Physical Therapy Didn’t Work…

I tried physical therapy and it didn’t work.

Many of our patients in Bethesda have seen other physical therapists prior to seeing us. In their previous physical therapy experiences, they did not achieve the results that they were looking for and are coming to us for answers.

Personally, I love working with these people because they continue to believe that our profession can help them. However, negative experiences in physical therapy often cause many others to lose faith in the profession.

Perhaps you are one of these people. If so, I don’t blame you as I once was in your shoes!

When I was in High School, I experienced a quadricep injury that was impacting my ability to play football.

I went to my local physical therapy practice searching for help in overcoming this injury and play in my junior season. It was going to be my first season starting on both offense and defense causing this injury to constantly remain in the front of my mind.

My introduction to physical therapy was not what I had hoped for, and I now realize that my physical therapists were not taking great care of me (to learn more about how you can determine if this is the case, see my latest blog here).

Luckily, I was still able to play in my season and was back to 100% by the middle of the year. However, I can’t help but wonder if I would have been fully healthy to start the season if I saw a different physical therapist.

Like all other professions, the physical therapy industry has great professionals and poor ones. Furthermore, some physical therapists specialize with athletes, some with cardiac patients and others with people living in nursing homes.

As a result, my hope is that instead of saying “I tried physical therapy and it didn’t work”, you say “This physical therapist or physical therapy practice didn’t provide the results that I was looking for and I need to find someone that is a better fit for what I need.”

The truth about stretching and physical therapy

Many people believe that sports physical therapy and performance training should involve a significant amount of stretching. However, every aspect of injury rehabilitation or athletic training needs to serve a clear and specific purpose. When was the last time you paused and asked yourself, “What do I hope to gain from stretching this area?” or “Does this particular muscle even need to be stretched?”

The truth is, like most things in physical therapy, the answer isn’t black and white—it depends. To understand whether stretching is appropriate, you first need to know why a muscle has become stiff or tight in the first place.

Why Do Muscles Become Stiff?

Muscles can become stiff when they are held in a shortened position for extended periods of time. For example, if you spend most of your day sitting or standing in the same position, your muscles may “lock up” in that position and feel tight. Another common cause of stiffness is repetitive movement—when you continually perform the same motions without incorporating enough variety into your routine.

So, if your day involves repetitive tasks or being in a static posture for hours on end, stretching might temporarily relieve the stiffness, but it won’t address the root cause. The solution to “tight” muscles often lies in incorporating more varied movement into your daily routine.

Stretching Without Purpose: A Common Mistake in Physical Therapy

One of the biggest misconceptions in physical therapy is that stretching is always the answer to stiffness or discomfort. However, stretching a muscle without addressing the underlying reason it became stiff is like putting a bandage over the problem—it may help in the short term, but it won’t fix the issue.

For example, in many cases, a muscle might become stiff to protect the body from injury. This is particularly common with back pain. When your back muscles tighten up, they are often responding to underlying instability or strain in the spine. Stretching those muscles could actually make the problem worse by compromising the body’s natural protective mechanisms, increasing your risk of injury.

A Smarter Approach to Stretching in Physical Therapy

Next time you think about stretching a stiff muscle, ask yourself this important question: “Why is this muscle stiff in the first place?” In physical therapy, we focus on identifying and treating the root cause of muscular tightness, rather than just addressing the symptoms. Often, incorporating more variety into your daily movements or addressing imbalances through targeted exercises is a far more effective approach than simply stretching.

Remember, physical therapy is about **rehabilitation with purpose**. Instead of stretching without knowing why, work with a physical therapist who can help you identify the root cause of stiffness and develop a plan to address it safely and effectively. This will not only help you overcome your current discomfort but also reduce your risk of future injuries.

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

Building Shoulder Strength in End Ranges: How Physical Therapy Can Prevent Injury

Many shoulder injuries that bring athletes to physical therapy are the result of overuse or instability when the shoulder reaches its end range of motion. Whether you’re lifting weights, throwing a ball, or performing overhead movements, your shoulder is vulnerable when pushed to its limits.

It’s common to assume that the solution to these issues lies in increasing flexibility through stretching and mobility drills. While flexibility is important, it’s only part of the equation. The real issue often lies in a lack of strength and stability when the shoulder is in these extreme positions.

Why Strength at End Range Matters

When the shoulder reaches its end range of motion—whether during an overhead press, a throw, or any extreme movement—your muscles can’t generate the same amount of force as they can when the shoulder is in a more neutral position. This weakness leaves the shoulder joint less stable and more prone to injury.

Without the ability to control the joint at these extreme ranges, you’re at an increased risk of instability-related injuries such as shoulder dislocations or subluxations. Over time, these challenges can lead to wear and tear on the shoulder joint, causing issues like rotator cuff tears, labral injuries, or impingement syndromes.

However, there’s good news! By incorporating targeted physical therapy exercises, you can train your shoulder to be strong even in these vulnerable positions. Strengthening the muscles that support the shoulder at end range can significantly reduce your risk of injury and improve your overall performance in sports and daily activities.

Strengthening the Shoulder in End Ranges with Physical Therapy

At its core, physical therapy is about improving movement quality and building strength where it’s needed most. For athletes and active individuals, this often means focusing on increasing shoulder stability in the ranges of motion where injuries are most likely to occur.

Here’s where physical therapy really shines—helping you develop strength at the edges of your mobility. Instead of simply increasing flexibility, we work to build strength and control in these end ranges. This approach not only enhances performance but also prevents injuries by ensuring that your muscles can stabilize the shoulder joint in even the most extreme positions.

PAILs and RAILs in Shoulder Rehab

One of the best ways to strengthen the shoulder at end range is through Progressive Angular Isometric Loading (PAILs) and Regressive Angular Isometric Loading (RAILs) exercises. These exercises involve applying tension to the muscles in both their stretched and shortened positions, helping to increase both flexibility and strength in end ranges.

For example, Shoulder Flexion PAILs with a Lift Off Challenge and Shoulder External Rotation PAILs with a Lift Off Challenge are highly effective exercises for targeting the muscles that stabilize the shoulder when it’s in its most extended and rotated positions. These exercises focus on developing strength while the joint is near its limit of movement, allowing for greater control and reducing the likelihood of injury.

I recently demonstrated these drills to a group of CrossFit athletes, who need exceptional shoulder strength and stability to lift heavy weights overhead and perform complex movements. However, you don’t need to be a CrossFit athlete to benefit from these exercises. Whether you’re involved in overhead sports like swimming, tennis, or volleyball, or simply want to improve your shoulder health, these exercises are fantastic for anyone looking to build strength and prevent injuries.

Exercises to Try:

1. Shoulder Flexion PAILs with a Lift Off Challenge

2. Shoulder External Rotation PAILs with a Lift Off Challenge

Why Physical Therapy is Key for Shoulder Health

Incorporating these types of exercises into your routine can dramatically improve your shoulder strength and stability, particularly in those vulnerable end ranges of motion. Working with a physical therapist ensures that you’re doing the exercises correctly and progressively, so you can safely build strength without putting your joint at risk.

A physical therapist will assess your specific needs, tailoring exercises to your unique shoulder mechanics and helping you regain control over your movements. With proper guidance, you can significantly reduce your risk of injury and improve your overall performance in your sport or daily life.

Ready to Strengthen Your Shoulders and Prevent Injury?

If you’re experiencing shoulder pain or instability, or if you want to improve your strength in end ranges of motion, physical therapy can help. Contact us today to learn how a tailored treatment plan can get your shoulders strong, stable, and ready for anything life or sport throws your way!

How Focusing on Mental Health Improves Physical Therapy Outcomes

Can focusing on mental health improve outcomes in physical therapy?

Yup!!

This concept is challenging to grasp because the medical system often tries to attribute physical pain to a direct cause. However, it isn’t that simple and this is important for every physical therapist to understand.

Humans are complex and physical pain is influenced by several different factors. One of which is the brain.

An individual’s mental state has a large impact on their physical state and the effectiveness of physical therapy interventions.

Do not miss the latest episode of the CHP Spotlight Interview series with Dr. Kelly Forys Donahue and Dr. Danielle Miro from DC Health Psychology (www.dchealthpsychology.com).

Check out the full interview here.

Photo Credit

“World Mental Health Day Observance” by United Nations Photo is marked with CC BY-NC-ND 2.0.