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 Physical Therapy Can Help You Keep Training Through Shoulder Pain

For anyone dealing with a history of shoulder pain, getting a solid upper body workout can feel like a minefield. Bench presses, overhead presses, pull-ups—many of the staple movements in strength training can feel off-limits when your shoulder isn’t moving or functioning the way it should.

But here’s the good news: physical therapy can help you get back to doing what you love in the gym—safely and effectively.

Why Overhead Movements Hurt

Many overhead exercises require a full range of motion at the shoulder. But for that to happen, the shoulder joint isn’t working alone. It relies on a coordinated effort between your shoulder blade (scapula) and your rib cage to allow your arm to move overhead without pain or compensation.

What often gets overlooked is that the rib cage needs to move 360 degrees—expanding and compressing both in the front (anterior) and back (posterior). If it can’t, your scapula can’t rotate properly, and your shoulder joint gets stuck—leading to stiffness, discomfort, or pain.

The Role of the Rib Cage in Shoulder Mobility

When you raise your arm overhead, your scapula upwardly rotates around your rib cage. But if your rib cage lacks the ability to expand and compress, especially in the upper back or chest wall, that scapular movement becomes restricted. Over time, this restriction limits your range of motion and contributes to shoulder issues.

At our physical therapy clinic, one of the first things we assess in patients with shoulder pain is how well their rib cage moves. If we find restrictions, we often start with targeted breathing and mobility drills.

Two Foundational Drills We Recommend

Here are two exercises we commonly use with patients:

1. Hooklying Overhead Reach with Breathing

This drill helps facilitate sternal movement—the rise and fall of your chest bone—which is essential for true overhead mobility. By combining this position with focused breathing, you can restore motion in the front of the rib cage.

2. Quadruped or Seated Upper Back Expansion Drills

These are designed to open up the posterior rib cage. Again, breathing is key. You’re forcing air into the areas that need more movement to help your scapula glide the way it should when you lift your arm overhead.

These exercises don’t just improve mobility—they create the preconditions for strength. Here is one example!

Build Strength in End Ranges

It’s not enough to just be mobile—you also need to be strong in those new positions. That’s one thing many people overlook. We rarely train in end-range positions, yet we expect to perform demanding lifts like pull-ups or overhead presses from those same angles.

Once mobility is restored, a good physical therapy plan includes strengthening drills that target those vulnerable ranges. This helps ensure that your body is prepared to handle the loads you’re placing on it.

Smart Modifications You Can Make in the Gym

Sometimes, even with mobility and strength gains, certain movements might still feel sketchy. That’s where smart exercise modifications come into play.

Here are two of our go-to adjustments:

1. Recline Your Bench for Overhead Pressing

Instead of pressing from a fully upright 90-degree position, try adjusting your bench to 70 degrees. This slight incline reduces the mobility demands on your shoulder but still gives you the same strength-building benefits.

2. Modify Your Pull-Up Angle

If you find yourself arching your back or “rowing” yourself to the bar during pull-ups, you’re likely compensating for a lack of mobility. Use bands, assist machines, or change your grip and angle to allow for vertical pulling without strain.

Physical Therapy: More Than Just Rehab

The beauty of physical therapy is that it’s not just for injury recovery—it’s also about performance optimization. Whether you’re a recreational lifter or a competitive athlete, working with a physical therapist can help you:

Identify the root cause of pain or restriction
Restore movement and strength
Learn smarter ways to train around limitations
Get back to enjoying your workouts without setbacks

Final Thoughts

Shoulder pain doesn’t have to be the end of your upper body training. By addressing rib cage mobility, strengthening in end ranges, and applying smart gym modifications, you can continue progressing—even with a history of pain.

If you’re tired of missing workouts or avoiding the exercises you love, consider reaching out to a physical therapy professional who understands performance. We’d love to help you move better, feel stronger, and train pain-free.

Interested in working with us?
Contact us today to schedule a performance-based physical therapy evaluation and start building a body that’s ready for anything—pain-free.

Back Squats & Back Pain: What Your Physical Therapist Wants You to Know

If You’re Dealing with Back Pain, Not All Squats Are Created Equal

In my physical therapy practice, I work with a wide range of athletes and active individuals dealing with back pain. Earlier today, I had a conversation with a local personal trainer who is about to start working with one of my patients—a patient currently in physical therapy for back pain.

We were collaborating on how to design a training program that supports their recovery. Naturally, the topic of squatting came up. It’s a staple in most fitness routines, but when you’re dealing with low back pain, the type of squat you choose can make a big difference.

Why Back Squats Might Not Be Ideal for Back Pain

Let’s get one thing clear: I’m not saying back squats are inherently bad. But when it comes to physical therapy for back pain, we have to weigh the risk-to-reward ratio of every exercise.

In a traditional back squat, the barbell rests behind the head. This positioning shifts the center of mass forward and often leads to excessive lumbar extension—or over-arching of the lower back. That posture increases spinal compression, limits hip mobility, and can aggravate existing pain.

For patients going through physical therapy for their back, this added pressure on the spine is something we want to avoid—not just for comfort, but for long-term recovery and performance.

Better Squat Alternatives for Back Pain Relief

In my work with patients, I often recommend squat variations that are more compatible with spine-friendly movement mechanics. Examples include:

Goblet Squats
Safety Bar Squats

These exercises shift the load in front of the body, promoting a more back-friendly spine position, stronger abdominal engagement, more open hips, and reduced stress on the lumbar spine.

In fact, many patients find that these alternatives not only feel better but allow their legs to work harder—because their back is no longer overcompensating for poor positioning.

What This Means for Back Pain Rehab

One of the most important principles in physical therapy for back pain is knowing what to modify and when. You don’t need to stop training—you just need to train smarter.

If you’ve struggled with low back pain in the past or are currently recovering from an injury, making small changes like adjusting your squat style can protect your spine while still building strength, muscle, and endurance.

Need Help with Your Training Program?

At our Bethesda and McLean clinic, we specialize in physical therapy for back pain and helping people return to high-level performance without re-injury. Whether you’re a weekend warrior, a competitive athlete, or someone simply trying to move pain-free, we’re here to help.

Simple contact us and we will take things from there.

Spring Break Travel Tips: How to Stay on Track with Physical Therapy While You’re Away

Spring break season has arrived here in the DC area, and for many active adults, that means hitting the slopes, heading to the beach, or hopping on a plane for some much-needed downtime. But if you’re currently in physical therapy, staying consistent with your rehab while traveling can feel like a challenge.

Good news: it doesn’t have to be.

Whether you’re recovering from an injury or working toward a performance goal, a few simple strategies can help you stay on track without sacrificing your vacation.

Travel Smart: Prioritize Your Physical Therapy Plan

Before you pack your bags, have a quick check-in with your physical therapist. Ask:

Which physical therapy exercises are the most important to keep up with while I’m away?
What minimal equipment do I need to bring, if any?

Often, it’s as simple as tossing a small resistance band in your suitcase or doing a few bodyweight movements in your hotel room. Your physical therapist can help you narrow it down to 2–3 key exercises that maintain your progress without adding stress to your travel plans.

Move More During Travel

Extended travel—whether by plane or car—can leave your body stiff and achy. One of the most common tips we give our physical therapy patients:

“The best posture is the one that keeps changing.”

While you’re en route:

Shift positions frequently
Fidget a little—switch from one hip to the other
On road trips, get out and move every few hours
On flights, stay hydrated (more water = more walks to the bathroom)

Pro tip: Sit in the front of the plane? Use the rear bathroom. Sitting in the back? Walk to the front. It’s a simple way to sneak in extra steps and reduce joint stiffness.

Reset with Mobility Once You Arrive

Even if you can’t move much while traveling, you can still hit the reset button when you arrive. One of the best tools we use in physical therapy to improve mobility after long periods of sitting?
CARs – Controlled Articular Rotations.

These movements help lubricate the joints and restore mobility by taking them through your available range of motion—perfect after hours in a cramped seat.

Try the Hip CAR video below —a great example of a mobility drill you can do anywhere: hotel rooms, Airbnbs, or even outside.

Make Physical Therapy Travel-Friendly

Your physical therapy routine shouldn’t weigh you down while you travel. With the right plan, you can maintain momentum, prevent setbacks, and still enjoy your time away.

Need help building a vacation-ready movement routine? We’re here for you.

Our team at Cohen Health and Performance can design a custom program that fits your destination, your equipment (or lack of it), and your goals.

Hamstring Strains: A Sports Physical Therapy Guide to Recovery & Injury Prevention

Hamstring strains are among the most common injuries for athletes, especially those involved in sprinting, jumping, or cutting movements. If you’ve ever felt that sudden pull in the back of your thigh, you know how frustrating and limiting a hamstring strain can be.

At Cohen Health and Performance, we specialize in sports physical therapy designed to help athletes recover from injuries efficiently and come back stronger. In this blog, we’ll break down why hamstring strains happen, how to rehab them properly, and what you can do to reduce the risk of reinjury.

Why Do Hamstring Strains Happen?

Hamstring injuries most often occur when an athlete is sprinting or decelerating. The primary reasons include:

✔️ Fatigue – Tired muscles are more prone to injury.
✔️ Poor lumbopelvic control – Weak core and hip stability put excess strain on the hamstrings.
✔️ Lack of eccentric hamstring strength – The hamstring must absorb force while lengthening during sprinting, making it vulnerable to injury.
✔️ Previous hamstring strain – A history of injury significantly increases the risk of another strain.

Understanding these risk factors allows us to customize sports physical therapy programs that target weak points and prevent future injuries.

Early Rehab: What to Do (And What NOT to Do)

The first instinct after a hamstring strain might be to stretch it out—but this is a common mistake that can slow recovery. Instead, follow these steps:

🚫 Avoid aggressive stretching in the early stages. Stretching an injured muscle too soon can aggravate the strain.
✅ Control pain and inflammation with rest, ice, and gentle movement.
✅ Maintain blood flow through pain-free activity to speed up recovery.

At this stage, a sports physical therapy approach focuses on reducing pain and preserving mobility while preventing further irritation.

Rebuilding Strength & Function

Once the pain and inflammation have decreased, it’s time to gradually load the hamstring to restore strength and function.

At Cohen Health and Performance, we use the Nord Board, a state-of-the-art tool that measures eccentric hamstring strength. This allows us to:

✅ Compare the injured leg to the healthy leg
✅ Assess an athlete’s risk for future hamstring injuries
✅ Develop a personalized strength program based on objective data

The Phases of Hamstring Rehab in Sports Physical Therapy

A structured rehab program moves through progressive phases:

🔹 Phase 1: Isometric Exercises – These exercises activate the hamstring without movement, minimizing strain while building early strength.
🔹 Phase 2: Eccentric Strengthening – Once tolerated, we introduce slow, controlled lengthening exercises to mimic the hamstring’s function in sprinting.
🔹 Phase 3: Velocity-Based Training – To fully restore athletic performance, we gradually add speed, agility, and explosive movements to rebuild elasticity and power.
🔹 Phase 4: Sport-Specific Drills – The final step is returning the athlete to high-level sport movements like sprinting, cutting, and jumping. This is often the most neglected phase, but skipping it can lead to reinjury.

Preventing Hamstring Strains: The Key to Longevity

The best way to avoid a hamstring strain is to ensure your body is strong, mobile, and well-conditioned. In our sports physical therapy programs, we focus on:

✔️ Eccentric hamstring training to build resilience
✔️ Core and pelvic stability work to reduce unnecessary strain on the hamstrings
✔️ Sprint mechanics coaching to improve movement efficiency
✔️ Individualized risk assessments using tools like the Nord Board

Ready to Recover Stronger? Let’s Get Started!

If you’ve suffered a hamstring strain or want to reduce your risk of injury, our expert team at Cohen Health and Performance is here to help. Our sports physical therapy approach ensures you recover the right way—so you don’t just heal, but return to your sport stronger than before.

📩 Contact us today to schedule an evaluation and start your journey back to peak performance!

Orthotics: Do You Really Need Them? A Physical Therapy Perspective

When it comes to orthotics, one of the most common questions we get in physical therapy is:

“Should I use orthotics — or not? Will they help, or could they make things worse?”

The short answer?
It depends.

As frustrating as that may sound, orthotics are not a universal solution. At our physical therapy clinic, we talk with patients daily about whether orthotics are right for them — and it’s never a black-and-white answer. Let’s break down why.

How Orthotics Really Work — And Why It’s Not So Simple

Many people think orthotics are designed to “push” the foot into a better position — like boosting a flattened arch or correcting a high arch that’s rolling outward. It sounds logical, right? Almost like fixing a building or a machine.

But here’s the problem with that approach:
➡️ Our bodies aren’t buildings.
➡️ Our feet are dynamic, not static.

As physical therapists, we understand that your body is constantly adapting to its environment. Take walking, for example — the way pressure shifts through your foot as you step is always changing. Your body responds to those shifting pressures by adjusting muscles, joints, and posture up the chain (think knees, hips, and back).

Flat Feet vs. High Arches — Why You May or May Not Need Orthotics

If you have high arches (like me), you may not feel the ground well, which can make you feel unstable. Your body senses that instability and often tenses up — creating stiffness in other areas. For people like this, a small arch support can sometimes help them “find” the ground better, improving balance and movement efficiency.

On the flip side, if you have flat feet, your weight may be dumped onto the inside edge of your foot. In that case, a different type of orthotic might give some gentle lift to the arch, helping distribute weight more evenly and improving the way the whole body moves.

But here’s the catch — it’s never just about the arch.

What Physical Therapy Teaches Us About Orthotics

At our physical therapy practice, we evaluate how each person moves — not just how their feet look. Some people with flat feet move beautifully and don’t need orthotics. Others with “perfect-looking” arches may have pain and need extra support.

And sometimes, the right shoe can make all the difference — no orthotics required.

So… Do You Need Orthotics?

The answer is unique to you. That’s why working with a physical therapist who understands biomechanics, gait, and functional movement is crucial before jumping into orthotics.

If you’ve ever wondered:

“Do I need orthotics or just better shoes?”
“Why do my knees/hips/back hurt when I walk or run?”
“Can orthotics help my performance in sports?”

➡️ We can help you figure that out.

Ready to Take the Next Step?

If you want personalized help to figure out whether orthotics are right for you — or you’re struggling with pain related to your feet, knees, hips, or back — contact us today for an evaluation.

We’re here to help you move better, feel better, and get back to doing what you love.

Should Your Knees Go Over Your Toes? The Truth About ACL Physical Therapy

If you’ve spent time in a gym or around physical therapists, you’ve likely heard the advice:
“Never let your knees go over your toes!”

This myth has been around for years, but the reality is—your knees should go over your toes—especially during physical therapy and rehab.

Think about it: You can’t walk, run, or even rise from a chair without your knees naturally moving forward. For athletes, movements like deceleration, cutting, and landing demand the tibia (shin bone) to angle forward, known as forward inclination.

Yet, many people recovering from ACL injuries fear this knee movement. After an ACL reconstruction, it’s common for patients to hesitate when allowing their knee to pass over their toes. Unfortunately, avoiding this necessary motion can slow down rehabilitation and leave the patient unprepared for real-world physical activity.

Why Knees Over Toes is Essential in Physical Therapy for ACL Rehab

One of the main goals of physical therapy following an ACL injury is restoring movement confidence. As rehab progresses, patients work on drills that allow for controlled knee translation. This begins with slow, straight-line movements and gradually introduces more speed and direction changes to mimic real-world activities.

Athletes don’t just move in a straight line. They cut, pivot, and absorb forces from multiple angles. This is why physical therapy for ACL recovery involves exercises that recreate these unpredictable movements—giving the knee the chance to regain its strength, stability, and range of motion.

Preparing Athletes for the Stressors of Sports with Physical Therapy

The last thing an athlete recovering from ACL surgery should face is their knee being tested in high-stress situations for the first time during a game. That’s why physical therapy should simulate sport-specific movements in a controlled and progressive environment. This prepares the body for the unique demands of each sport and builds up knee resiliency.

In many cases, the goal is not only to return the ACL-repaired knee to its pre-injury strength but to make it even stronger than before to prevent reinjury.

Rehab That Mirrors Performance Training

This is why end-stage rehab should look like performance training. Athletes need to be ready to perform at their peak—prepared for the physical demands of their sport—before returning to competitive play. Physical therapy should not just focus on recovery but also on preparing athletes for the challenges they’ll face once back on the field or court.

If you’re recovering from an ACL injury or looking for a sports-specific physical therapy approach, we can help you get back to peak performance. Contact us today to learn more about how we tailor physical therapy to meet your rehab and athletic goals!