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.

One Quick Test of Shoulder Health

It’s not as easy as it sounds.

Maintaining a quadruped position (hands and knees) reveals a great deal about your upper body strength and preferred movement strategies. For these reasons, we use this position as a test and exercise within our sports physical therapy setting.

Even strong and muscular patients commonly assume a quadruped position with their shoulder blades pinched close together and deep lower back arch (belly button dropped towards the ground).

This position is often utilized because it conserves energy and allows the body to be lazy. Compression from the lower and upper back is used to hold the torso up against gravity, instead of the abs and muscles involved with reaching. These strategies are common among folks experiencing back pain, shoulder pain and a variety of other issues.

The abs and muscles involved with reaching (for example, the serratus anterior) are essential components of athletic performance, running, walking and pretty much being a human being.

As these skills diminish, the risk of experiencing various injuries may increase.

The bear test is a great way to see if test your upper body strength and movement capabilities.

Think you have what it takes to pass the test? Give it a shot with this drill!

Photo Credit

“Polar bear” by tharendra is licensed under CC BY-ND 2.0.

Why I Don’t Train Barefoot

Barefoot training and the use of minimalist footwear has become a widely discussed topic in sports physical therapy and the running community. Many folks in the fields of sports medicine, injury rehabilitation, and performance training are all-in on the idea of training in bare feet.

Training barefoot provides great benefits.

The absence of shoes gives the body a direct connection to the ground for quicker and more accurate feedback which helps to improve balance.

Barefoot training also strengthens the feet themselves. When the feet do not have assistance from footwear for support, they must do the entirety of that job for themselves. Muscles, tendons, and ligaments in the feet work to support the arch, the heel, and the forefoot which strengthens them over time. For this reason we often prescribe barefoot training for our physical therapy patients.

However barefoot training is not appropriate for all people.

Most of us walk on hard surfaces like concrete and unlike grass or dirt, concrete is not a forgiving surface. We are unable to manipulate concrete and we have less shock absorption as we step onto harder surfaces.

In addition to an external environment that may not be conducive for barefoot training, many people have unique foot structures or previous injuries that make barefoot training unrealistic. In these situations, a shoe may help their foot function better.

An appropriate shoe allows for the foot to find the ground optimally and properly transition through the different phases of the gait cycle. This allows the body to properly alternate from one leg to the other.

A proper shoe must provide optimal heel control, allow for the arch of the foot to contact the shoe properly (and at the correct time in the gait cycle) and bend only where the toes bend.

The correct shoe can have an incredibly powerful effect on a variety of different ailments and can make a huge difference in the effectiveness of someone’s rehabilitation and training program.

Are you eager to find out if barefoot training is right for you? Contact us today to learn more!

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!