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How Our Physical Therapists Coach Squats for People with Low Back Pain

Did you know that experts estimate up to 80% of the population will experience back pain at some time in their lives.

The sports physical therapy patients that we often assume that they no longer can perform common weight training exercises like squats.

However this is not the case. People experiencing lower back can continue to perform these exercises however may require the help of a performance physical therapist to learn how to most effectively do so.

Check out the video below to see how I coach squats for our physical therapy patients experiencing lower back pain.


Is Your Doctor (or physical therapy clinic) Taking Care of You?

Recently, I joined my mother-in-law for a visit to a physician’s office.

The physician she saw has a solid reputation and is known as a “go-to” expert in his field.

During the visit he spent a total of 5 minutes with my mother-in-law, glossing over test results and providing very brief recommendations.

He appeared to be speaking as fast as he could so that he could finish the visit and to get to his next patient. After his rushed explanation, we attempted to ask questions, which he answered while backing out of the room.

Sadly, experiences like this are very common in the world of healthcare and I do not blame the healthcare providers because they oftentimes are not left with much of a choice.

The health insurance industry consistently reduces reimbursement to health care providers, forcing them to schedule more patients within a fixed time period. As a result, the quality of care suffers, and everything becomes less personalized.

This also occurs in physical therapy, forcing many clinicians to resort to “cookie cutter” protocols.

If you go to Physical Therapy because of lower back pain then you get put on the lower back pain protocol, shoulder pain=shoulder protocol, etc.

Many times, this works, however, it is not the best choice for those looking to live an active, pain free, and healthy life.

For this reason I typically seek out practitioners that are out of network with health insurance as it enables them to provide me with the highest quality of care possible. In this approach I am treated like an individual and I get to ask all the questions that I would like so that I can a better understanding of my health.

We are out of network providers here at Cohen Health and Performance. We strive to get the best possible results for our patients in the least number of visits, while also providing the education necessary to prevent future issues from occurring.

People can feel better, move better, and enjoy an active lifestyle.  Our mission at CHP will always be to take the best possible care of our patients and that is why we are out of network with health insurance.

Interested in learning more about how this approach can help you? Contact us here!

Why Are You Bench Pressing?

How often do you stop and think about how you want to perform an exercise and if that is conducive to your goals?  Our physical therapy patients here in Bethesda often have the goal of learning to train without pain or discomfort. Training clients, most concerned with sports performance may have goals that include becoming stronger, faster, or building muscle mass.

There is not always a “correct” way to perform every exercise.⁣ Let’s take the bench press as an example.

Depending on your goals and capabilities, you may want to play around with the angle of your arms when bench pressing.⁣

Is your goal to build big pecs? Perform the lift with the arms closer to 90 degrees and do not allow the arms to drift past the body as you can see in the video here.

Do you want to lift more weight while keeping your shoulders and lower back healthy? If so, perform this lift with the arms closer to 45 degrees to take the stress off the front of the shoulders. Check out this bench press variation here.⁣

This is just one of many exercises that can be altered to change the focus.

The key is being clear on the outcome that you have in mind!⁣

Image Source

Bench Press” by A. Blight is licensed under CC BY 2.0.

A More Scientific Approach to Shoulder Mobility

Many of the sports related shoulder injuries that bring patients in for physical therapy occur when the shoulder is at it’s end range of motion.

Many assume that stretching and other drills to increase shoulder flexibility are the best ways to address these issues.

However, the issue lies in the ability (or lack-thereof) to demonstrate strength in end ranges of motion.

When in these positions, the muscles that control the shoulder are not able to generate as much force as when they are in less extreme positions. They struggle to control the shoulder joint and this challenge increases the chances of experiencing an instability related injury (like a dislocation) and can wear down the joint over time.

The good news is that we can train strength in end ranges of motion where our shoulders are often most vulnerable.

I recently taught the 2 drills below to a group of Crossfit athletes. In Crossfit, athletes must be able to lift and control heavy weights overhead which requires a large amount of strength in extreme ranges of motion.

These are fantastic exercises to work on these capabilities and you do not need to be a Crossfit athlete to benefit from them. Give them a shot!

Shoulder Flexion PAILs with a Lift Off Challenge

Shoulder External Rotation PAILs with a Lift Off Challenge



What The End Of My Sports Career Taught Me

Boy have times changed. Look at all that hair! Apparently they couldn’t do anything about the sun on picture day…

“I need to stretch more. Maybe I should try Yoga.”

“I’ve heard Pilates is really good for my core. Maybe I need to check out a class?”

“Strength training is important so perhaps I need to start lifting weights but where do I start?”

Most of us have had thoughts like this when considering different types of exercise.

The world of health, fitness, sports physical therapy and injury rehabilitation is huge and may seem overwhelming. I recall when I felt confused about how to proceed with my fitness journey.

After finishing my college football career, I no longer had coaches to guide my training. No longer did I have prescheduled practice, conditioning workouts, weight training, and recovery workouts (usually a mixture of foam rolling, stretching, yoga and light cardio).

I was unsure of what to do so I simply continued training as I always had. I lifted weights as per my usual off-season program and performed a couple conditioning workouts per week.

After a few weeks of doing this, I decided to ask myself a simple question. “Why?”

What was my training goal now? What were the best ways to achieve these goals? Upon some reflection and jotting down a few notes I quickly realized that my training program was not in line with my goals at that time.

My football career was over. I finally had the opportunity to get healthy and stay that way.

However, I really enjoyed feeling strong and the process of lifting weights. Also, I was studying to become a Certified Strength and Conditioning Specialist (CSCS) so had to practice what I preach (this was prior to physical therapy school).

I decided to create a strength training program that consisted of exercises to promote strength, while also improving my mobility. The goals were to improve my strength and muscle mass, while feeling great overall.

This was the optimal training approach for me at the time and I was only able to realize that by slowing down and asking a few simple questions.

When was the last time you did that? Try asking yourself the following questions.

  • What are the outcomes that I am looking for from my training? Do I want to become stronger? Do I want to live with less discomfort? Become more mobile? The key is being honest here!
  • What are the best ways to achieve the outcomes I am looking for?
  • If I am not sure of #2 above, who can help me figure that out?

As you can see with question 3 above, you do not need to have all the answers yourself. There are many people out there available to help you reach your goals but no one can determine what those goals are.

Once you gain clarity about your goals, our team of Performance Physical Therapists in Chevy Chase would love to help you achieve them. In addition to being Doctors of Physical Therapy, our team of Performance Physical Therapists are Certified Strength and Conditioning Specialists that specialize in helping injured athletes get back in the game.

How to “Fix” Rounded Shoulders

As physical therapists, we often answer questions pertaining to “poor posture.” One of the most common reports from our patients in Bethesda and Chevy Chase is having “forward shoulders.”

The solution to this, which is often taught by other physical therapists, is to stretch the muscles in the front of the shoulders. The most common of these muscle groups is the pecs.

The logic goes something like this. “Your pecs are tight and pulling your shoulders forward. If you stretch them, your shoulders can move back and correct your posture.”

While this reasoning isn’t necessarily wrong, it is shortsighted. It fails to question why muscles like the pecs became tight in the first place. Simply stretching these muscles won’t correct the root cause of the issue.

The shoulder complex rests on top of the rib cage and the pecs attach to the sternum (ribs 1-7 attach to the sternum) as well as the ribs on the front of the rib cage.

As we breath in the rib cage should expand in 360 degrees and as we breath out it should do the opposite.

People with forward shoulders and stiff pecs often have difficulty expanding the front part of their rib cage during a relaxed breath in. This prevents the pecs from lengthening fully and often causes them to remain stiff, pulling the shoulders forward.

If you are looking to improve your posture and “pull your shoulders back”, the solution must include breathing exercises that emphasis relaxation and expansion of the chest/front part of the rib cage.

Here is an example from our YouTube page that illustrates this concept.

If you are looking to improve your posture or shoulder function, contact us now!

Photo Credit

“Orlando’s Poor Posture” by hewy is licensed under CC BY-NC-ND 2.0