Cryotherapy, what’s the verdict?

I was at a conference a few months ago with a group of physical therapists and personal trainers, and we were discussing the day’s events over a meal. The conference also had different companies pitch their products and services to the healthcare providers that were in attendance. One of them was a cryotherapy company and their rep recognized us.

He came to our table and gave us his pitch.

“Cryotherapy will help your patients reduce pain, enhance their muscle recovery, decrease inflammation, and improve their overall wellness.”

Have you heard something similar and wondered if Cryo is all they say it is? We have gotten many questions within our physical therapy clinics in Bethesda and McLean with questions related to Cryo.

First let’s talk about what cryotherapy is. The body is exposed to extremely low temperatures for a short period of time, usually a few minutes. There are several forms of cryotherapy, but the most popular is whole-body cryotherapy. This involves standing in a chamber filled with liquid nitrogen vapor for a few minutes that can get as low as -200 or -300 degrees Fahrenheit (yes, you read that correct).

Cryotherapy is a matter of debate in the medical, physical therapy and training community, with some studies showing positive results while others have shown little to no effect.

Proponents of cryotherapy claim that it can help with a variety of conditions, including chronic pain, arthritis, inflammation, and depression. The theory is that the cold temperatures cause the body to release endorphins, which are natural painkillers, and reduce inflammation in the affected area. Some studies have shown that cryotherapy can help to reduce pain and inflammation in people with rheumatoid arthritis, but more research is needed to confirm this.

Claims are also made that it can help with muscle recovery after exercise. The theory is that the cold temperatures cause blood vessels to constrict, reducing blood flow to the affected area. Then, when the body warms back up, blood vessels dilate, which increases blood flow and promotes healing. Some studies have shown that cryotherapy can help with muscle recovery, but others have shown little effect.

So, what is the verdict? Cryo is new and as with all new things, the evidence is limited, early research is mixed, and more is needed. Also, don’t forget that there are risks associated with the super cold temperatures involved with Cryo, such as skin damage and frostbite.

If you are planning on giving Cryo a shot, please talk to your physician and make sure it is safe for you to do so!

3 Tips to Help You Find the Best Shoe

Minimalist shoes, running shoes, cross-training sneakers, weightlifting shoes. As sports physical therapists, personal trainers and performance coaches in McLean and Bethesda, we are asked all sorts of footwear questions. If you are like me, and do several different things, it may seem that you need a special shoe for each activity.

In my closet you can find running, hiking, cross-training, basketball, and special weightlifting shoes. But these days I mostly use 1 pair for all of my training.

I’m more of a generalist now. I dabble in many different things but spend most of my “fitness time” exercising in the gym. Sorry ego, my days of being a specialist are behind me.

If you are training for a particular sport or are a high-level runner, you are a specialist and likely need a special shoe for your sport (and the footwear recommendations in a sports physical therapy setting will be different). But if you are a generalist like me, you need a shoe that is comfortable, designed for your foot type, and can do everything that you need.

Here are 3 things that you should look for to choose the right shoe for you.

  • It must have a firm and snug heel cup. Your heel sits at the base of the shoe, in a place called the heel cup. The heels cup should fit snugly around your heel and should not be much wider than your heel itself. This prevents your heel from sliding within the shoe, which may negatively impact foot mechanics.
  • The shoe must have a toe break that bends where you toes bend. Place your shoe on the ground and hold it there. Pull the front of your shoe up from under it. The folding point of the shoe should be located where your toes bend. If your shoe folds at another location, your shoe is not accommodating to the mechanics of your foot and can lead to breakdown within the structure of the foot itself.
  • You should be able to feel the entirety of both your feet on the ground as you are standing still in your shoes. People are often unable to feel their arches, which results in more stress on the areas that have more contact with the ground.

There are 26 bones and 30 joints within the foot. This results in many ways that our foot can compensate but these 3 tips can help solve these issues.

Would you like help finding the right brand and model shoe for you? Our performance physical therapy team would be happy to provide you with recommendations based on the brands and models that are on the market right now!

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. 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!