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 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!

An Essential Part of Athletic Physical Therapy: Strength Training for Runners

Many of the runners that we work with at CHP supplement their running with strength training. Strength training is a large component of athletic physical therapy and provides a host of benefits including, but not limited to; reduced injury risk, increased muscular endurance, and faster running times. Research shows that regular strength training improves a runner’s speed and VO2 max. VO2 max is a measure of the maximal amount of oxygen that a person can use during exercise.

However, there is one important caveat to all of these great benefits. A runner’s strength training program must be designed and executed appropriately, and according to the runner’s goals and individual characteristics.

Luckily, most runners have similar goals. They wish to run faster and/or farther, and avoid injury.

Strength training programs for runners should consist of exercises that improve qualities specific to running.

When running, there is never a time when both feet are touching the ground simultaneously. The arms and legs are constantly moving in opposite and alternating directions as the body transitions from one foot to the other.

Therefore, we commonly advocate for runners to include more single leg exercises into their training.

These exercises include, but are not limited to: lunges, single leg squats, split squats, and single leg RDLs (Romanian deadlifts). Simply adding one of these activities into each of your strength training sessions can have a large impact. Take a look at the videos below for examples of these activities.

https://www.youtube.com/watch?v=aazACzyUR-Q

https://www.youtube.com/watch?v=KK05iugeIDE

https://www.youtube.com/watch?v=EjDtPek261c

Furthermore, runners should not neglect upper body training. Arm drive is an essential component of running and helps to drive leg action. An effective runner cannot have one without the other!

A thoughtful and more scientific approach to strength training, specifically designed for runners, may be all that is needed to drastically improve your running performance.

How Tom Brady Approaches Off-Season Training

Tom Brady is a marvel to the world of Sports Physical Therapy and performance training.

As you may know, Tom Brady is about to make his 10^th trip to the Superbowl at the age of 43. The opposing Quarterback in this game will be Patrick Mahomes. Mahomes was in kindergarten when Brady played in his first Superbowl back in 2002!

Athletes like Brady approach their off-season training with very specific goals in mind. These include sport and position specific goals (ex. Improving footwork, accuracy, throwing mechanics), as well as goals related to health and fitness.

The greats across sports such as Brady, Lebron James in basketball, and Wayne Gretzky in hockey focus their off-season training on staying healthy throughout the upcoming season. They understand the classic saying that “the best ability is availability.”

They realize that attributes that make them more resilient to injury will also improve their performance on the field, court, or ice.

Brady requires a great deal of mobility to best absorb the hits that accumulate throughout a football season. An increase in mobility will also allow him to throw accurately from the variety of awkward positions that the body is contorted into throughout a game, thus improving his performance as well.

Lebron James possesses an incredible amount of single leg control and strength. This is necessary to propel his nearly 270-pound body into the air as he jumps off 1 leg. This control and strength are equally important to avoid injury as he lands and must quickly adapt to awkward situations (players falling under him or contact him in the air).

Much like Brady, Gretzky must also be capable of contorting his body into a variety of different positions to pass or shoot from varying angles, absorb contact, or maneuver around opponents. These abilities require lots of mobility and strength throughout a variety of different positions.

The actual off-season training for Brady, James, and Gretzky will look different for each. However, the bulk of their training likely will not include commonly performed gym-based exercises, such as deadlifts or bench press. These are fantastic exercises when performed in the right context, however do little to help with the performance of these athletes.

It is essential for more athletes, specifically youth athletes to think more like Brady, James, and Gretzky when approaching their own off-season training. What are their goals for the off-season? What attributes best contribute to success on the field of play and help the athlete to stay there? Are the exercises being performed the best choices for this?

The optimal off-season program is unique to each individual and will even be different among athletes that play the same sport. However, it is essential that the previous questions are asked at the start of the off-season to ensure that weight room improvements will be transferred to the field of play.

Would you like help determining the attributes that you must work on this off-season to take your performance to the next level for the upcoming season? A custom designed off-season training program may be what you need to blow your coaches away.

Why “Shoulders Down and Back” Is Not Helpful

“Shoulders down and back” is a cue that is commonly used to correct one’s posture. However, as performance physical therapists we find this cue to be detrimental to how the shoulder complex is meant to function. In fact, correcting this belief has been one of the most helpful suggestions during our virtual physical therapy sessions and throughout the injury rehabilitation process.

Pulling the shoulder blades down and back opposes necessary shoulder blade during reaching activities. The shoulder blades are meant to elevate and abduct (move apart) as the arm is moved away from the body.

The motion of the shoulder blades moving away from the spine is called protraction. Protraction is required to properly perform pushups or reach in any direction.

This is of particular importance for active people that wish to lift weights or play a sport. Attempting to keep the shoulders “down and back” as the arms need to move away from the body will negatively impact the mechanics of the shoulder and possibly result in injury.

“Shoulders down and back” may work for drills such as deadlifts, rows, and farmers carries, however it is useful to forget this cue for other activities, such as posture correction!