I Wish I Didn’t Hear This At The Gym

“It will hurt your knees if they go past your toes.”

I was recently exercising in the gym close to 2 young men performing barbell squats. I even heard one say that they just finished going to physical therapy and I hope that the following information didn’t come from their physical therapist…

One of them (let’s call him lifter 1) finished a set of squats and was chatting with the other (let’s call him lifter 2). I overheard Lifter 2 tell Lifter 1 that he shouldn’t let his knees go past his toes when squatting because that is bad for them.

This is a common belief in fitness circles, the personal training industry, and I used to hear it a lot in the physical therapy industry. But it is not true.

Your knees must go over your toes to walk or run. Proper squat technique requires your knees to move far past your toes.

To prevent this, you need to push your hips back and arch your lower back. This places more stress onto your lower back and increases your risk of back pain.

But you may be wondering if pushing your knees past your toes places more stress onto your knees.

It does not! In fact, research has shown that training your knees to go past your toes helps create healthy knees and take stress off your back.

Check out the squatting tutorial below to retrain your squat and your knees to be comfortable going over their toes as they should!

Squat Tutorial

Don’t forget, there is no bad exercise or good exercise. One exercise may be more appropriate for you when compared to another for a variety of factors including your fitness goals, injury history (talk to your physical therapist), unique body traits, and movement capabilities. Keep this in mind when you hear someone make a generalized or “one size fits all” statement about exercise.

Create Your BS Meter

I’m lying on the couch as I got sucked into Instagram and all of their sports physical therapy videos. While scrolling, one exercise video grabbed my attention. This wasn’t because it was good information. It was because it wasn’t and had thousands of likes.
There is so much information out there and anyone with a social media account can have a platform. You have access to the best and the worst information. It is overwhelming!
You need a BS detector so that you aren’t doing bicep curls while standing on a ball, blowing up a balloon (not far off what I saw the other day).
So how do you determine when you should ignore a social media post?
Speaking in absolutes. Most times, the best answer that a professional can give you is “it depends.” Rarely is there a correct answer for every situation. For example, stretching or mobility is often promoted as a “fix” for a given injury. Yet, many people have more important problems to solve. For more information, check out our post, Is Mobility Overrated? It is impossible to know of every possible factor that could be contributing to pain or injury. Even the best among us cannot be 100% certain, especially on social media.
It is too complicated. An expert can take a complex topic and break it down so that it makes sense to you. Complicated medical jargon is a red flag that the presenter does not understand what they are posting.
Promoting personal success stories as evidence. Personal success stories are subjective and ignore the facts and research. Many influencers post personal success stories as evidence for their approach. This ignores all the other factors that may have contributed to the results being promoted (genetics, differences in lifestyle, priority differences, etc.). Quality research requires thousands of trials before it is valid. A case study of 1 or 2 people only applies to those 1 or 2 people!
P.S. If someone is promoting a “quick fix”….run!

How to Train for Your First Race

Training for your first running race can be difficult – where do you start? What program do you follow? How long should you train for? What even is “training”? These are questions that we constantly ask as sports physical therapists and strength and conditioning professionals.

Training means conditioning your body to adequately manage the future demands you want to place on it. This typically includes gradually increasing your volume or intensity of physical exercise over time in order to perform your best, prevent injuries, and avoid needing a sports physical therapy clinic like us!

There are a million different answers and a million different resources on the Internet you can utilize, which can be overwhelming. Whether it’s a 5K, marathon, triathlon, or Iron Man, here’s a few tips you can follow to streamline your training process: 

  1. Establish your goals: Are you aiming just to finish the race? Or do you have a goal time in mind? This can help you determine your pace and intensity of training sessions. 
  2. Identify your starting point: AKA have you already done any conditioning for this activity? (ex: recreational running/biking/swimming) If you are starting from square 1, you will want to begin training earlier than someone who has been consistently exercising. 
  3. Utilize cross training: This can include an alternative form of cardio (swimming, biking, running, HIIT training) and strength training! Different forms of exercise will strain different tissues, and is important for preventing injuries. 
  4. Taper before your race: Give your body time to recharge 1-2 weeks before race day – you shouldn’t be at your heaviest volume the week before. 
  5. Follow a Program: Depending on when your race is, there are several great running programs you can find online that fit your own time frame. Running Training Plans. Nike.com has great running programs to download! 

If you have any questions about the above, the sports physical therapists and performance training specialists are always here to help at Cohen Health and Performance. While the points listed above are a great starting point for getting into a running routine, we can help with insight into calculating correct mileage for risk reduction, strengthening your muscles to complement your training schedule, and helping you train along the way to your race! 

What a Foot and Ankle Surgeon Recommends For Youth Athletes

I recently had the pleasure of interviewing Dr. Thomas Sanders for the latest edition of the CHP Spotlight Interview Series. The mission of the CHP Spotlight Interview Series is to share information with you from the greatest experts in the fields of sports medicine, physical therapy, fitness and performance. Now, more than ever, there is a seemingly infinite amount of information available and finding the most credible information is a challenge. The good news is that we are here to help you find the best information related to physical therapy, training, and sports medicine from experts surrounding us in Bethesda, DC, McLean and Northern Virginia.

If you or your child has suffered a foot/ankle ankle, don’t miss this interview! Dr. Sanders explains what you should do if you have experienced a foot/ankle injury and what risk factors your child can address right now to lower their risk of injury. He goes on to share when surgery may be appropriate and when conservative options like physical therapy are a better choice. He even shares his experiences as an athlete, playing rugby, and how that lead him to specialize in helping injured athletes!

Dr. Thomas Sanders, MD, is an orthopedic foot and ankle specialist at the Centers for Advanced Orthopedics in Northern Virginia and Chief of Foot and Ankle surgery for the INOVA Health system. Dr. Sanders specializes in the treatment of ankle arthritis, lower extremity trauma, and fractures of the ankle and foot. He also helps patients in the Washington, DC, area with post-traumatic reconstruction, midfoot and forefoot arthritis, flatfoot reconstruction, and bunions/hammertoes.

To learn more about Dr. Sanders, click here and check out our interview below!


2 Drills to Improve Your Running Times

If you are a dedicated runner you likely have suffered an injury and maybe even gone to physical therapy. Whether you realized it or not, this injury limited your ability to train effectively.

Here in Bethesda (and soon to be, McLean!), physical therapy involves helping runners overcome injuries that otherwise would limit their ability to train, ultimately causing disappointing results.

There is not a one size fits all solution to helping runners. However, we often discover that runners are limited by the mobility of their hamstrings.

During a run, the hamstrings need the ability to lengthen as the thigh is in front of the body. This should be achieved without drastically changing the position of the pelvis. Many runners struggle to maintain control of their pelvis as the hamstring lengthens. This increases the stress placed onto a variety of soft tissues through the lower body and alters foot strike position.

Hamstrings, like many other muscles, must be strong when in lengthened positions. Otherwise the body will not allow you to keep any of the short-term flexibility improvements that you have made with stretching.

Below are 2 drills that you can incorporate into your strength training routine to improve hamstring strength and flexibility that the body will hold on to!

Kickstand RDL
Single Leg Eccentric Glute Bridge

A thoughtful and more scientific approach to training that is specifically designed for runners is likely all you need to drastically improve your running performance. It may not even require you to train any harder, just smarter!

Why I Don’t Train Barefoot

Barefoot training and the use of minimalist footwear has become a widely discussed topic in sports physical therapy and the running community. Many folks in the fields of sports medicine, injury rehabilitation, and performance training are all-in on the idea of training in bare feet.

Training barefoot provides great benefits.

The absence of shoes gives the body a direct connection to the ground for quicker and more accurate feedback which helps to improve balance.

Barefoot training also strengthens the feet themselves. When the feet do not have assistance from footwear for support, they must do the entirety of that job for themselves. Muscles, tendons, and ligaments in the feet work to support the arch, the heel, and the forefoot which strengthens them over time. For this reason we often prescribe barefoot training for our physical therapy patients.

However barefoot training is not appropriate for all people.

Most of us walk on hard surfaces like concrete and unlike grass or dirt, concrete is not a forgiving surface. We are unable to manipulate concrete and we have less shock absorption as we step onto harder surfaces.

In addition to an external environment that may not be conducive for barefoot training, many people have unique foot structures or previous injuries that make barefoot training unrealistic. In these situations, a shoe may help their foot function better.

An appropriate shoe allows for the foot to find the ground optimally and properly transition through the different phases of the gait cycle. This allows the body to properly alternate from one leg to the other.

A proper shoe must provide optimal heel control, allow for the arch of the foot to contact the shoe properly (and at the correct time in the gait cycle) and bend only where the toes bend.

The correct shoe can have an incredibly powerful effect on a variety of different ailments and can make a huge difference in the effectiveness of someone’s rehabilitation and training program.

Are you eager to find out if barefoot training is right for you? Contact us today to learn more!