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.

Two Common Reasons You Have Neck Pain (And How to Fix It)

Neck pain is a common complaint of people seeing a physical therapist in Chevy Chase or Bethesda. Although a variety of different factors can cause it, two of the most common explanations of neck pain and discomfort are rib cage stiffness or overtraining.

One effective treatment of neck pain can be to reduce any rib cage stiffness that may be causing a lack of mobility below the neck. The muscles of the upper back and shoulders attach directly to the neck and can cause tension when unable to expand freely. To have pain-free neck mobility, the rib cage must be able to expand 360 degrees.

One simple method to improve rib cage stiffness is with a breathing exercise such as Rockback Breathing off an elevated surface (see below).

Rockback Breathing on a Bench

Another common cause of neck pain in our patients is overtraining. When patients disregard the warning signs and continue to push themselves, there is an increased stress response throughout the body. This causes the accessory respiratory muscles to work harder, thus developing neck stiffness and discomfort.

If overtraining is the issue, it can help take a couple of days to give your body time to rest and recharge. Similarly, it can be invaluable to work directly with a professional to ensure overtraining doesn’t become a long-term issue. Although it’s enticing to continue to train harder, you can usually achieve better results by giving your body more opportunity to recover.

When your neck pain has persisted for longer than a few weeks, it’s time to meet with a professional who can help identify more subtle reasons for the discomfort. If you’re in the Bethesda or Chevy Chase area, our physical therapists can help you get back to living your life pain-free!

Make the most of your visit: 3 questions to ask your physical therapist

Whether you’re attending in-person or virtual physical therapy, your success largely depends on how engaged and involved you are in the process. A physical therapist’s role is to identify issues, develop a personalized treatment plan, and guide you toward recovery. However, as the patient, your active participation is just as crucial. Asking the right questions during your sessions can empower you to take control of your health and recovery journey.

Here are three essential questions to ask your physical therapist to ensure you get the most out of your sessions in McLean or Bethesda.

1. Why Did This Happen, and How Can We Prevent It from Happening Again?

One of the key goals of physical therapy is not just to treat the symptoms but to address the root cause of your pain or injury. Whether it’s a recurring injury, chronic pain, or post-surgery rehabilitation, understanding *why* the issue occurred in the first place is crucial to preventing it from becoming a long-term or recurring problem.

By asking your physical therapist about the underlying cause, you’ll gain insights into the factors that contributed to the issue—whether it’s poor posture, repetitive strain, muscle imbalances, or even lifestyle habits. With this knowledge, you and your PT can develop a plan to not only treat the current problem but also take proactive steps to ensure it doesn’t happen again. This might include correcting your movement patterns, strengthening weak areas, or making adjustments to your daily activities.

2. What Should I Be Doing at Home to Support My Recovery?

Physical therapy sessions are often limited to a few hours per week, but your recovery continues long after you leave the clinic. The majority of your time will be spent outside of the physical therapist’s office, which is why it’s critical to know what exercises, stretches, or adjustments you should be doing at home.

Ask your physical therapist for a clear and detailed home exercise program that complements your in-person treatment. This plan should be tailored to your specific needs and capabilities, ensuring you’re doing the right movements to support your progress. A good physical therapist will not only show you the exercises but also explain why they are important, how to perform them correctly, and how often you should do them.

On the flip side, it’s equally important to know what not to do. Certain activities or movements could slow down your recovery or even worsen your condition. By clarifying both the “dos” and “don’ts,” you’ll feel more confident in managing your rehabilitation at home.

3. How Can You Measure and Ensure I’ll Make Progress?

The ultimate goal of physical therapy is to make meaningful progress toward your recovery goals, whether that’s reducing pain, improving mobility, or returning to your favorite activities. However, many healthcare systems focus on generic benchmarks, such as returning to basic activities of daily living (ADLs) or reaching a general “baseline.”

While these objectives are important, physical therapy should go beyond just meeting minimum standards—it should be about helping you achieve your personal goals. By asking how your progress will be tracked and measured, you set the expectation that the focus is on your individual needs, not just generalized outcomes set by insurance companies.

Your physical therapist should provide a clear roadmap for your recovery, outlining the specific milestones and indicators they’ll use to track your progress. This could include improved range of motion, increased strength, reduced pain levels, or functional abilities tied to your lifestyle. Regular check-ins and reassessments will ensure that your treatment stays on track and is adjusted as needed.

Physical therapy is a partnership, and the more actively engaged you are, the better your results will be. By asking thoughtful questions and staying informed, you’ll not only deepen your understanding of your treatment plan but also enhance your ability to manage your health outside of therapy sessions.

Athletic injury rates are on the rise

As the weather warms up, COVID-19 cases decline, and spring sports resume, many young athletes are eager to return to their favorite activities. While the excitement to get back on the field is high, it’s crucial to prepare your body properly to avoid injuries and maintain good health. In the Bethesda and Chevy Chase areas, proper performance training can make all the difference between a dream season and being sidelined.

After a long break from sports, the risk of injury is elevated because the body isn’t accustomed to the demands of sport-specific activities. That’s why it’s essential to spend time before the season starts preparing both mentally and physically for peak performance.

Research shows that strength and conditioning training can reduce sports injuries by 33% and overuse injuries by nearly 50%. Therefore, it’s important to begin with simple, manageable exercises to get back in shape and stay injury-free.

A smart approach to preseason training starts with individual sport-specific drills focused on conditioning. From there, athletes can gradually progress to drills with a partner or opponent. Eventually, they can increase their activity level to include team drills, scrimmages, and full game play. This gradual increase in activity, similar to what is seen in professional and collegiate sports, allows the body to adapt and handle the cumulative stress.

The best way to develop a sport-specific training program that meets an athlete’s individual needs is to consult a professional who can tailor the program to their unique strengths and weaknesses. If you’re looking to optimize your performance after a long offseason or recovery from injury, consider seeking performance training in Bethesda or Chevy Chase to kickstart your dream season.

Here’s to a fantastic new season—don’t forget to enjoy it!

How Stiff Ankles Lead to Back Pain

Those of you that have been to athletic physical therapy have likely learned about how a limitation in one area of the body can contribute to pain or injury elsewhere. It is common to find that runners, fitness enthusiasts, and other active people experiencing chronic lower back pain also have stiff ankles.

Exercises such as squats and lunges are a staple of many workouts and group exercise classes. These movements, in addition to many others, require a great deal of ankle dorsiflexion (the action of the knee moving over the toe). If an individual has stiff ankles and wishes to perform these activities, he or she must compensate and figure out another way to complete the exercise.

People are forced to reach their bottoms farther backwards when stiff ankles prevent their knees from advancing far enough beyond their toes. This pushes belly button forward in an effort to avoid falling backwards. As a result, the lower back arches excessively, compressing the area, and often results in discomfort.

Check out the article below from fellow Northeastern University Alumni, and former Physical Therapist for the Red Sox, Mike Reinold, to learn how you can measure if you have enough ankle dorsiflexion.

Ankle Mobility Exercises to Improve Dorsiflexion

Now that you measured your ankle dorsiflexion, what do you do about it if it?

In addition to some of Mike’s great recommendations, we suggest that you try the activities below from Dr. Cody!

If any of these activities cause pain or result in a pinching sensation in the front of the ankle, please contact us.

Have fun!

Why Your Big Toe Matters

Our poor big toes. They are one of the unsung heroes of our lower extremity and are integral for walking, running, and optimal function during standing activities. We commonly focus portions of treatment within an athletic physical therapy session to big toe function.

The big toe helps with shock absorption and propulsion while often bearing over 50% of our body weight. It provides an essential role in sustaining the arch of the foot, thus setting the stage for optimal function of the rest of the foot.

For these reasons, people that suffer big toe amputations typically experience balance deficiencies and struggle with a variety of upright activities.

The great toe needs approximately 60 degrees of extension for walking, specifically during the terminal phase of gait (push off) when the weight is on the front of the foot and the heel is off the ground.

Even more motion is needed for running and athletic activities like sprinting. We commonly find that our athletic patients have limited great toe mobility which forces the body to compensate, and increases the risk for overuse injuries elsewhere.

A good target for a committed runner or athlete is 90 degrees of great toe extension, which you can test on yourself!

Begin seated with your foot flat and relaxed on the ground. While keeping the balls of your feet on the ground, use your hand to lift your big toe up towards the ceiling. Can it reach 90 degrees and get perpendicular to the ground?

If not, our Director of Education, Dr. Alex Immermann has a fantastic drill to help you! Check it out below!

Big Toe Extension PAILs/RAILs

If this drill created any pain or discomfort, please contact us.

How to Know if an Exercise is Good or Bad

Athletic physical therapy often consists of answering questions about particular exercises.

What is your opinion on deadlifts? How do you feel about pushups? Is running bad for your knees?

My answers typically start by highlighting the context involved with any particular exercise.

Exercises are often labeled as good or bad, however most exercises are appropriate in a particular context, while being inappropriate in another.

For example, the deadlift is a great exercise when the goal is to build muscle and strength of the “pulling” musculature (glutes, hamstrings, upper back). However, this same exercise can be problematic for an individual with a history lower back pain, and cannot properly control his/her spine as the hips bend.

If a deadlift is inappropriate for a particular person, he/she can work on the qualities necessary to safely perform the movement, should that be a priority. Check out the video below as a reference for how Dr. Cody teaches the ability to brace the abs during a deadlift.

Bracing During a Deadlift

It is much simpler simply label the deadlift as “bad for your back” or “the best exercise for xyz”, however as with most things, the answer is not black and white.

Unfortunately, this way of thinking also applies to entire methods or schools of thought. Well-known strength coach Eric Cressey (and sadly the strength coach of the New York Yankees) wrote a great article about his process for assessing particular methodologies.

What do you think of XYZ method?

Keep an eye out for any professionals in the field of health, medicine, or fitness that label things as good or bad. Things are rarely that simple as a myriad of different factors exist within the presentation of every individual. If you experience a professional that claims he/she has the only guaranteed solution, and everyone else is wrong, run!