Understanding Sciatica: How Physical Therapy Can Help You Find Relief

Sciatica is one of the most common issues we treat in physical therapy, especially among active adults. It’s not just a “back problem”—sciatic nerve pain can affect your entire lower body. Why? Because the sciatic nerve is the largest and longest nerve in the human body, stretching from your lower back through the hips, glutes, hamstrings, and all the way into your lower leg and foot.

When something irritates or compresses this nerve, it can lead to pain, numbness, tingling, or weakness—anywhere along its path.

Sciatic Nerve Pain: A Highway with Potential Roadblocks

Think of your sciatic nerve like a long, busy highway. This “road” passes through many key areas of the body—your spine, hips, glutes, hamstrings, and calves. Along the way, there can be roadblocks: tight muscles, joint dysfunction, or disc-related issues that compress or irritate the nerve.

Common culprits include:

Disc herniations in the lower back
Muscle tension in the glute or piriformis region
Scar tissue or soft tissue restrictions further down the leg

That’s why sciatica symptoms can vary so much. You might feel pain in your lower back, or it could shoot all the way down to your foot. This is exactly why seeing a trained physical therapist is so important—we’re trained to find where the issue is actually coming from, not just treat where it hurts.

Nerves Need to Move: Why Mobility Matters

Many people are surprised to learn that nerves need to move just like muscles and joints. The sciatic nerve must be able to glide and slide as your body moves. If its mobility is restricted, you may feel sharp pain, tightness, or tingling, even when there’s no actual structural damage.

A good way to think about this is with a piece of dental floss. If you gently pull one side of the floss while holding the other still, it moves freely. But if it gets stuck somewhere along the path, tension builds. The same can happen with your nerves.

Restoring nerve mobility is a key part of an effective physical therapy plan for sciatica.

Physical Therapy Techniques for Sciatica Relief

At Cohen Health and Performance, we often use nerve gliding exercises as part of a broader physical therapy program. These movements help restore the sciatic nerve’s ability to move through the tissues without restriction, reducing pain and improving function.

Here are two examples we often prescribe:

1. Supine Nerve Glide (Lying Down)

Repeat for 20 reps, 1–2 times a day.

2. Standing Nerve Slide (More Advanced)

Repeat for 15–20 reps.

These drills are gentle and should not be painful. They’re just one piece of a complete physical therapy approach designed to restore movement and reduce irritation of the sciatic nerve.

When to Seek Physical Therapy for Sciatica

If you’re experiencing any of the following, physical therapy can help:

Pain that radiates down your leg
Numbness or tingling in your lower body
Difficulty sitting, standing, or walking without discomfort
Weakness in your leg or foot

An experienced physical therapist can assess your mobility, strength, posture, and movement patterns to find the source of the problem—not just the symptoms. From there, we create a custom treatment plan to get you back to moving pain-free.

Take Control of Your Recovery

Sciatica doesn’t have to sideline you from the activities you love. With targeted physical therapy, many active adults see significant improvements in just a few sessions. Whether your goal is to get back to the gym, return to the tennis court, or simply move without pain—physical therapy can help you get there.

Need Help with Sciatica?
Book a evaluation with our team at Cohen Health and Performance here. We specialize in helping active adults and athletes resolve pain, improve movement, and get back to doing what they love—without limitations.

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, and pull-ups are staple movements in strength training, but they can start to feel off limits when your shoulder is not moving or functioning the way it should.

But here is the good news. Physical therapy and shoulder pain rehab can help you get back to doing what you love in the gym safely and effectively. For athletes and active adults looking for shoulder pain rehab in Bethesda, the right approach allows you to continue training while improving how your shoulder actually functions.

Why Overhead Movements Hurt

Many overhead exercises require a full range of motion at the shoulder. For that to happen, the shoulder joint is not 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 in both the front (anterior) and back (posterior). If it cannot, your scapula cannot rotate properly and your shoulder joint becomes restricted. This can lead to stiffness, discomfort, or pain.

This is something we frequently address in shoulder pain rehab programs, especially for athletes who want to continue lifting and training.

The Role of the Rib Cage in Shoulder Mobility

When you raise your arm overhead, your scapula upwardly rotates around your rib cage. 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 pain.

In our Bethesda physical therapy clinic, one of the first things we assess in patients who need shoulder pain rehab 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 during shoulder pain rehab.

1. Hooklying Overhead Reach with Breathing

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

2. Quadruped or Seated Upper Back Expansion Drills

These drills are designed to open up the posterior rib cage. Breathing is key. You are directing air into the areas that need more movement so your scapula can glide properly when you lift your arm overhead.

These exercises do not just improve mobility. They create the foundation for rebuilding strength.

Build Strength in End Ranges

It is not enough to simply restore mobility. You also need to be strong in those new positions.

This is a key part of effective shoulder pain rehab. Many people regain movement but never build strength in those ranges. That is often why pain returns once they go back to training.

A well designed physical therapy program includes strengthening drills that target these vulnerable positions so your body can handle the demands of lifting, throwing, or overhead sports.

Smart Modifications You Can Make in the Gym

Even as mobility and strength improve, certain movements might still feel uncomfortable. Smart exercise modifications can help you continue training while your shoulder recovers.

Here are two adjustments we often recommend during shoulder pain rehab.

1. Recline Your Bench for Overhead Pressing

Instead of pressing from a fully upright 90 degree position, adjust your bench to around 70 degrees. This reduces the mobility demands on the shoulder while still allowing you to build strength.

2. Modify Your Pull Up Angle

If you find yourself arching your back or rowing yourself to the bar during pull ups, you may be compensating for limited mobility. Bands, assisted machines, or grip modifications can allow you to maintain a more vertical pull without irritating your shoulder.

Physical Therapy Is More Than Just Rehab

The best shoulder pain rehab programs are not just about reducing pain. They focus on helping you move better and train smarter.

Working with a physical therapist can help you:

Identify the root cause of shoulder pain
Restore proper movement and strength
Learn ways to train around limitations
Return to lifting and sport without recurring setbacks

For active adults and athletes searching for shoulder pain rehab in Bethesda, the goal is not simply to stop pain. The goal is to build a shoulder that is resilient enough for the demands of training.

Final Thoughts

Shoulder pain does not have to mean the end of upper body training. By improving rib cage mobility, strengthening end ranges, and making smart gym modifications, you can keep progressing while addressing the underlying problem.

If you are struggling with persistent shoulder pain, working with a physical therapist who understands strength training and performance can make all the difference.

If you are looking for shoulder pain rehab in Bethesda, our team focuses on helping athletes and active adults return to training stronger, more resilient, and 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.

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!

Unlock Your Best Run: Physical Therapy for Runners

Are pain and stiffness holding you back from running your best? If you’re tired of reaching for Advil like it’s candy and feeling like something is just not right with your stride, it’s time to consider a more proactive approach—physical therapy tailored specifically for runners.

Imagine a Pain-Free Run

Picture waking up with fresh legs, excited to tackle your run without nagging pain. Imagine gliding through your favorite routes, feeling strong, confident, and powerful with every stride. With the right physical therapy guidance, you can reclaim your running potential and experience these benefits every day.

Discover the Benefits of Physical Therapy for Runners

Our exclusive Running Performance Lab is designed with one goal in mind: to help you run pain-free and reach your peak performance through targeted physical therapy techniques and drills. Here’s what you can expect:

Pinpoint Your Barriers: Identify hidden physical limitations that may be sabotaging your performance. With a customized plan, you can overcome these barriers and even shave minutes off your personal record.
Reclaim Your Speed and Power: Learn simple yet effective exercises that enhance your movement efficiency. Our physical therapy and performance strategies are tailored to help you move stronger and run faster.
Ditch Temporary Fixes: Move beyond quick fixes like medication, braces, or band-aid solutions. A dedicated physical therapy approach addresses the root causes of pain, ensuring lasting results.

Who Can Benefit?

Whether you’re a weekend warrior, a seasoned marathoner chasing a personal best, or simply a casual runner who wants to feel good while staying active, the benefits of targeted physical therapy are universal. Every runner faces challenges such as nagging injuries, stiffness, or unexplained performance plateaus. Left unchecked, these issues not only persist—they often worsen. But it doesn’t have to be that way.

Join Our Running Performance Lab

I’m excited to offer 10 exclusive spots for our Running Performance Lab, and it’s absolutely FREE. This is your chance to discover how a customized physical therapy plan can help you overcome pain and stiffness and unlock your full potential.

Don’t wait!
Spots are limited. Click HERE for more information and to secure your spot in the lab. Take action now, and let targeted physical therapy help you rediscover the joy of running.

Happy Running,

-Zac