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.

Are You Really Out of Alignment? What You Need to Know Before Your Next Adjustment

“I think my hips are out of alignment.”
“My pelvis feels shifted.”
“My sacrum must be twisted.”

These are phrases we hear all the time at Cohen Health and Performance. If you’ve ever said something similar—or been told this by a friend or provider—you’re not alone. The idea of being “out of alignment” is a commonly held belief and often used to explain nagging pain or movement issues. But here’s the truth:

Your body is built to move—and that includes your pelvis.

Understanding “Misalignment”

Let’s clear something up: your pelvis, hips, and sacrum are supposed to move. With every step you take, your pelvis naturally rotates, shifts, and adapts. This isn’t dysfunction—it’s a sign of a healthy, dynamic system.

The sensation of being twisted or “off” often comes from the body favoring one side over the other. It’s not that you’re structurally broken. It’s that your movement patterns are biased—and over time, those biases can create imbalances that feel like misalignment.

Why Do We Get Stuck in These Patterns?

Most people have a natural tendency to favor one side, especially the right. Why?

We’re mostly right-handed
We carry kids, bags, or groceries on the right
Even society is designed for right-handers (think door handles, tools, etc.)

This daily repetition subtly trains our bodies to prefer the right side. Over time, this can show up in the gym—like when one leg feels stronger during a leg press—or in daily life, where you feel “off” or stuck on one side.

But here’s the important part: you don’t need to be cracked, popped, or adjusted repeatedly to fix it.
You need a plan to address the underlying cause.

A Smarter Approach to Feeling “Realigned”

One of our go-to exercises at Cohen Health and Performance (see the video at the beginning for a demonstration) is a drill that retrains how the body pushes off the right side to shift weight to the left. Here’s what it looks like:

Lying on your back with your right foot on a wall
Left leg lifted with the hip in flexion
Pushing through the arch of the right foot to activate the right glute

This simple but effective movement mimics what your glute should do during walking, sprinting, or cutting—helping you get off the right side and balance your body’s movement patterns.

Done consistently, drills like this can help you:

Reduce your reliance on constant adjustments
Improve strength and control in underused muscles
Feel more balanced and symmetrical in daily life and workouts

Physical Therapy That Addresses the Root Cause

At Cohen Health and Performance, our goal isn’t just to “fix” you temporarily.
We help you understand why you feel off in the first place—and give you the tools to stay better aligned through movement, not manipulation.

Whether you’re looking for physical therapy in Bethesda or physical therapy in McLean, our team specializes in performance-based care that empowers you to move better, feel stronger, and stay pain-free.

Ready to Stop Chasing Adjustments?

If you feel like your body is out of alignment—or you’ve been told that it is—it’s time to dig deeper. Contact us today to schedule an evaluation. We’ll help you understand what’s really going on and create a plan that actually sticks.

Still Struggling with Knee Pain? Why Physical Therapy May Be the Missing Link

At Cohen Health and Performance, we recently worked with an athlete who came to us months after injuring his knee during a workout at the gym. After seeing his doctor, he was told there was nothing structurally wrong—no damage on imaging, no major red flags. The advice? Take a couple of weeks off and slowly return to exercise.

Fast forward several months, and he was still modifying workouts and struggling with lingering pain and frustration.

Sound familiar?

This scenario is incredibly common—especially among active individuals dealing with chronic knee pain. Whether you’re a weekend warrior, a gym enthusiast, or a competitive athlete, you may have been told to rest, stretch, or foam roll your way out of pain. And yet, the discomfort persists.

Why Traditional Approaches Often Fall Short

Most general advice focuses on reducing symptoms—not solving the root cause. Many rehab programs stop as soon as pain decreases or when daily activities become tolerable again. But for those who want to lift heavy, sprint, or change direction on the field, this simply isn’t enough.

Effective therapy for knee pain needs to go beyond the basics. It should train your knees to handle the specific stresses of your sport or activity.

For example, sports that involve cutting and multidirectional movement place your knees in angled, high-force positions. If your rehab never prepares you for those forces—if your shin is never loaded at those angles during training—you’re setting yourself up for continued breakdown.

The Importance of Load-Specific Training

To truly recover and thrive, the tendons and muscles around the knee—especially the patellar tendon and quad tendon—must be reconditioned to tolerate the demands of real movement. Whether you’re jumping, landing, or squatting under load, your knees must be gradually exposed to the stresses they’ll face in the real world.

That’s why our rehab process includes drills and exercises tailored to your goals. Below is an example from our specialist, Dr. Cat, demonstrating exercises that teach the knee how to absorb and produce force under real-world conditions.

By gradually increasing load and focusing on the angles and demands of your sport, we prepare the knee—and the entire lower body—to handle life beyond the treatment table.

Don’t Let Knee Pain Linger

If you’ve been dealing with chronic knee issues, tried resting, icing, stretching, or following online exercise videos with no real progress, it’s time to dig deeper. At Cohen Health and Performance, we take a comprehensive look at your movement patterns, strength, mobility, and sport-specific demands to uncover why your knee pain persists—and how therapy for knee pain in Bethesda can fix it for good.

We don’t just want to help you feel better.

We want to get you back to training, competing, and living life without limitations.

Ready to Get to the Root of Your Knee Pain?
Contact us today to schedule a comprehensive evaluation and find out how therapy for knee pain can help you move better, feel stronger, and finally leave knee pain behind.

Why Shoulder Injuries Are So Complex

At Cohen Health and Performance, we specialize in physical therapy in Bethesda and physical therapy in McLean for active adults and athletes who want to get back to the activities they love. One of the most common mistakes we see in traditional care—yes, even among other physical therapists—is a failure to appreciate how complex the shoulder really is.

The shoulder is the most mobile joint in the entire body. That’s what makes it so essential: reaching, throwing, lifting, pushing, and pulling all require freedom of motion. But that same mobility also opens the door to a ton of possible compensations and dysfunctions when something isn’t moving well.

Your Shoulder Isn’t Just a “Ball-and-Socket”

Think of your shoulder like a golf ball sitting on a tee. The ball is your humeral head (upper arm bone), and the tee is the glenoid (part of your shoulder blade or scapula). But that “tee” isn’t grounded into the earth—it’s actually floating on your rib cage. That means your shoulder’s stability is influenced by your rib cage shape, position, and even how you breathe.

Most providers stop at the shoulder joint itself. But for us at Cohen Health and Performance, whether it’s physical therapy in McLean or physical therapy in Bethesda, we know that treating shoulder pain means looking beyond the joint.

If the shoulder blade doesn’t sit securely on the rib cage, the muscles around it—like the upper traps or rhomboids—often work overtime to stabilize things, leading to tightness, knots, and nagging pain in the upper back or neck.

The Rib Cage is the Unsung Hero

One of the foundational drills we use to retrain shoulder mechanics involves placing your forearms on the wall. Here’s the key:

Straight line from wrist to elbow
Externally rotate through the shoulders
Use your rib cage—not your arms—to press back into the shoulder blades. Perform 5 breaths in this position.

A cue we love: Imagine a hot poker hovering in front of your sternum. Your job? Pull away from it without slumping forward. This activates a crucial muscle called the serratus anterior, which helps anchor your scapula and sets the stage for clean, pain-free movement.

Getting the Shoulder Blade Moving Again

Once you’ve created a supportive rib cage, the shoulder blade (scapula) can do its job again—mainly rotating upward as your arm reaches overhead.

A simple but effective exercise to improve this scapular movement is Downward Dog:

Start in a push-up (or all 4’s) position
Press away from the floor with your hands
Drive your chest toward your knees
Focus on feeling the shoulder blades rotate upward and outward

This kind of targeted movement work is exactly what we emphasize in our programs for physical therapy in Bethesda and physical therapy in McLean. Without proper scapular motion, your rotator cuff is forced to overwork—and that’s when breakdowns happen.

What About the Rotator Cuff?

Only after we’ve addressed rib cage position and scapular movement do we move to the rotator cuff. By this point, rotator cuff exercises are finally in the right environment to be effective—rather than just throwing rubber band exercises at a deeper problem that hasn’t been solved yet.

Final Thoughts: There’s Hope for Your Shoulder

If you’ve had shoulder treatment in the past and it didn’t work—or if you’ve been dealing with shoulder pain for months or even years—don’t lose hope.

The truth is, shoulder pain is multifactorial. It can stem from poor rib cage positioning, scapular movement limitations, limited mobility, or underdeveloped rotator cuff function. And many healthcare providers simply don’t take the time to look at all of these layers.

That’s where we come in.

If you’re looking for expert-level physical therapy in Bethesda or physical therapy in McLean that goes beyond surface-level care, contact us today. Our team of Doctors of Physical Therapy will work with you to get to the root of your shoulder pain and get you back to doing what you love—stronger and smarter than ever.

What Africa’s Maasai Tribe Can Teach Us About Movement

After recently returning from an unforgettable trip to Tanzania and Kenya, I’ve found myself reflecting on more than just the incredible wildlife we encountered on safari. The people also left an imprint — particularly the Maasai tribe, whose way of life offers some insights into human movement and performance.

As a sports physical therapist and business owner serving active individuals in both Bethesda and McLean, I’m always observing movement through the lens of biomechanics, environment, and long-term physical resilience. And the Maasai tribe? They’re a living example of how environment and development shape the human body’s capacity for movement.

The Barefoot Reality

The Maasai grow up immersed in motion — running, walking, jumping, and herding cattle amidst unpredictable terrain and wild animals like lions and hyenas. What’s even more fascinating? They do all of this in traditional sandals they make themselves — minimalistic by our standards, offering little support compared to today’s athletic shoes.

Yet despite the lack of external support, they move efficiently and powerfully, as they developed this way from birth. Their feet, ankles, and lower limbs were conditioned over years to tolerate the high forces of running and jumping — essentially barefoot.

What This Means for Us in Bethesda or McLean

In our society, we’re influenced by very different environmental forces. We spend most of our time on concrete and hard surfaces, not grasslands. Most of us wore structured shoes as children, so our feet developed differently from those of the Maasai.

That’s why trends like barefoot running, inspired by books like “Born to Run”, need to be approached thoughtfully. While the intention behind minimal footwear and natural movement is often positive, our bodies may not be ready for that shift without a smart, progressive plan.

At our performance physical therapy clinics in Bethesda and McLean, we help patients understand how to safely incorporate barefoot-style training — but we do so within the context of their unique background, history, and goals. What works for someone raised in rural Kenya might not be the best place to start for someone who’s been training on gym floors or running on paved roads their whole life.

Context Is Everything

Whether it’s about footwear, mobility drills, strength work, or running technique, context matters. What’s optimal for one person may lead to injury in another — especially when their musculoskeletal system hasn’t adapted to a new stimulus.

That’s where expert guidance can make all the difference.

Looking to Train Smarter?

If you’re experimenting with new training strategies, transitioning to minimalist footwear, or just looking for ways to optimize performance while preventing injury, our team at Cohen Health and Performance would love to help.

We specialize in physical therapy for active adults and athletes in both McLean and Bethesda, helping bridge the gap between rehab, performance, and long-term health.

Contact us today to schedule an evaluation and get expert guidance on how to move better, train smarter, and thrive in your own environment.