The Most Overlooked Reason Runners Keep Getting Injured

Repetitive soft tissue injuries are one of the most frustrating issues runners face. Calf strains, hamstring pulls, hip flexor pain, and lingering tendon problems often seem to appear out of nowhere, especially in runners who are otherwise consistent and motivated in their training.

One of the most overlooked causes of these injuries has nothing to do with mileage alone. Instead, it comes down to how close your body is operating to its maximum capacity during your runs.

Why Running Pace Matters More Than You Think

Imagine a car that can technically reach highway speed, but doing so requires maximum effort. Pushing it that hard, day after day, eventually causes things to break. Not because the distance is too long, but because the system is constantly operating near its limit.

The same principle applies to running.

If you are running close to your maximum sustainable speed just to hit your target training pace, your body is under significantly more strain. That strain is absorbed primarily by your soft tissues such as your calves, hamstrings, hip flexors, Achilles tendon, and connective tissue. Over time, this accumulated stress often leads to overuse injuries.

Two runners may complete the same 5-mile run at the same pace, but if one runner is operating at 80% of their maximum effort while the other is closer to 60%, the internal load on their bodies is very different.

This difference matters.

Why Faster Runners Often Stay Healthier

Elite and highly trained runners are fast, but more importantly, their speed ceiling is high. Because of this, moderate and long-distance paces require less relative effort. Their muscles and tendons are conditioned to tolerate higher forces, which makes everyday training less stressful on their bodies.

For recreational runners, this is where many training programs fall short.

A common assumption is that preparing for longer races simply means running more miles. While mileage is important, it is only one part of the equation. One of the most underutilized tools in injury prevention is strategic speed training.

How Speed Training Reduces Injury Risk

Speed training isn’t just about racing faster, it’s about raising the maximum speed your body can safely handle.

Incorporating interval-style workouts helps:

Improve force tolerance in muscles and tendons
Reduce strain during slower, longer runs
Improve running efficiency and resilience

A simple and effective example includes:

400-meter intervals on a track or measured flat surface
Running at a high effort (roughly 80–90%)
Taking longer rest periods to ensure quality movement and speed

The goal is not exhaustion. The goal is adaptation, teaching your body to handle higher forces so that everyday running feels easier and places less stress on vulnerable tissues.

Even runners training for half marathons or marathons benefit from this approach, particularly during the off-season or early build-up phases. As race day approaches, speed work often becomes less frequent while mileage increases, but having already raised your speed ceiling can dramatically reduce injury risk.

How Physical Therapy for Runners Helps

This is where physical therapy for runners becomes especially valuable.

At Cohen Health & Performance, we work with runners to:

Identify strength, mobility, and load-management limitations
Assess running mechanics and tissue tolerance
Design training strategies that reduce injury risk
Integrate speed work safely and progressively
Treat recurring soft tissue injuries at the root cause

Rather than simply addressing pain after it appears, our approach focuses on helping runners train smarter so injuries are less likely to occur in the first place.

Serving Runners in McLean and Bethesda

We provide specialized physical therapy for runners at our clinics in McLean, VA and Bethesda, MD, working with runners of all levels, from recreational athletes to competitive endurance runners.

If you’ve been dealing with recurring calf strains, hamstring tightness, hip flexor pain, or feel like your body breaks down whenever you increase training intensity, it may be time to take a closer look at how you’re training, not just how far you’re running.

Our team helps runners stay healthy, improve performance, and continue progressing toward their goals without constantly being set back by injury.

If you’re looking for expert physical therapy for runners in McLean or Bethesda, we’re here to help.

Therapy For Knee Pain: How to Prepare Your Body for Ski and Snowboard Season

Winter is here, and with it comes ski and snowboard season. After a fresh snowfall and a morning spent shoveling the driveway, I was reminded how quickly winter sports sneak up on us. I also thought back to a trip I took out west last year. It was an amazing experience, but I remember feeling more sore afterward than I had in years past.

As I approach 40, I have realized something many skiers and snowboarders experience. You cannot get away with the same preparation you once did.

If you ski or snowboard and deal with knee pain, or want to avoid it altogether, a little intentional preparation can make a significant difference. This is where knee pain physical therapy becomes especially valuable.

Why Skiing and Snowboarding Stress the Knees

Both skiing and snowboarding place repeated, high-load demands on the knees. Every turn, landing, edge change, and deceleration sends force through the knee joint. By the end of the day, fatigue sets in, technique changes, and the risk of pain or injury rises.

For snowboarders, rotational forces through the hips and knees are constant. Controlling the board requires the knees to tolerate twisting forces while staying stable. Skiers face repeated knee flexion and extension under load, especially when carving or navigating uneven terrain.

If you have ever noticed your knees becoming sore late in the day, struggling to carve clean turns, or feeling stiff after a trip, those are signs your body may not be fully prepared for the demands of the sport.

Our team sees this every winter, which is why knee pain physical therapy is one of the most common reasons skiers and snowboarders come into our clinics.

You can learn more about common causes of knee pain we treat here:
Knee Pain Physical Therapy in Bethesda and McLean

The Role of Strength, Endurance, and Control

One of the biggest misconceptions is that knee pain is only about weakness. In reality, skiing and snowboarding demand a combination of strength, muscular endurance, and control.

Most gym exercises are performed in mid-range positions for short sets. On the mountain, however, your knees live in deeper positions for long periods of time. This means your muscles must sustain force, not just produce it briefly.

In knee pain physical therapy, we often shift training to better match sport demands. This may include:

Longer sets with moderate loads to build endurance
Hinge-based exercises such as RDL and deadlift variations
Controlled rotational drills to improve knee and hip stability
Landing and deceleration training to prepare for jumps and terrain changes

Small programming changes like increasing reps from 5 to 10 or 12 can significantly improve how your knees tolerate a full day on the slopes.

Why Falls Matter for Knee and Joint Health

Falls are part of skiing and snowboarding. When they happen, the body often ends up in vulnerable positions. Knees, shoulders, wrists, and elbows are commonly exposed to sudden forces.

Most people train strength with their arms and legs close to their body. Injuries, however, tend to occur when limbs are farther away. Part of effective knee pain physical therapy includes preparing the body to tolerate force in these vulnerable positions.

This means incorporating drills that teach the body how to absorb force quickly and safely, helping protect the knees and surrounding joints when things do not go as planned.

If you have had a previous knee injury, this type of preparation becomes even more important. You can read more about how we approach post-injury knee rehab here:
Sports Physical Therapy for Knee Injuries

Do Not Forget About Ankles and Feet

Knee pain is often influenced by what is happening above and below the joint. Boots and bindings limit ankle mobility, which changes how force is transferred through the legs.

Snowboarders, in particular, know the burning sensation in the shins that can build up when riding the toe edge or getting stuck on flats. If the ankles and shins fatigue, the knees often compensate.

A comprehensive knee pain physical therapy program will address ankle strength, endurance, and control to reduce unnecessary stress on the knees.

Skill Level Matters

The demands on your knees vary depending on how you ski or ride. Higher-level skiers and snowboarders who ride steeper terrain or hit jumps experience much higher forces through the knees.

In these cases, plyometric training and controlled jumping drills are often incorporated to prepare the knees for rapid deceleration and landing forces. These drills are progressive and tailored to the individual, not random high-impact exercises.

This is a core principle of how we approach knee pain physical therapy for active adults and athletes.

Keep It Simple and Consistent

Preparing for ski and snowboard season does not require an overhaul of your workouts. In fact, simpler is usually better.

Choose two or three drills that closely match the demands of your sport. Spend five to ten minutes incorporating them into your warm up two to three times per week. This approach is often more effective than long, exhausting workouts that are difficult to sustain.

Consistency matters more than complexity.

When Knee Pain Physical Therapy Can Help

If you already have knee pain, a history of injury, or want a personalized plan to prepare for ski or snowboard season, knee pain physical therapy can help you address the root cause rather than just managing symptoms.

This is something we see consistently every winter at our Bethesda and McLean clinics. Our goal is to help you enjoy longer days on the mountain with fewer setbacks.

If you would like to learn more or schedule an evaluation, visit:
Schedule a Physical Therapy Evaluation

Skiing and Snowboarding Physical Therapy FAQs

Q: Why do skiers and snowboarders commonly experience knee pain?
A: Skiing and snowboarding place repeated rotational and impact forces on the knees. Fatigue, poor muscular endurance, limited mobility, or prior injuries can increase stress on the knee joint, leading to pain during or after time on the slopes.

Q: How can knee pain physical therapy help before ski season?
A: Knee pain physical therapy helps identify strength, mobility, and control deficits that increase injury risk. A targeted program improves knee stability, muscular endurance, and force absorption to better prepare the body for skiing and snowboarding demands.

Q: Should I do physical therapy even if I don’t currently have knee pain?
A: Yes. Preventive knee pain physical therapy can reduce injury risk, improve performance, and help you tolerate longer days on the mountain by preparing your joints and muscles for winter sport demands.

Q: What exercises help prevent knee pain for skiing and snowboarding?
A: Common exercises include hinge-based strength work, controlled rotational drills, landing mechanics training, and muscular endurance exercises. These movements better match the real demands placed on the knees during skiing and snowboarding.

Q: How often should I train to prepare my knees for ski season?
A: Incorporating 5 to 10 minutes of targeted knee-focused drills into your warm-up two to three times per week is often sufficient to build resilience and reduce knee pain risk.

Free Weights vs. Machines: What’s Best for Your Training?

When I look back at the things I believed in college, I can’t help but laugh a little, especially when it comes to my views on weight training. At that time, I was all in on free weights and completely against using machines. If it didn’t involve a barbell or dumbbell, I didn’t want anything to do with it.

Fast forward to today, and my perspective has evolved. I still love free weights, but I’ve come to appreciate the value that machines can bring to a well-rounded training program. As a performance-focused physical therapy provider in McLean, I now help patients and athletes combine both methods for stronger, safer, and more effective results.

Why Free Weights Are So Valuable

Free weights will always have a place in great strength training programs. Exercises like squats, lunges, and deadlifts require balance, coordination, and total-body control. These movements train not just strength, but also stability and athleticism.

For example, a lunge closely mimics the way your body moves when you decelerate, cut, or plant during sports. This is one reason our sports physical therapy team in McLean uses these exercises with athletes returning to play after an injury. They have tremendous carryover to real-world movement.

The Case for Machines

That said, machines offer benefits that free weights can’t always match. For one, they’re less intimidating for beginners and have a lower learning curve. If you’re new to training or getting back into the gym after time off, machines allow you to move safely and confidently while you build your foundation.

But even for experienced athletes, machines have a valuable place. They make it possible to isolate specific muscles that may be weaker or underdeveloped. In physical therapy sessions here in McLean, we often see this after injuries.

Take knee injuries, for instance. It’s common for the quadriceps to lag behind the rest of the leg during recovery. A knee extension machine is an excellent way to directly target and rebuild that strength. By improving the muscle’s capacity to handle load, we help ensure that the knee and the athlete can perform at a high level without increased risk of re-injury.

How to Combine Both for Best Results

If you’ve ever walked into a gym where all you see are barbells, dumbbells, and kettlebells, you might think machines are “less effective” or even unnecessary. But the truth is that the most successful training programs use both free weights and machines strategically.

Free weights build functional strength and athleticism. Machines help strengthen weak links and support recovery. Together, they provide a complete approach that promotes performance, resilience, and long-term health.

Work with Our Physical Therapy Team in McLean

At Cohen Health and Performance, our physical therapy team in McLean specializes in helping active adults and athletes recover from injury, rebuild strength, and return to the activities they love. We take a scientific, individualized approach to training, using both free weights and machines when appropriate, to make sure every part of your body is prepared for the demands of your sport or lifestyle.

If you’d like help designing a program that’s customized to your needs, we’d love to help.

Contact us today to schedule an assessment and discover how our McLean physical therapy experts can help you train smarter, recover faster, and perform better.

ACL Physical Therapy: How We Determine When It’s Safe to Return to Sport

Guest Post by Dr. Ethan Lennox, ACL Rehabilitation Specialist at Cohen Health and Performance (CHP)

One of the toughest challenges athletes face after ACL surgery is knowing whether they are truly ready to return to play. Getting this wrong can have serious consequences, not only a higher risk of re-tearing the repaired ACL, but also the possibility of injuring the other knee or sustaining a completely new lower body injury.

If you’re an athlete, parent, or coach navigating the ACL recovery process, this guide will walk you through the objective criteria that determine readiness for a safe return.

Why Time Alone Isn’t Enough

A safe return to sport after ACL surgery isn’t about simply waiting 6, 9, or 12 months. At CHP, our ACL physical therapy program goes beyond the calendar. We use specific benchmarks for strength, movement quality, knee health, and confidence.

For athletes in cutting or pivoting sports, we typically recommend at least 9–12 months before full competition, as research shows that early return carries a much higher risk of re-injury. Our goal is not just to “clear” an athlete, but to build a durable return that lasts.

What Really Determines Readiness?

1. Strength

Strength is the foundation of ACL physical therapy. But it’s not just about moving heavy weight in the gym. The question is:

Can the athlete produce strength quickly in the chaos of sport?
Can they tolerate the workload of practices and games?

We focus heavily on restoring quadriceps strength to sport-specific demands, not just symmetry between legs. A common benchmark is ≥ 3.0 Nm/kg of knee-extension torque relative to body weight. Symmetry matters, but hitting an absolute strength threshold is what keeps knees safe during high-speed stops and cuts.

2. Force-Plate Testing

Traditional field tests often miss hidden deficits. At CHP, our ACL physical therapy program uses force-plate technology to analyze how each leg produces and absorbs force during jumps, landings, and change-of-direction tasks. To learn more about our forceplates, check out this link.

We track asymmetry (aiming for ≤10%) and test both when athletes are fresh and fatigued. This helps us individualize rehab, catch weaknesses before they become injuries, and make safer clearance decisions.

3. Movement Quality

Numbers matter, but how an athlete moves under fatigue is just as critical. During ACL rehab, we look for:

Controlled deceleration
Proper knee and hip alignment
Strong trunk stability
Quiet, efficient landings at game speed

By combining movement analysis with force-plate data, we ensure athletes are not just strong on paper—but resilient in real game conditions.

4. Knee Health

A successful ACL recovery also depends on the joint’s response to load. Non-negotiables include:

Full, pain-free range of motion
No swelling or irritation after training
Zero “giving way” episodes

If the knee flares up as we increase intensity, we scale back. Just because the calendar says “9 months” doesn’t mean the knee is ready.

5. Confidence

Physical readiness means little without mental readiness. At CHP, our ACL physical therapy program uses validated questionnaires like the ACL-RSI (Return to Sport after Injury) to track confidence. Scores in the mid-60s or higher, paired with strong physical metrics, usually indicate safe readiness.

We also coach mindset—helping athletes rebuild trust in their body is just as important as rebuilding strength.

Clearance Does Not Mean Full Game Readiness

“Cleared” to return to sport means an athlete can begin practicing. It does not mean they’re ready for full minutes or their pre-injury role. Building back to game-day fitness requires another 6–12+ weeks of gradual progression:

Non-contact practice and controlled drills
Controlled contact with planned rest
Increased intensity and practice density, monitoring workload
Gradual introduction of limited game minutes

This measured progression is how we prevent setbacks and ensure long-term success.

How CHP Puts It All Together

At Cohen Health and Performance, our clearance testing includes:

Strength testing with precise benchmarks
Force-plate assessments for braking and propulsion
Movement quality reviews under fatigue
Knee health evaluation for calm, stable joints
Confidence tracking for mental readiness

From there, we design a stepwise return-to-play plan that gradually increases training load and game minutes while monitoring next-day knee response.

Our philosophy is simple: earn the right to do more, then prove you can repeat it.

If you or your athlete is recovering from ACL surgery, don’t settle for a clearance based only on time or basic hop tests. A true ACL physical therapy program should integrate strength, force-plate data, movement analysis, joint health, and confidence.

At CHP, our ACL specialists are committed to helping athletes not only return safely, but come back stronger than before.

If your athlete is working toward a safe, confident return to sport, our ACL rehabilitation team would love to guide the process. Contact us here.

Shoulder Pain Physical Therapy: Understanding and Managing Shoulder Instability

In just a couple of weeks, I’ll be part of a panel at the Mid-Atlantic Shoulder and Elbow Society Conference, sitting alongside several orthopedic surgeons as the lone physical therapy representative. Our panel topic: shoulder instability—a complex condition that affects many active adults and young athletes.

Why Shoulder Instability Matters

Shoulder instability is a challenging issue because it can be caused by a variety of factors and present in several different ways. The shoulder is the most mobile joint in the human body, but that same mobility makes it the most unstable.

With great mobility comes great responsibility. When the ligaments and tendons that normally stabilize the shoulder can’t provide enough support, the demand shifts to our muscles and nervous system to keep the joint under control. This is where physical therapy becomes essential.

How Physical Therapy Helps with Shoulder Pain and Instability

A well-designed rehab program for shoulder instability doesn’t just treat pain—it addresses the underlying mechanics that protect the joint and restore performance. Proper physical therapy can:

Improve ribcage and shoulder blade control – helping reduce stress on the shoulder joint.
Strengthen the rotator cuff – allowing it to more effectively stabilize the joint during activity.
Integrate improvements into movement strategies that carryover to sport – ensuring athletes and active adults can safely return to the demands of their sport or daily life.

Rehab vs. Surgery: Making the Right Choice

While there are times when surgery is necessary, physical therapy for shoulder pain and instability can often help determine whether non-surgical care is a viable option. The best surgery is the one you can avoid. Once a shoulder has been operated on, it’s never quite the same—the tissue has been altered, and function changes over time.

That’s why early intervention is so important, especially for young athletes such as baseball players who place high demands on their shoulders. Addressing pain and instability early can make all the difference in avoiding long-term damage and reducing the likelihood of surgery.

Take Action Early

If you or your athlete is dealing with shoulder instability or persistent shoulder pain, don’t wait. Getting evaluated by a skilled physical therapist can help you understand the cause, create a personalized plan, and in many cases, avoid the need for surgery.

From the Field to the Physical Therapy Clinic: Common Fall Sports Injuries We’re Seeing

The fall sports season is officially here in the DC area!

Athletes are returning from their summer break, easing back into practices, and—unfortunately—we’re already starting to see a familiar trend in our clinics: a rise in sports-related injuries.

At Cohen Health and Performance, with locations in McLean and Bethesda, we work with athletes every fall who develop issues as they ramp up their training and competition schedules. Whether it’s a cranky knee, a sore ankle, hip discomfort, or a soft tissue strain, these injuries can derail a season before it really gets going.

Why Are Athletes Getting Injured at the Start of the Season?

The start-of-season injury spike often happens for two main reasons:

Sudden Increase in Training Volume
Some athletes simply aren’t fully prepared for the jump in intensity that comes with daily practices, scrimmages, and games. Even if they’ve stayed active over the summer, their bodies may not be ready for the sport-specific demands of their season.
Mismatch Between Off-Season Training and In-Season Demands
Many athletes train hard in the summer—lifting weights, running, and following conditioning plans from coaches—but those workouts don’t always replicate the unpredictable, reactive movements of live gameplay. Without that sport-specific preparation, even well-trained athletes can still get hurt.

The Importance of Sport-Specific Preparation

The best off-season training programs start general and gradually become more specific to the sport as the season approaches. This ensures the athlete’s muscles, tendons, and ligaments are ready for the exact movements they’ll face on the field or court.

For example, football is highly reactive—players must change direction quickly in response to opponents. Our video above shows one hurdle based drill that we use in our McLean and Bethesda physical therapy clinics. The athlete reacts to an unpredictable cue, changing direction while clearing hurdles—just like they might have to do in a game. This type of training prepares the body for rapid deceleration, re-acceleration, and sudden direction changes.

Why Deceleration Training Matters

Many injuries, especially hamstring strains, happen during deceleration—when the body must slow down rapidly. The hamstring works hardest when it’s putting on the brakes during sprinting, and if it’s not prepared for that high force, injury risk skyrockets.

That’s why we integrate drills designed to strengthen the hamstring’s ability to decelerate quickly, reduce injury risk, and keep athletes competing at their best.

Free Injury Consultations for High School Athletes

Right now, our McLean physical therapy location is offering free injury consultations for high school athletes returning to play.

If your son or daughter is:

Complaining about pain in a joint or muscle
Recovering from a recent sports injury
Feeling “off” since the season began

…our team can help identify the problem, address it quickly, and get them back to playing without missing significant time.

These consultations are performed by our expert sports physical therapy team in McLean, including myself, Dr. Matt, and Dr. Sam. We’ll assess the injury, pinpoint the cause, and provide sport-specific drills to get the athlete back to full strength as quickly as possible.

Don’t Wait—Act Early

The earlier we address sports injuries, the faster athletes can return to pain-free performance. If you’re in the McLean or Bethesda area and want to make sure an injury doesn’t sideline your athlete this season, contact us today to schedule an appointment.