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.

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!

When You Should Be Using a Workout Machine

Workout machines like the prone hamstring curl are underutilized in the sports performance setting and often get a bad rap in the sports physical therapy industry. I have heard people (physical therapists, strength coaches, running coaches, personal trainers, etc.) say negative things about using machines for a variety of different reasons.

“Machines are not functional. Humans should provide their own stability and not rely on a machine to do it for them.”

“X, Y, or Z machine isolates only one area of the body and we do not move 1 area at a time in real life.”

The support that machines provide, allowing people to focus on working one area has many advantages when used appropriately.

Even athletes can benefit from using machines.

High level sprinting requires an athlete to have a great deal of hamstring strength as the muscle is in a shortened position (when the knee is fully bent).

During the recovery phase of sprinting (as the leg is being brought back to the front of the body) the heel should be as close to the athlete’s bottom as possible. As this motion begins, the hip is a relatively extended position.

The prone hamstring curl trains end range hamstring strength when the hip is in this position. Dr. Cohen even pauses briefly in this video when at the end of the movement to stress this position.

During this exercise, the machine will dictate the movement however remember to use your abs to prevent the lower back from extending during any portion of the exercise.

There is no such thing as a good or bad exercise. Almost every exercise is appropriate when used properly. The key is to be clear on the desired outcome of the drill and how to implement it most effectively into your training routine.

Would you like to learn how to design your training most effectively to best accomplish your goals? If so, contact us to receive a customized training program designed specifically for you!

Speed Up Your Recovery From Back Pain

As anyone who has thrown their back out and needed physical therapy will tell you, bending over feels rough for several days after.

Putting on socks and even sitting down is uncomfortable as the body attempts to prevent the lower back from moving, especially into flexion.

Flexion of the spine is commonly the most aggravating movement for anyone experiencing an acute episode of back pain. In physical therapy we test this by asking our patients to touch their toes. Once the acute episode subsides, the next step is training and learning to tolerate slow, controlled movements of the spine.

When tolerated well, the reverse crunch is great drill to teach this quality and can be used effectively as a warmup in the gym.

Oftentimes this is where the injury rehabilitation process stops. At this point the body can tolerate all normal daily activities however it has not learned to manage rapid movements of the spine, such as those that occur in sport or in the gym.

The Med Ball slam is a great drill to train the spine to tolerate movements that involve rapid spinal flexion. This drill should be pain free before attempting any heavy Olympic lifts like a clean or a snatch.

Also, remember to avoid using a ball that bounces as we don’t want any broken noses from this drill!

Physical Therapy Didn’t Work…

I tried physical therapy and it didn’t work.

Many of our patients in Bethesda have seen other physical therapists prior to seeing us. In their previous physical therapy experiences, they did not achieve the results that they were looking for and are coming to us for answers.

Personally, I love working with these people because they continue to believe that our profession can help them. However, negative experiences in physical therapy often cause many others to lose faith in the profession.

Perhaps you are one of these people. If so, I don’t blame you as I once was in your shoes!

When I was in High School, I experienced a quadricep injury that was impacting my ability to play football.

I went to my local physical therapy practice searching for help in overcoming this injury and play in my junior season. It was going to be my first season starting on both offense and defense causing this injury to constantly remain in the front of my mind.

My introduction to physical therapy was not what I had hoped for, and I now realize that my physical therapists were not taking great care of me (to learn more about how you can determine if this is the case, see my latest blog here).

Luckily, I was still able to play in my season and was back to 100% by the middle of the year. However, I can’t help but wonder if I would have been fully healthy to start the season if I saw a different physical therapist.

Like all other professions, the physical therapy industry has great professionals and poor ones. Furthermore, some physical therapists specialize with athletes, some with cardiac patients and others with people living in nursing homes.

As a result, my hope is that instead of saying “I tried physical therapy and it didn’t work”, you say “This physical therapist or physical therapy practice didn’t provide the results that I was looking for and I need to find someone that is a better fit for what I need.”