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.

Blood Flow Restriction Training in Physical Therapy

If you’ve ever visited our Bethesda or McLean physical therapy facilities, you may have seen patients wearing unique-looking cuffs around their arms or legs while exercising. At first glance, it might not look like the most comfortable experience, but it’s certainly sparking curiosity among many of our clients/patients at Cohen Health and Performance.

This technique is called Blood Flow Restriction (BFR) Training, and we frequently use it in physical therapy to help patients recover from injuries, maintain muscle strength and mitigate muscle loss. We’ve received many questions about how BFR works, so let’s dive into its benefits and who might benefit from it.

What is Blood Flow Restriction (BFR) Training?

BFR training is a specialized method used in physical therapy that involves placing controlled cuffs around the arms or legs to partially restrict blood flow to those areas. This restriction creates an effect similar to lifting heavy weights, even though the actual resistance is much lower.

This makes BFR especially useful when an injury prevents traditional strength training. Instead of losing muscle and strength due to inactivity, BFR allows us to stimulate muscle growth and prevent atrophy—an essential part of effective physical therapy rehabilitation.

How Does BFR Work?

When blood flow is restricted during exercise, it creates a hypoxic (low oxygen) environment in the muscles. This leads to:

Increased Growth Hormone Production – A key factor in muscle recovery and repair.
Enhanced Strength Retention – Even with light weights, BFR promotes muscle activation similar to traditional strength training.
Faster Injury Rehabilitation – By maintaining muscle mass and strength, BFR helps patients recover more efficiently and return to their activities sooner.

Who Can Benefit from BFR in Physical Therapy?

At Cohen Health and Performance, we integrate BFR into physical therapy treatment plans for a wide range of patients, including:

Athletes recovering from ACL tears or knee injuries
Active adults with calf strains, tendon issues, or post-surgical rehab needs
Individuals with upper extremity injuries, such as biceps tendon strains

Since BFR allows us to effectively train muscles without excessive load, it is a valuable tool in physical therapy for injury recovery, muscle preservation, and performance enhancement.

Is BFR Right for Your Physical Therapy Plan?

If you’re undergoing physical therapy and want to prevent strength loss, muscle atrophy, or delayed recovery, BFR training could be a powerful addition to your rehabilitation program. At Cohen Health and Performance, our Doctors of Physical Therapy use this innovative technique to help patients get back to the activities they love—stronger and faster.

If you’re interested in learning more about BFR training and how it fits into your physical therapy plan, contact us today—we’d love to help!

Your Tools to Recovery: What Actually Works?

When it comes to sports recovery, athletes today have access to an overwhelming number of tools—foam rollers, ice baths, saunas, compression boots, and more. But what’s actually worth your time? And what recovery methods truly make a difference?

Our physical therapy team at Cohen Health and Performances work with athletic adults, college and high school athletes every day, helping them overcome injuries and perform at their best. Let’s break down some of the most popular recovery methods and see which ones are worth incorporating into your routine.

Foam Rolling

Foam rolling is one of the most common recovery techniques used in gyms, both before and after workouts. You may even have a foam roller at home that you use on recovery days.

The Science Behind Foam Rolling

The research on foam rolling is mixed. Some studies suggest that it can reduce short-term muscle stiffness and improve flexibility by increasing blood flow to the muscles. However, other research indicates that it may not have a significant long-term impact on recovery.

Should You Use It?

Yes, if… You feel a benefit from it—less tightness, improved movement, or reduced soreness.
Skip it if… You’re just doing it because someone told you to, and you don’t notice a difference.

Like with most recovery tools, if it helps you feel and move better, keep doing it. But if you’re not noticing any changes, it’s probably not a must-have in your routine.

Ice vs. Heat: Which One Should You Use?

One of the more common questions we hear in physical therapy is:
Should I use ice or heat for recovery?

When to Use Ice (Cold Therapy)

If you’re recovering from a recent injury, such as a sprained ankle or muscle strain, icing can help reduce swelling and inflammation. Ice can also be useful after high-intensity activities—like a basketball game or heavy leg day—to prevent excessive soreness and irritation.

When to Use Heat (Heat Therapy)

Heat is great for relaxing tight muscles and improving blood flow. It can be especially beneficial before workouts to increase mobility or on recovery days to relieve stiffness.

Key Takeaway:
Both ice and heat have their place, depending on your needs. If you’re unsure which is best for your recovery, consult with a physical therapist to help you create a plan tailored to your sport and training level.

Compression Therapy: Is It Worth the Hype?

Compression therapy, such as Normatec boots, has become increasingly popular among elite athletes. These devices work by pumping air into different chambers of the boot to promote circulation and reduce muscle swelling.

Does It Work?

📖 Research suggests that compression therapy can help reduce muscle soreness/inflamation and speed up recovery. However, it’s not necessarily a must-have for most athletes.

Should You Invest in Compression Boots?

Use them if… You have access to them and feel they help with your recovery.
Not necessary if… You don’t want to spend money on expensive recovery tools when other free methods (like active recovery) work just as well.

My Favorite Recovery Method: Active Recovery

If there’s one recovery tool that every athlete should use, it’s active recovery.

Instead of sitting on the couch after a tough workout or game, the best thing you can do is get moving.

Try this simple active recovery routine:
✔️ 10-15 minutes of light cardio (stationary bike, walking, or rowing)
✔️ Mobility exercises targeting sore or stiff areas
✔️ Basic bodyweight movement drills to promote blood flow

Why It Works:
Active recovery flushes out waste products from your muscles, reduces soreness, and helps prepare your body for the next workout.

Pro Tip: Professional athletes often dedicate 20-30 minutes on recovery days to movement-based sessions that include light cardio and flexibility work. Implementing this in your routine can boost recovery and prevent injuries.

The 90% Rule

While tools like ice baths and compression boots can be useful, they won’t make a difference if you’re neglecting the basics.

Nutrition – Fuel your body with enough protein, carbs, and healthy fats to support muscle repair.
Sleep – Prioritize 7-9 hours of quality sleep to maximize recovery.
Consistent Training – Train smart and take a thoughtful approach to your programming
Stress Management – Too much stress (physical or mental) can slow down recovery, so make sure you’re managing it effectively.

The basics account for the majority your recovery results. The best recovery tools in the world can’t replace proper sleep, nutrition, and training habits.

Final Thoughts: What Should You Prioritize?

Recovery is not one-size-fits-all. The best approach is the one that helps you feel and move better.

Key Takeaways:

Foam rolling: Use it if it works for you, but it’s not essential.
Ice vs. heat: Ice for recent injuries, heat for stiffness and mobility.
Compression therapy: Helpful, but not a must.
Active recovery: The most effective and accessible recovery tool.
Focus on the basics: Sleep, nutrition, and smart training are 90% of the equation.

If you’re struggling with muscle soreness, an injury, or just want to optimize your recovery, physical therapy can help.

Contact us today to get a personalized recovery plan designed for your sport and training needs!

What Stretches Should I Be Doing?

When one of my sports physical therapy patients in McLean recently asked, “What stretches should I be doing?” my answer surprised them: none. While stretching often feels like the go-to solution for muscle tightness, the real issue may not be a lack of flexibility. Instead, the body’s tightness is often a protective response, signaling something deeper that needs attention.

Why Do Muscles Feel Tight?

Muscles don’t become tight without reason. Often, tightness is a response to:

Overtraining or Inefficient Training: If your body senses overuse or improper technique, it may stiffen tissues as a protective measure to avoid injury.
Weakness in Key Positions: Muscles may feel tight because they lack strength in the positions or ranges of motion they’re required to operate in. Without adequate strength, the body compensates by tightening tissues to stabilize and protect itself.

The Role of Strength in End-Range Positions

Athletes, especially those in McLean and Bethesda who engage in high-demand sports like baseball, gymnastics, or weightlifting, frequently encounter this issue. For example, a baseball pitcher’s peel-back position or a gymnast’s overhead movement requires strength and control in extreme ranges of motion. When the body perceives instability or weakness in these ranges, it responds by tightening muscles to guard against potential harm.

This concept applies to non-athletes too. Everyday tasks—like reaching into a cabinet, turning in your car, or bending to pick something up—demand strength in extended ranges of motion. If you’re not strong in these positions, you’re more likely to experience tightness and discomfort.

Exercises That Build Strength and Relieve Tightness

Building strength in lengthened positions can address the root cause of muscle tightness. Two effective exercises we frequently recommend in our sports physical therapy practice are:

Romanian Deadlifts (RDLs):
- Why It Works: RDLs target glute and hamstring strength while promoting core stability in a hinged position. The hamstrings must control the descent of the body and weight, creating tension while lengthening.
- Benefit: When hamstrings are strong through a full range of motion, they feel stable and are less likely to tighten unnecessarily.
Split Squats:
- Why It Works: This exercise builds lower body strength and challenges the hip flexors and quads to stabilize and generate force in a stretched position.
- Benefit: Strengthening these muscles in lengthened positions reduces the likelihood of tightness and enhances overall mobility.

Why Choose Sports Physical Therapy in McLean and Bethesda?

Whether you’re an athlete or just someone looking to move better in everyday life, strength training in extended ranges of motion is crucial. Our sports physical therapy team in McLean and Bethesda specializes in identifying the root causes of stiffness and designing tailored programs to address them.

Take the First Step Towards Relief

If stiffness or tightness is holding you back, it’s time to rethink your approach. Contact us to discover why your muscles feel tight and how to resolve the issue once and for all. Let’s work together to build strength, improve mobility, and get you back to moving comfortably and confidently.

Get Started Today: Contact us!

Whether you’re in McLean, Bethesda, or the surrounding areas, we’re here to help you unlock your full potential through effective sports physical therapy.

Don’t Be an Alligator

One of the most fascinating lessons I ever learned came from a course taught by a Louisiana native. He opened by describing how to wrestle an alligator—not exactly what I expected in a physical therapy context. But as he unpacked the metaphor, it turned out to be a great analogy for human movement and performance.

Here’s how it goes: When wrestling an alligator, you want to jump on its back, grab its snout, and make it arch and extend. Why? Because when the alligator arches, it can’t do its death roll. And if you get caught in that roll, it’s game over.

What does this have to do with physical therapy? As human beings, we’re surprisingly similar to the alligator in this regard. When we arch and extend excessively through our spine, we lose the ability to rotate effectively. This limitation has huge implications for activities that require rotation, such as golf, baseball, tennis, running, and even walking. Rotation is a foundational movement pattern that keeps us functional, efficient, and injury-free.

Avoiding the Alligator Trap

So, how do we avoid becoming the human equivalent of an alligator? It all starts with understanding how to stack our ribcage and pelvis properly.

Imagine a snowman with three balls stacked on top of each other:

Top ball: Your head
Middle ball: Your ribcage
Bottom ball: Your pelvis

For optimal movement, these three “balls” need to be aligned. When your ribcage and pelvis are stacked, your spine has the freedom to move in all directions—rotation, side bending, and flexion/extension. This alignment also allows you to build strength in functional positions, which has the greatest carryover to sports and everyday activities.

Practical Application: The Role of Load Placement

One key way we apply this concept in physical therapy and training is by being mindful of where the load or weight is placed relative to the body. Let’s take the squat as an example.

The traditional barbell back squat—where the barbell rests behind your head on your shoulders—often pushes the body into an arched and extended position. This makes it difficult to maintain a stacked posture, limiting your rotational capacity and potentially leading to back discomfort.

Instead, we recommend exercises where the load is placed more in front of the body. Two great options include:

Goblet Squat: Holding a kettlebell in front of your chest helps keep your ribcage and pelvis stacked.
Safety Bar Squat: A safety bar shifts the weight slightly forward, promoting better alignment.

A good indicator that you’re doing these exercises correctly is feeling your abs engage rather than your lower back. This feedback ensures you’re maintaining a stacked position and avoiding the “alligator trap.”

How Physical Therapy Can Help

If you’re experiencing pain, struggling with movement, or simply looking to optimize your training, physical therapy can provide tailored solutions. At Cohen Health and Performance, we ensure that your programming carries over to the activities that matter most to you. Whether you’re a golfer, runner, tennis player, or just someone who wants to move better, we’re here to help.

Don’t let poor movement patterns hold you back. Contact us today to take the first step toward pain-free, efficient movement—and remember, don’t be an alligator!

Core Training Reimagined

When I create training programs for our physical therapy or performance training clients here at Cohen Health and Performance, one of the most common requests I hear is, “Hey Zac, can you add more core training?” Or, “Can you give me a core circuit to put into my routine?”

But here’s the thing: Most of us don’t train our core as effectively as we could—at least not in a way that matches how our core is designed to function. Let’s rethink core training together.

What Does Your Core Really Do?

Your core—your trunk—is so much more than just a six-pack waiting to be revealed. Its primary function is to manage internal pressure and support your body against gravity. Think of it as your body’s central stability system.

To help you visualize this, imagine the iconic wacky waving inflatable tube man you see outside car dealerships. That tube man is held up by air pressure. If you fill it with maximum pressure, it stands tall and firm. But if you let some air out, it becomes more flexible and moves with the wind. Let out too much air, and it collapses entirely.

Your core operates in a similar way. When you need maximum stability—like lifting a heavy object—you brace hard to build internal pressure, stabilizing your spine and supporting the load. On the flip side, for everyday activities, you rely on just enough core engagement to keep you upright and mobile, without overexerting yourself.

Core Training: Beyond Crunches and Planks

So, how does this translate into smarter core training? It starts with understanding that the core’s role goes beyond traditional exercises like crunches or static planks. Instead, think of your core as a dynamic stabilizer, adapting to different demands in sport, exercise, and daily life.

During physical therapy or performance training at Cohen Health and Performance, we focus on exercises that challenge the core’s ability to:

Reposition the pelvis. For example, certain drills help align the pelvis in an optimal position for athletic performance or functional movement.
Maintain pressure and support the spine. Exercises like the body saw are excellent for this. The body saw challenges your abs to prevent your belly from sagging toward the ground—a movement gravity constantly encourages. The stronger your abs, the better they counteract this pull, giving your spine the support it needs.
Engage during full-body movements. Did you know that a perfectly executed squat or deadlift can give your abs a serious workout? Core engagement is critical during these exercises to stabilize your trunk and prevent injury.

One of the biggest mistakes I see in gyms is improper technique during “core” exercises. For example, take the plank. Many people let their belly sag toward the ground, leaning on their lower back for support instead of engaging their abs. Over time, this can lead to discomfort and even injury.

Proper core training requires awareness of your body’s position and the intent behind each movement. That’s why we incorporate a variety of drills in our programs—not just for the sake of variety but to train the core in ways that reflect its real-life function.

Ready to Elevate Your Core Workouts?

If you’re looking for inspiration, check out the exercises on our YouTube page. You’ll find everything from pelvis-positioning drills to challenging moves like the body saw. And remember, core training isn’t just about isolating your abs. It’s about integrating them into your movements—squats, deadlifts, and even overhead presses can be incredible core exercises when done correctly.

So, the next time you think about adding core work to your routine, ask yourself: Am I training my core to look good, or am I training it to function well? The best part? You don’t have to choose one or the other. With intentional training, you’ll get both.

Let’s build that pressure, stabilize that spine, and transform the way you think about core training.

Why Distance Runners Sprint in Physical Therapy

If you’re a distance runner training for a 5K, 10K, half marathon, or even a full marathon, the idea of sprinting might seem a bit strange. After all, why would you focus on short bursts of speed when your goal is to cover long distances? Surprisingly, incorporating sprints into your training can significantly boost both performance and injury prevention. As physical therapists often emphasize, sprinting can make a big difference in improving biomechanics and reducing injury risk. Let’s dive into why distance runners should sprint and how it can benefit your training.

Raise Your Speed Ceiling

Think of sprinting as raising the ceiling of what your body is capable of. Imagine you’re driving a car. If the car has a top speed of 100 mph, cruising at 60 mph feels easy. But if your car’s top speed is only 70 mph—like the 1991 Mercury Topaz I drove in high school—going 60 mph might feel like it’s about to fall apart.

The same principle applies to running. If you increase your top-end speed through sprinting, running at slower paces for longer distances will feel much easier and more efficient. In other words, sprinting improves your speed reserve, enabling you to sustain faster paces during races without exhausting yourself. In physical therapy we often recommend sprinting as a way to condition the muscles and nervous system to handle faster speeds efficiently.

Injury Prevention Benefits

Sprinting isn’t just about getting faster—it also plays a critical role in injury prevention. When you sprint, you naturally strike the ground underneath your body rather than reaching out in front of you. This reduces the braking forces that occur when your foot lands too far forward.

Remember Newton’s Third Law from high school science? Every action has an equal and opposite reaction. When your foot lands ahead of your body, the ground pushes back against you, creating extra stress on your feet, ankles, knees, hips, and lower back. Over time, this repetitive impact can lead to discomfort, inefficiency, and even injuries. Many physical therapy programs focus on drills and techniques similar to sprinting mechanics to retrain the body and reduce injury risk.

Sprinting teaches you to land underneath your center of mass, reducing impact forces and improving running mechanics. It also builds elasticity in your joints, making you more springy and bouncy. This elasticity helps you spend less time on the ground with each foot strike, which adds up to faster, more efficient running over long distances. Physical therapy principles emphasize the importance of joint elasticity to enhance performance and lower injury risk.

Simple Ways to Incorporate Sprinting

The good news is that you don’t need to overhaul your training plan to start reaping the benefits of sprinting. You can incorporate a few sprint drills into your warmups or cross-training sessions without adding excessive stress to your body. These drills are also often included in physical therapy sessions focused on improving running mechanics.

Some great drills to get started include:

A-March – Focus on proper posture and knee drive.

A-Skip – Adds rhythm and coordination to the marching movement.

Step-Over Drill – Enhances knee lift and foot placement.

Performing a couple of sets of these drills as part of your routine can make a big difference. These exercises help reinforce proper running mechanics and prepare your body for both speed and endurance. If you’ve ever attended a physical therapy session, you may recognize some of these movements as foundational drills to improve mobility and stability.

Take the First Step

Not sure where to start? Check out our YouTube page for detailed demonstrations of these drills. For those of you who have been training with us for a while, you might even recognize a familiar face in the videos!

Sprinting might not seem like the obvious choice for a distance runner, but it’s one of the most effective ways to elevate your performance and protect yourself from injury. Start small, stay consistent, and watch how your running transforms. If you’re struggling with any specific discomfort or mobility issues, consider reaching out to our physical therapy team to guide you through personalized strategies.