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 a physical therapist trains with back pain

Back pain is one of the most common issues encountered in sports physical therapy and injury rehabilitation, especially among runners. Those with sensitive lower backs often need to carefully manage the total amount of activity they perform over time.

It’s particularly important to pay attention to exercises that involve significant axial loading, which refers to weight bearing directly down onto the spine.

Exercises with high axial loading, such as barbell squats, typically involve supporting the weight on the shoulders.

For individuals with back pain, it’s crucial to keep the volume of axial loading reasonable. However, reducing the number of exercises that can be performed may limit progress for those who want to achieve their fitness goals.

The trap bar squat is an excellent exercise that targets the legs and, when executed correctly, keeps the back feeling great.

Here’s how to do it:

1. Set up a trap bar with a box placed in the center.
2. Stand on the box and position yourself inside the trap bar.
3. Exhale to engage your core by bringing the ribs down and activating your abs.
4. Inhale as you squat down by pushing your knees forward to reach the bar—this is not a deadlift!
5. If needed, reset your abs, take the slack out of the bar, and stand tall as you exhale.
6. Repeat.

Performance training for knee pain

When your knees are acting up, how could using them more possibly help? Many of our patients have the same concerns during the injury rehabilitation process, especially when they first start physical therapy.

Knee pain often stems from a reduced ability to tolerate stress. This stress can occur during activities like squatting, lunging, running, or jumping.

Every tissue in the body has a certain stress tolerance—the amount of stress or load it can handle before pain or injury occurs. When this tolerance decreases, it takes less stress to cause discomfort or injury. However, when the tissue’s loading tolerance increases, it can withstand more stress. In sports physical therapy, finding the right balance between these factors is crucial.

The only way to increase a tissue’s loading tolerance is through training—or in other words, applying stress to the tissue!

The key is to apply the right amount of stress to the targeted tissues. Too little stress won’t prompt the body to adapt, while too much could lead to further injury.

It’s similar to weight training. To build stronger muscles, you need to lift weights, which stresses the muscles. This stress triggers an adaptation, allowing the muscles to handle more in the future.

In cases of chronic knee pain, people often avoid loading the knees. Over time, this avoidance leads to a decrease in the loading tolerance of the tendons and tissues around the knees. As tolerance decreases, the likelihood of pain increases, creating a snowball effect.

We can reverse this by introducing pain-free exercises that challenge the tissues around the knees. Isometric exercises, which involve holding a challenging position for a set period, are particularly effective.

Another type of exercise that often benefits those with chronic knee pain is eccentric exercises. These exercises work the tissues as they lengthen slowly. One of my favorites, which we frequently use, is the Eccentric Step Up.

When dealing with knee pain, there aren’t inherently “good” or “bad” exercises. The goal is to find the exercises that apply the right amount of stress so the surrounding tissues adapt appropriately.

Our team of Performance Physical Therapists would love to help you find the best exercise routine to improve your knees’ loading tolerance. Contact us to receive a comprehensive home program tailored to you!

P.S. Don’t forget to subscribe to our YouTube channel and check out our new and improved Instagram page @cohenhealthandperformance!

What Touching Your Toes Really Says

Can you see the difference in these photos? The toe touch is a simple test that is often performed in injury rehabilitation and sports physical therapy settings.

However, important parts of this test are commonly missed. Simply touching your toes doesn’t tell the whole story. If you can touch your toes, great, however there are different ways that you can get there.

Have you stretched your hamstrings to such a degree that they allow you to nearly palm the floor?

If you are a gymnast that may be a great thing. However field sport athletes (ex. Lacrosse, football, basketball, baseball) and weight lifters need a level of hamstring stiffness for explosive movement.

Is your lower back straight or does it flex into more of a C curve to allow you to more easily touch your toes? Is your lower back bending in certain areas but not in others?

Your lower back consists of multiple bones (vertebrae) that are stacked on top of each other. Our backs are built this way to allow for movement of one segment on the next. However many times these small movements do not occur and the lower back moves as one unit. The result is a lower back that looks straight in places despite being bent over. Over time, a lack of lower back movement can increase the risk for injury.

The toe touch is a great test and can be made even better when directed by a professional with a trained eye.

Contact us for more information about how a customized movement assessment may help you optimize your training and avoid injury!

I felt stuck

Times have certainly changed, haven’t they? Just look at all that hair! And it seems like they couldn’t do much about the sun glare on picture day either…

“I really need to stretch more. Should I try Yoga?”

“Everyone’s talking about how Pilates strengthens your core. Maybe I should take a class?”

“I know strength training is crucial, but where do I even begin?”

If you’ve ever had thoughts like these when thinking about exercise, you’re not alone.

The world of health, fitness, sports physical therapy, and injury rehabilitation can feel massive and even a bit daunting. I remember a time when I was unsure about how to approach my own fitness journey.

After wrapping up my college football career, I no longer had coaches designing my training plans. No more structured practices, conditioning workouts, weightlifting sessions, or recovery routines that typically involved stretching, foam rolling, yoga, and light cardio.

With no clear direction, I stuck with what I knew best: lifting weights, following my old off-season routine, and adding a couple of conditioning sessions each week.

After a few weeks of this, I stopped and asked myself a simple but important question: “Why?”

Why was I training this way? What were my goals now? And what were the most effective ways to achieve them? After reflecting and writing down my thoughts, I realized that my training program no longer aligned with my new goals.

My football days were behind me, and it was time to focus on staying healthy long-term.

At the same time, I still enjoyed strength training and the feeling of being strong. Plus, I was working toward becoming a Certified Strength and Conditioning Specialist (CSCS), so I needed to practice what I preached (this was all before I entered sports physical therapy school).

I ultimately designed a new strength training program that focused on increasing strength and muscle mass while also enhancing my mobility. The goal was to feel strong and stay healthy.

This approach worked because I took a moment to slow down and ask myself a few basic questions.

When was the last time you did that? Ask yourself these questions:

– What are the outcomes I want from my training? Do I want to be stronger? Have less discomfort? Improve my mobility? Be honest with yourself.
– What are the best methods to achieve these outcomes?
– If I don’t know the answer to the above, who can help guide me?

As question three suggests, you don’t need to figure it all out on your own. There are experts available who can help you reach your goals, but only you can determine what those goals are.

Once you have that clarity, our team of sports physical therapists in Bethesda and McLean is here to help. Along with being Doctors of Physical Therapy, our Performance Physical Therapists are also Certified Strength and Conditioning Specialists. We specialize in helping injured athletes recover and get back to doing what they love.

Ergonomics Are Overrated (Maybe)

Blasphemy! Every physical therapy professor from Bethesda to New Zealand just made me public enemy number one.

I am exaggerating, of course, however it sounds outrageous for a sports physical therapist or anyone working in the injury rehabilitation field to state that ergonomics could be overrated.

This is not to say that they are not important. An individual’s workplace setup, for example, is an important factor to consider when addressing ailments such a chronic neck or back pain.

However, if you look on social media or watch an episode of shark tank, you are likely to find several different devices claiming to fix your posture and solve your pain. Many then purchase these products and become discouraged when their ailments are not cured.

Claiming that a single ergonomic correction will solve all your issues is to ignore the myriad of different factors that contribute to pain or injury. Furthermore, it ignores the fact that there are other, more influential factors.

Look at the picture above. An ergonomic specialist would give me a failing grade. I am slouching and looking down at my computer with my legs stretched straight out. Even worse I’m resting my computer on my poor pup, Chip (he is under the blanket)!

However, I’m feeling pretty good today. I slept well last night and went on a long walk this morning after exercising. These factors outweigh the impact of an hour of computer work.

Improving large components of health such as sleep, nutrition, exercise, and stress enhance the resilience of our bodies.

Resilience is an awesome thing. It creates room for error and means that we can still feel great despite having an imperfect desk set up.

Overall, it is worth repeating that you should still try to improve ergonomics whenever possible, however do not expect it to solve much when the larger components of health are being ignored.

For more information on these larger components of health, check out the articles below!

Does Your Metabolism Actually Slow As You Age?

Benefits of Walking for Physical and Mental Health

Exercise Stacking

Pullup and keep your shoulders happy

The Impact of Breathing on Shoulder Function and Pull-Up Performance

As we discussed in a recent article (which you can find here), our ability (or lack thereof) to breathe effectively can significantly influence shoulder function. This is a common area of focus in sports physical therapy and performance training, particularly for runners. Breathing can affect posture, shoulder mobility, and even lead to issues like clicking, popping, or decreased strength in the shoulders.

Among these factors, reduced shoulder mobility is often the most noticeable.

In many cases, a slight reduction in shoulder mobility isn’t problematic unless you’re engaging in exercises that demand extensive shoulder movement.

One such exercise is the pull-up or chin-up. Performing these exercises correctly requires substantial shoulder flexion and overhead pulling strength. When these abilities are lacking, the body tends to compensate in ways that can affect form and function.

A common compensation is leaning back and puffing out the chest when initiating the movement from a hanging position. This causes the front ribs to flare out, altering the position of the shoulders and reducing their overall effectiveness.

So, how can you ensure proper form during vertical pulling movements like pull-ups and chin-ups?

The key is to perform these movements in a tucked position. This position flexes the hips, aligning the pelvis underneath the body, which makes it difficult to excessively puff out the chest.

However, be prepared—this position makes chin-ups and pull-ups significantly more challenging!

Not only does it increase the workload for your abdominals, but anytime you eliminate compensations, the movement becomes more demanding.

When starting out, try supporting your legs or feet. Once you’ve mastered this, progress to holding them up on your own.

Check out this video of Dr. Cohen incorporating these techniques into his training routine.