engage the larger muscles of the trunk and core, enhancing shoulder resilience.

Developing Full-Body Power

Swimming is a full-body workout, so it’s essential to include elements of full-body power in your dryland routine to prevent injuries during high-speed training or racing. Overhead medicine ball passes are excellent functional exercises that challenge both your overhead strength and full-body stabilization in a dynamic setting. To further simulate the pull-through motion of your stroke, progress to full medicine ball slams—no water required!

What Does It Mean To Be “Out of Alignment?”

“My body feel out of alignment.”

“My <insert healthcare professional here> said that my hips are off.”

“I think I just need to be adjusted.”

These are examples of a few of the comments that patients may express in physical therapy or other injury rehabilitations settings.

The belief that we are like a vehicle that needs to be re-aligned is often the fault of the healthcare industry, including physical therapy.

In the past, healthcare providers would tell their patients that a part of their body is out of alignment and needs to be adjusted to put it back in place. They explain that this is the reason for any discomfort that may be present.

Thankfully, this is no longer taught by most healthcare providers as this thought process has been disproven.

Our bodies are incredibly resilient.

Our joints do not simply fall out of alignment. In fact, our bodies are designed to move and if we were constantly “in line”, it would be impossible to move anywhere!

So, what is happening when an area of our body feels “off”?

As we perform a movement repetitively, compensations and movement limitations become more noticeable.

One area of the body may be moving excessively, while another area of the body may be moving too little. For example, if your ankle mobility is limited during a squat, you will move excessively at the hips to pick up the slack, causing more stress in that area. As a result, pain, or the feeling of being out of alignment may occur in the hips/pelvis.

If you feel “off” or have been told that you are out of alignment, the solution is likely to begin with discovering what movement limitations may have led to this feeling in the first place. This information can then be used to teach you strategies to move and feel better!

Are you interested in discovering what solutions may be right for you? Contact us to find out more about our physical therapy services!

Try this to improve your hip and trunk mobility

Who doesn’t want to loosen up their hips and trunk while building strong hamstrings and glutes?!

It is common to encounter youth athletes and active adults in athletic physical therapy and injury rehabilitation settings who have tight posterior hips and stiff rib cages. This limits the amount of rotation that they available through the trunk and reduces mobility in a variety of different directions within the hips.

As a result, more stress is placed onto the lower back, knees, and other areas of the body. Overuse injuries often follow that send people to physical therapy, including general lower back pain, lumbar disc injuries, knee arthritis, meniscus injuries, etc.

The good news is that the root causes of these kinds of injuries can be addressed and often do not require a boring home exercise program.

The Single Leg RDL (Romanian Deadlift) is a fantastic drill that you can implement into your workout routine to improve your hip/trunk mobility and strengthen your glutes/hamstrings.

This drill is particularly powerful for rotational athletes like golfers, tennis players, lacrosse players, and hockey players.

We typically start our patients and training clients with the kickstand version of the Single Leg RDL before progressing to the more advanced versions below.

Kickstand RDL (front leg emphasis)

Kickstand RDL with Foot on Wall

The key with these activities is to ensure that you feel the back of your hip, glute, and hamstring working (on the working leg), while also feeling your abs working. You should not be feeling your lower back at any point during the drill.

Are you interested in learning more ways that you can adjust your exercise program to correct old injuries, improve your performance and/or stay pain free? If so, simply contact us!

Do I Need Surgery?

This is a very common question in physical therapy and injury rehabilitation settings .

As humans we think of ourselves as machines. Something is broken and needs to be fixed.

However, we are not machines, and surgeons are not mechanics that fix something broken. In fact, they are closer to janitors “cleaning up” accumulated damage that was created by something else.

A recent literature review published in the prestigious journal, JOSPT, found no evidence to support having surgery versus non-surgical interventions and 9 different areas of the body were researched! The study can be found here.

Now before we jump to conclusions, surgery is an essential part of healthcare.

It is the best option after trauma occurs that causes structural damage which will prevent the body from functioning as required for sport or daily life. Examples include broken bones that are displaced, as well as tendon or ligament ruptures like ACL or Achilles tears.

Surgery may also be a solution to chronic pain or injury that has not improved with non-surgical interventions such as physical therapy.

In the instances described above surgery is utilized as a last resort or because of significant, clear structural damage which can be reliably repaired.

Research, such as the article referenced previously, commonly shows poor long-term outcomes for surgery because we are commonly led to believe that surgery “fixes” the issue.

Surgery does not address the root causes of an injury and it is essential to learn is what caused the damage requiring surgery in the first place. As a result, we can address the root causes of pain, injury, or tissue damage before surgery, hopefully avoiding it altogether. If surgery is still warranted, then the factors that lead to it must be addressed in the post-operative process. If not, we will continue to see more studies like the one referenced in this article showing poor outcomes from surgery.

As the saying goes, if we don’t learn from history, we are bound to repeat it!

Should you be concerned about shoulder popping?

Do you ever notice a snap, crackle, or pop—like a bowl of Rice Krispies—coming from your shoulder when you lift your arm overhead or exercise? If so, you might be wondering if this is something to be concerned about and whether physical therapy can help address it.

The short answer? It depends. But let’s explore why this might be happening and when it’s time to seek help from a physical therapist.

Why Does My Shoulder Pop?

The shoulder is one of the most complex joints in the body, boasting the largest range of motion. It’s made up of a combination of bones, ligaments, cartilage, and tendons that all work together to allow for smooth movement in many directions. Because of its remarkable mobility, the shoulder is also prone to instability and compensation when it encounters stress or strain over time. This is why shoulders are often susceptible to injuries.

When the shoulder compensates for poor movement patterns or muscle imbalances, it can result in a variety of issues—some minor, some more serious. So, if you’ve experienced that infamous “snap, crackle, pop,” you’re not alone. However, before you panic, it’s important to ask yourself a few key questions:

1. Is the popping painful?
2. Have you recently injured your shoulder?
3. Does your shoulder feel unstable during activity?
4. Do you experience any weakness in the shoulder or arm?

Answering these questions can help determine whether the clicking or popping is something to worry about. Here’s why.

When Shoulder Popping is Harmless

If the popping or clicking is painless, you may be experiencing a common condition known as **crepitus**. Crepitus refers to harmless joint noises that occur when gas bubbles within the joint are released, similar to when you crack your knuckles. This type of clicking often occurs during normal movement and doesn’t indicate an underlying injury or cause for concern. In many cases, it’s simply a result of pressure changes within the joint or tight tendons rubbing over bones.

While it may be annoying, painless popping generally doesn’t require treatment. However, that doesn’t mean you shouldn’t be mindful of your shoulder health, as regular maintenance and mobility exercises can help prevent future issues.

When Shoulder Popping Could Signal a Problem

If the clicking or popping in your shoulder is accompanied by pain, instability, or weakness, that’s a different story. These could be signs of a more serious underlying issue, such as:

– Rotator cuff injury: The rotator cuff is a group of muscles and tendons that stabilize the shoulder. Tears or inflammation in the rotator cuff can cause both pain and clicking during movement.
– Labral tears: The labrum is a ring of cartilage that helps stabilize the shoulder joint. Tears in the labrum can cause a catching or popping sensation, often accompanied by instability or pain.
– Shoulder impingement: This occurs when the tendons of the shoulder are pinched during movement, causing pain and popping.
– Joint instability: Repetitive overhead movements or trauma can lead to shoulder instability, which may result in both painful popping and the feeling that the shoulder is “slipping” out of place.

If you answered “yes” to any of the questions above—especially if the popping is painful or you’ve recently experienced a shoulder injury—it’s important to have your shoulder assessed by a healthcare professional. **Sports physical therapy** is often the first line of treatment for addressing shoulder issues, and it’s highly effective in treating conditions like these.

How Physical Therapy Can Help with Shoulder Popping

The most important aspect of physical therapy is determining the root cause of your shoulder symptoms. A skilled physical therapist will evaluate your shoulder’s range of motion, strength, and overall movement patterns to pinpoint what’s contributing to the clicking or popping. From there, they will create a tailored treatment plan designed to correct any imbalances, strengthen the muscles around your shoulder joint, and improve overall mobility.

Some key benefits of working with a physical therapist for shoulder issues include:

– Improving strength and stability: Strengthening the muscles around your shoulder can help stabilize the joint, reducing the risk of further injury and improving function.
– Addressing poor movement patterns: Physical therapists identify and correct any compensatory movements or muscle imbalances that may be contributing to the popping or pain.
– Enhancing flexibility and mobility: Tight muscles and tendons can cause friction within the shoulder joint. A physical therapist will guide you through stretches and exercises to improve mobility and prevent stiffness.
– Preventing future injuries: Beyond addressing the current issue, physical therapy helps you develop better habits and movement strategies, so you can avoid shoulder problems down the road.

By identifying the root cause and addressing the underlying issue, physical therapy helps restore pain-free movement and protects your shoulder from further damage.

When to Seek Help

If you’re experiencing annoying clicking, popping, or pain in your shoulder and want to determine what’s causing it, don’t wait until the issue worsens. A comprehensive evaluation from a physical therapist can give you the answers you need and a clear path toward recovery.

At our clinic, we specialize in sports physical therapy and shoulder rehabilitation. Contact us today to schedule an assessment, and let’s get to the bottom of your shoulder issues—so you can move without pain or discomfort.

Unlocking mobility

Do your hips or lower back feel tight when you squat? Do your shoulders feel stiff when you try to raise your arms overhead, or do your ankles feel restricted during certain movements? These are common complaints seen regularly in the field of sports physical therapy.

Mobility issues like these are often frustrating, but they aren’t random. In fact, it’s your body—and more specifically, your nervous system—deliberately limiting your range of motion. That stiff muscle you feel is your body’s way of protecting itself or adapting to the physical demands placed on it.

As a physical therapist, I frequently reflect on my experiences working with elite athletes, particularly during my time with the National Basketball Association (NBA). Many of these athletes experienced ankle mobility restrictions, which were a natural adaptation to their sport. Their constant sprinting, jumping, and cutting movements—often performed with their heels rarely touching the ground—caused their bodies to adapt in a way that improved performance but at the cost of mobility.

In these athletes, the tissues around their ankles functioned like tight springs, making them more explosive without requiring excessive energy expenditure. While these adaptations allowed them to excel on the court, they also came with trade-offs, limiting ankle mobility. Over time, these performance-enhancing adaptations can lead to increased risk of injury if mobility is sacrificed too much.

When Does an Adaptation Become a Problem?

Adaptations like limited ankle mobility can be beneficial for specific movements or sports. However, when these adaptations go too far, they can put you at a higher risk for injury.

The key question is: How do we know when adaptations have gone too far?

The answer is simple: when the body can no longer perform the basic movements required by your daily life or sport. At this point, your joints have less mobility than necessary, and that’s when you begin to experience discomfort, stiffness, or injury.

For instance, a basketball player who spends most of their time on the balls of their feet may lose the ability to properly flex their ankles. This lack of mobility may not seem like an issue during the game, but it can lead to compensations elsewhere in the body, causing lower back pain, knee problems, or even an Achilles injury. Similarly, if your shoulders are stiff when lifting weights, it might not be the weights that are causing pain, but rather the shoulder’s inability to move through its full range of motion due to overuse or compensatory patterns.

How Can Physical Therapy Help?

One of the core principles of physical therapy is identifying and addressing these movement limitations before they turn into bigger problems. By targeting areas of the body that have adapted too far, physical therapy helps restore balance between mobility and stability.

At its core, mobility isn’t just about increasing flexibility or stretching. It’s about teaching your body how to move in a variety of ways. This is especially important for athletes and active individuals who have developed specific movement strategies over time. For example, if you primarily engage in forward-motion activities (like running or cycling), your body may over-adapt to these movements and lose the ability to move comfortably in other directions.

The Importance of Varying Your Movements

To counteract these adaptations, I encourage athletes and patients alike to incorporate daily exercises that challenge their bodies to move outside of their typical patterns. By regularly practicing movements that are different from their usual routines, individuals can maintain better overall mobility and reduce the risk of overuse injuries.

For example, I recently worked with a patient who had limited shoulder mobility. This patient experienced stiffness when raising their arms overhead due to years of repetitive shoulder movements. I introduced a daily shoulder mobility drill to improve their range of motion and reduce the risk of injury.

In another case, I advised a runner to incorporate lateral movement drills into her routine to counterbalance the constant forward motion of running. This allowed her to develop strength and mobility in muscles that weren’t being used as much, ultimately improving her performance and reducing her risk of injury.

Try These Mobility Drills for Better Movement

Here are a couple of examples of the mobility drills I often prescribe:

These exercises are simple but effective ways to restore mobility and ensure that your body doesn’t over-adapt to a single movement pattern.

Ready to Improve Your Mobility?

If you’re tired of feeling tight, stiff, or restricted during your favorite activities, physical therapy can help you restore balance and improve your movement. Whether it’s your hips, back, shoulders, or ankles causing trouble, understanding and addressing the root cause of your mobility limitations is the first step to feeling better and moving more freely.

Would you like to discover daily exercises and routines that can help you improve your mobility and overall performance? Contact us today to schedule an evaluation and get started on the path to better movement!