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

How Out of Network Physical Therapy May be More Cost Effective

Why Choose Cohen Health and Performance for Sports Physical Therapy?

At Cohen Health and Performance (CHP), we are frequently asked a critical question when someone first seeks our help for pain and limitations interfering with their active lifestyle: Do you accept health insurance?

This is a completely reasonable question, but the answer is more nuanced than a simple yes or no.

Our Mission: Elevating Sports Physical Therapy

At CHP, our mission is to enhance the lives of individuals who prioritize an active lifestyle by providing elite-level sports physical therapy. We are committed to not only helping people recover from pain and injuries but also empowering them to sustain long-term health and peak performance.

This mission drives every decision we make, including our choice to remain out of network with health insurance. For us, the decision was clear—being in-network would make it impossible to provide the high-quality, individualized care necessary to help our patients recover faster, stay injury-free, and return to the activities/sports they love as effectively as possible.

The Limitations of In-Network Sports Physical Therapy

Many people don’t realize how the constraints of in-network insurance impact their quality of care. Due to declining reimbursement rates, in-network physical therapists are often required to see multiple patients per hour—typically 2-3 patients at a time. As a result, treatment sessions become standardized, and truly customized care becomes nearly impossible.

In-network providers frequently have only 20-30 minutes per patient before moving on to the next. This leads to:

Generic treatment plans that don’t address the unique needs of athletes and active individuals.
Over-reliance on passive modalities such as ultrasound and electrical stimulation—techniques with questionable effectiveness in addressing the root cause of pain.
Frequent delegation of care to assistants, aides, or techs, rather than a licensed physical therapist providing hands-on, expert-level treatment.

Because of these limitations, in-network physical therapy patients often require 2-3 visits per week for months to achieve results—if they achieve them at all.

The CHP Difference: High-Quality, Personalized Sports Physical Therapy

By remaining out of network, CHP provides a superior level of care that gets our patients better, faster. Here’s how we stand out:

One-on-one, individualized treatment with a dedicated sports physical therapist every session.
Customized recovery plans designed for athletes and active individuals, addressing not just symptoms but the root cause of pain.
Faster recovery times due to focused, high-quality care, reducing the overall number of visits needed.
Education and injury prevention strategies to keep you pain-free and performing at your best long after treatment ends.

Many of our patients come to us after experiencing limited results with traditional in-network physical therapy. Our approach allows them to return to their sport or active lifestyle stronger, more resilient, and less prone to future injuries.

Is Investing in Out-of-Network Care More Expensive?

At first glance, out-of-network care may seem like a greater financial investment per session. However, when factoring in the cost and frequency of in-network visits, our model often proves to be more cost-effective in the long run.

Here’s why:

Fewer total sessions are needed due to the quality and efficiency of care.
In-network co-pays add up quickly with 2-3 visits per week over several months.
We provide documentation for out-of-network reimbursement through your insurance.
You can use Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) to cover treatment costs.

Investing in Your Health and Performance

When it comes to sports physical therapy, the cheapest option is rarely the best. We believe that your health, well-being, and ability to stay active is simply too important to discount the care that you receive. At CHP, we offer a higher standard of care, ensuring that you not only recover but also gain the knowledge and strength to prevent future injuries.

If you’re serious about overcoming pain, optimizing performance, and getting back to the activities you love—faster and more effectively—Cohen Health and Performance is here to help.

Ready to experience the CHP difference? Contact us today to start your journey toward pain-free movement and peak performance.

Blood Flow Restriction Training in Physical Therapy

If you’ve ever visited our Bethesda or McLean physical therapy facilities, you may have seen patients wearing unique-looking cuffs around their arms or legs while exercising. At first glance, it might not look like the most comfortable experience, but it’s certainly sparking curiosity among many of our clients/patients at Cohen Health and Performance.

This technique is called Blood Flow Restriction (BFR) Training, and we frequently use it in physical therapy to help patients recover from injuries, maintain muscle strength and mitigate muscle loss. We’ve received many questions about how BFR works, so let’s dive into its benefits and who might benefit from it.

What is Blood Flow Restriction (BFR) Training?

BFR training is a specialized method used in physical therapy that involves placing controlled cuffs around the arms or legs to partially restrict blood flow to those areas. This restriction creates an effect similar to lifting heavy weights, even though the actual resistance is much lower.

This makes BFR especially useful when an injury prevents traditional strength training. Instead of losing muscle and strength due to inactivity, BFR allows us to stimulate muscle growth and prevent atrophy—an essential part of effective physical therapy rehabilitation.

How Does BFR Work?

When blood flow is restricted during exercise, it creates a hypoxic (low oxygen) environment in the muscles. This leads to:

Increased Growth Hormone Production – A key factor in muscle recovery and repair.
Enhanced Strength Retention – Even with light weights, BFR promotes muscle activation similar to traditional strength training.
Faster Injury Rehabilitation – By maintaining muscle mass and strength, BFR helps patients recover more efficiently and return to their activities sooner.

Who Can Benefit from BFR in Physical Therapy?

At Cohen Health and Performance, we integrate BFR into physical therapy treatment plans for a wide range of patients, including:

Athletes recovering from ACL tears or knee injuries
Active adults with calf strains, tendon issues, or post-surgical rehab needs
Individuals with upper extremity injuries, such as biceps tendon strains

Since BFR allows us to effectively train muscles without excessive load, it is a valuable tool in physical therapy for injury recovery, muscle preservation, and performance enhancement.

Is BFR Right for Your Physical Therapy Plan?

If you’re undergoing physical therapy and want to prevent strength loss, muscle atrophy, or delayed recovery, BFR training could be a powerful addition to your rehabilitation program. At Cohen Health and Performance, our Doctors of Physical Therapy use this innovative technique to help patients get back to the activities they love—stronger and faster.

If you’re interested in learning more about BFR training and how it fits into your physical therapy plan, contact us today—we’d love to help!

Why I Don’t Recommend Weight Belts for Low Back Pain—and What to Do Instead

If you’re an active adult or even a high school athlete dealing with low back pain, you might be tempted to rely on a weight belt when lifting. But as a sports physical therapy professional that sees many patients struggling with back pain, I don’t recommend it. Here’s why:

Your Abs Are Your Natural Weight Belt

The primary job of your abdominal muscles during weightlifting is to create internal pressure to stabilize your spine. When you lift, your abs push back against internal pressure, reinforcing your lower back and protecting it from excessive strain.

However, when you wear a weight belt, it takes over this role, preventing your abs from doing the job they were designed for. Over time, this can lead to weaker core muscles, which increases your reliance on external support instead of strengthening your body naturally.

When Does a Weight Belt Make Sense?

Weight belts can be beneficial for competitive powerlifters and Olympic lifters, whose goal is to lift the maximum amount of weight possible. In these cases, every little advantage matters. But for the average active adult who wants to move, lift, and train pain-free, weight belts are not a sustainable solution.

Think about it—if you rely on a belt at the gym, how will your body handle lifting groceries, moving furniture, or carrying your kids? If your goal is to move well in everyday life, you need to strengthen your core, not outsource its function to a belt.

How to Train Your Abs to Be Your Weight Belt

Instead of relying on external support, train your core to support your spine naturally. Start by mastering pelvic and rib cage alignment, which allows your core muscles to engage effectively.

Check at the video at the start of this article for two physical therapy-approved exercises to strengthen your core and reduce back pain.

By consistently training your abs in this way, you build a natural, internal weight belt—one that supports you in the gym and in real life.

Ready to Train Without Pain?

If back pain is holding you back from the active lifestyle you love, we can help. At our either of our two physical therapy practices in Bethesda and McLean, we specialize in helping active adults build strength, move better, and stay pain-free—without relying on weight belts or medication.

Contact us today to start feeling stronger from the inside out!

Your Tools to Recovery: What Actually Works?

When it comes to sports recovery, athletes today have access to an overwhelming number of tools—foam rollers, ice baths, saunas, compression boots, and more. But what’s actually worth your time? And what recovery methods truly make a difference?

Our physical therapy team at Cohen Health and Performances work with athletic adults, college and high school athletes every day, helping them overcome injuries and perform at their best. Let’s break down some of the most popular recovery methods and see which ones are worth incorporating into your routine.

Foam Rolling

Foam rolling is one of the most common recovery techniques used in gyms, both before and after workouts. You may even have a foam roller at home that you use on recovery days.

The Science Behind Foam Rolling

The research on foam rolling is mixed. Some studies suggest that it can reduce short-term muscle stiffness and improve flexibility by increasing blood flow to the muscles. However, other research indicates that it may not have a significant long-term impact on recovery.

Should You Use It?

Yes, if… You feel a benefit from it—less tightness, improved movement, or reduced soreness.
Skip it if… You’re just doing it because someone told you to, and you don’t notice a difference.

Like with most recovery tools, if it helps you feel and move better, keep doing it. But if you’re not noticing any changes, it’s probably not a must-have in your routine.

Ice vs. Heat: Which One Should You Use?

One of the more common questions we hear in physical therapy is:
Should I use ice or heat for recovery?

When to Use Ice (Cold Therapy)

If you’re recovering from a recent injury, such as a sprained ankle or muscle strain, icing can help reduce swelling and inflammation. Ice can also be useful after high-intensity activities—like a basketball game or heavy leg day—to prevent excessive soreness and irritation.

When to Use Heat (Heat Therapy)

Heat is great for relaxing tight muscles and improving blood flow. It can be especially beneficial before workouts to increase mobility or on recovery days to relieve stiffness.

Key Takeaway:
Both ice and heat have their place, depending on your needs. If you’re unsure which is best for your recovery, consult with a physical therapist to help you create a plan tailored to your sport and training level.

Compression Therapy: Is It Worth the Hype?

Compression therapy, such as Normatec boots, has become increasingly popular among elite athletes. These devices work by pumping air into different chambers of the boot to promote circulation and reduce muscle swelling.

Does It Work?

📖 Research suggests that compression therapy can help reduce muscle soreness/inflamation and speed up recovery. However, it’s not necessarily a must-have for most athletes.

Should You Invest in Compression Boots?

Use them if… You have access to them and feel they help with your recovery.
Not necessary if… You don’t want to spend money on expensive recovery tools when other free methods (like active recovery) work just as well.

My Favorite Recovery Method: Active Recovery

If there’s one recovery tool that every athlete should use, it’s active recovery.

Instead of sitting on the couch after a tough workout or game, the best thing you can do is get moving.

Try this simple active recovery routine:
✔️ 10-15 minutes of light cardio (stationary bike, walking, or rowing)
✔️ Mobility exercises targeting sore or stiff areas
✔️ Basic bodyweight movement drills to promote blood flow

Why It Works:
Active recovery flushes out waste products from your muscles, reduces soreness, and helps prepare your body for the next workout.

Pro Tip: Professional athletes often dedicate 20-30 minutes on recovery days to movement-based sessions that include light cardio and flexibility work. Implementing this in your routine can boost recovery and prevent injuries.

The 90% Rule

While tools like ice baths and compression boots can be useful, they won’t make a difference if you’re neglecting the basics.

Nutrition – Fuel your body with enough protein, carbs, and healthy fats to support muscle repair.
Sleep – Prioritize 7-9 hours of quality sleep to maximize recovery.
Consistent Training – Train smart and take a thoughtful approach to your programming
Stress Management – Too much stress (physical or mental) can slow down recovery, so make sure you’re managing it effectively.

The basics account for the majority your recovery results. The best recovery tools in the world can’t replace proper sleep, nutrition, and training habits.

Final Thoughts: What Should You Prioritize?

Recovery is not one-size-fits-all. The best approach is the one that helps you feel and move better.

Key Takeaways:

Foam rolling: Use it if it works for you, but it’s not essential.
Ice vs. heat: Ice for recent injuries, heat for stiffness and mobility.
Compression therapy: Helpful, but not a must.
Active recovery: The most effective and accessible recovery tool.
Focus on the basics: Sleep, nutrition, and smart training are 90% of the equation.

If you’re struggling with muscle soreness, an injury, or just want to optimize your recovery, physical therapy can help.

Contact us today to get a personalized recovery plan designed for your sport and training needs!