Back pain is one of the most common reasons people seek physical therapy. Yet many people spend months or even years trying stretches, exercises, or treatment plans that never address the actual source of their pain.

At Cohen Health and Performance, we see this every day in our back pain rehab McLean and Bethesda clinics. Many of our patients have already seen multiple providers before they arrive. They have completed physical therapy, rested, modified their workouts, or tried injections, but their symptoms continue.

The reason is often simple. Back pain is not one condition. Different diagnoses require different treatment strategies. There is no one size fits all approach.

If the treatment does not match the diagnosis, progress is often slow or nonexistent. In some cases, the wrong exercises can even make symptoms worse.

Here are two of the most common causes of back pain that we treat and why each requires a completely different rehabilitation approach.

Spinal stenosis

Spinal stenosis occurs when the space around the spinal cord becomes narrower, creating compression within the spine. It is most common as we get older but can affect active adults who still want to hike, golf, travel, lift weights, or keep up with their grandchildren.

People with spinal stenosis often experience:

• Pain, numbness, or tingling into both legs
• Difficulty standing upright for long periods
• Increased symptoms with walking or standing
• Relief when sitting or leaning forward

The goal of conservative treatment is to reduce the positions that increase compression while improving the body’s ability to move efficiently.

In our clinics, treatment often focuses on:

• Learning to stack the pelvis underneath the hips instead of standing in excessive lumbar extension
• Improving control of intra-abdominal pressure to better support the spine
• Increasing hip mobility so movement comes from the hips instead of the lower back
• Building strength that allows patients to return to daily activities with less pain

One of the first exercises we teach many patients with spinal stenosis addresses these exact goals.

Below is a video demonstrating one of the exercises we frequently use early in the rehabilitation process.

Disc bulge or herniation

A lumbar disc bulge or herniation occurs when disc material pushes beyond its normal position. Many people have disc bulges without ever knowing it. Problems occur when that disc places pressure on one of the nerve roots leaving the spine.

Unlike spinal stenosis, symptoms usually travel down one leg rather than both. Many people notice increased pain with bending forward, although every person’s movement preferences are slightly different.

Treatment focuses on reducing stress on the irritated nerve so inflammation can settle and symptoms begin to improve.

Once symptoms calm down, rehabilitation shifts toward answering the bigger question.

Why did the injury happen in the first place?

Sometimes the answer is poor hip mobility. Sometimes it is weakness, movement mechanics, training volume, or recovery habits. Identifying and correcting the underlying cause is one of the most important parts of preventing future flare ups.

Why an accurate diagnosis matters

These are only two examples of low back pain. Other conditions, including muscle strains, spondylolisthesis, facet joint irritation, and sacroiliac joint dysfunction, all require different treatment strategies.

That is why an individualized evaluation matters.

At Cohen Health and Performance, we don’t hand every patient the same sheet of exercises. We identify the source of your pain, understand how your body moves, and build a rehabilitation plan that fits your goals, whether you want to return to lifting, running, golf, or simply live without constant back pain.

If you are searching for back pain rehab in McLean or back pain rehab in Bethesda, our team specializes in helping active adults and athletes get lasting results by treating the cause of the problem, not just the symptoms.

Ready to stop guessing and start making progress? Schedule an evaluation with our team and let’s build a plan that is specific to your back, your goals, and your lifestyle.

At Cohen Health & Performance, continuing education is not just something we encourage. It is built into how we operate.

Every quarter, we close both of our clinics so our entire team can come together for our CHP Summit. These days are dedicated to learning from one another, discussing the latest research, and finding new ways to better serve the athletes and active adults who trust us with their care.

As a physical therapist in Bethesda or physical therapist in McLean, staying current with the latest evidence allows us to deliver the highest quality rehabilitation and performance training possible.

One of this quarter’s presentations focused on a topic that every athlete and parent should understand: the importance of in-season strength training.

Why athletes should continue strength training during the season

A common misconception is that athletes should stop lifting weights once games begin. Many worry that strength training will leave them sore, tired, or negatively affect performance on the field.

The research tells a different story.

According to the latest evidence presented during our CHP Summit, athletes can begin losing measurable strength and power after just two to three weeks without resistance training. These declines are even greater in younger athletes, who have not yet built years of training adaptations.

Even elite athletes experience significant strength losses after only a few weeks away from the weight room.

The takeaway is simple: maintaining strength during the season matters.

One session per week may be enough

The good news is that maintaining strength does not require spending hours in the gym.

Research suggests that even one quality strength training session each week can help athletes maintain many of the gains they built during the offseason. If schedules allow, two sessions per week can be even more beneficial.

Rather than performing dozens of exercises, athletes should prioritize compound movements such as:

• Squats
• Deadlifts
• Bench press
• Rows
• Split squats

These exercises train multiple muscle groups simultaneously and provide the greatest return on time invested.

In-season strength training can reduce injury risk

Perhaps the biggest reason to continue strength training during the season is injury prevention.

When athletes maintain their strength and power, they are better prepared to tolerate the physical demands of practices and games. Research has shown that athletes who continue strength training experience significantly lower injury rates than those who stop lifting altogether.

Even if an injury does occur, stronger athletes often return to play faster because they have maintained more of the physical qualities needed during rehabilitation.

For athletes competing nearly year-round, maintaining strength is one of the simplest ways to stay available throughout the season.

Quality matters more than quantity

An effective in-season program does not need to be complicated.

Instead of adding more exercises, focus on:

• Four to five compound movements
• At least one challenging working set for each exercise
• Proper technique
• Adequate recovery between sessions

The goal during the season is not necessarily to make dramatic strength gains. It is to preserve the hard work completed during the offseason while supporting performance and reducing injury risk.

Why continuing education matters at Cohen Health & Performance

At Cohen Health & Performance, our quarterly CHP Summits allow every clinician to stay current with the latest sports science research and apply those findings directly to patient care.

Whether you are working with a physical therapist in Bethesda or a physical therapist in McLean, you can be confident that your treatment plan is built on current evidence and tailored to your individual goals.

Looking for guidance with your in-season training?

If you’re an athlete preparing for a busy season, or a parent wondering how your child should balance practices, games, and strength training, we’re here to help.

Our team designs individualized in-season strength programs that help athletes maintain performance, reduce injury risk, and stay ready when it matters most.

Whether your goal is to compete at a higher level, stay healthy throughout the season, or recover from an injury, the right training plan can make all the difference.

At Cohen Health & Performance, we often talk about the importance of looking at the whole athlete. Great training and great physical therapy matter, but they are only part of the equation.

In our latest CHP Spotlight Interview, we sat down with registered dietitian Emily Arkin, founder of RD Emily & Team, to discuss one of the most overlooked aspects of performance, recovery, and long-term health: nutrition. Emily and her team work with athletes, active adults, and individuals navigating a wide variety of nutrition concerns, helping people cut through the noise and create sustainable strategies that fit their lives.

Meet Emily Arkin, RD

Emily Arkin is a registered dietitian and owner of RD Emily & Team, a group nutrition practice serving the DC, Maryland, and Virginia area. Her team specializes in sports nutrition, eating disorder recovery, gastrointestinal health, cardiometabolic health, and more. Their approach focuses on helping people make informed decisions about nutrition without relying on restrictive diets or one-size-fits-all recommendations.

One of the Biggest Problems Facing Young Athletes

One of the most valuable parts of our conversation centered around a challenge we frequently see in high school athletes: under-fueling.

According to Emily, many young athletes simply are not eating enough to support the demands of training, competition, recovery, growth, and everyday life. This is often unintentional. Busy schedules, school, practices, games, social activities, and a lack of planning can make it difficult for athletes to consistently consume enough calories throughout the day.

The consequences can be significant:

• Slower recovery between practices and games
• Increased fatigue
• Reduced performance
• Difficulty building strength and muscle
• Higher risk of recurrent injuries
• Poor sleep and recovery

As Emily explains, nutrition is not separate from athletic performance. It directly impacts how athletes train, recover, adapt, and stay healthy throughout a season.

Why Nutrition Advice for Athletes Is Different

One topic that generated a great discussion was the difference between nutrition advice for the general public and nutrition advice for athletes.

Many nutrition messages online focus on avoiding sugar, cutting calories, or restricting certain foods. While those recommendations may make sense in some contexts, athletes have very different demands.

Emily explained that carbohydrates, including simple sugars in the right situations, can be valuable fuel sources for training and competition. Athletes often need strategies that support performance and recovery rather than simply following generalized nutrition trends.

The takeaway?

Athletes are not the general population. Their nutritional needs should reflect the demands they place on their bodies.

Nutrition and Injury Recovery

As physical therapists, one area we are particularly passionate about is helping injured athletes return to the activities they love.

During our conversation, Emily discussed a common mistake athletes make after getting injured: dramatically reducing their food intake because they are no longer training at full capacity.

While it may seem logical to eat less when activity levels decrease, recovery itself requires energy. Healing tissues, maintaining muscle mass, and supporting rehabilitation all require adequate nutrition. Athletes who aggressively cut calories during recovery may unintentionally make the rehab process more difficult.

This is something we see regularly at CHP. The best rehabilitation program in the world can only take someone so far if recovery, sleep, stress management, and nutrition are not supporting the process.

Performance Is Bigger Than Any One Provider

One of the themes that emerged throughout the interview was the idea that optimal performance requires a team approach.

Physical therapists, strength coaches, physicians, nutrition professionals, parents, and athletes all play important roles. When these pieces work together, athletes are positioned to recover more effectively, perform at a higher level, and stay healthy longer.

If you are an athlete, parent, coach, or active adult looking to better understand how nutrition impacts performance and recovery, we encourage you to watch the full CHP Spotlight Interview with Emily Arkin.

At Cohen Health & Performance, we believe the best outcomes happen when every aspect of health and performance works together. Nutrition is one of the most powerful tools available, and this conversation is packed with practical insights to help you get more out of your training, recovery, and overall health.

To learn more about Emily, click on the link! https://www.rdemily.com

If you’re an athlete, runner, lifter, or active adult, there’s a good chance you have some form of maintenance routine. Maybe it’s a mobility program, a handful of stretches, or a few corrective exercises that you perform before or after workouts to stay healthy.

At our physical therapy clinics in Bethesda and McLean, we love seeing people take a proactive approach to their health and performance. However, we often see two common mistakes that prevent these programs from delivering the results people expect.

The Biggest Mistake We See in Physical Therapy Bethesda and McLean

Many people treat corrective exercises differently than they treat strength training.

When it’s time to squat, deadlift, run, or play a sport, effort is usually not a problem. But when it comes to mobility drills, stability exercises, or rehab work, people often go through the motions without challenging themselves enough.

The reality is that tissues need an appropriate amount of stress to adapt.

If your knee, shoulder, hip, or back has been giving you trouble, simply performing an exercise is not always enough. The muscles, tendons, and joints involved need sufficient loading to improve their capacity and tolerate the demands of your sport or activity.

This is one reason why many people feel like they’ve been doing the “right” exercises for months without seeing significant improvement.

Why Effort Matters During Corrective Exercise

One of the goals of physical therapy in Bethesda and McLean is helping patients build resilience, not just improve mobility.

For example, if you have a history of knee pain, stretching and mobility work may be helpful. But if the tissues surrounding the knee cannot handle the forces required during running, lifting, or sports, the problem often returns.

Corrective exercises should challenge the body enough to create adaptation. If they are too easy, they may not produce the changes you’re looking for.

The Second Mistake: Rushing Through Your Program

Another common issue we see is impatience.

Many athletes have a list of exercises they want to complete before moving on to the “real workout.” As a result, they rush through their corrective exercises with minimal rest and limited attention to detail.

Unfortunately, this often reduces the effectiveness of the program.

When you rush:

• Exercise technique often suffers
• Muscles fatigue too quickly
• You cannot generate as much effort on subsequent sets
• The targeted tissues may not receive the stimulus they need

Sometimes doing fewer exercises with better execution produces far better results than trying to complete a long list as quickly as possible.

Quality Over Quantity

Whether you’re managing shoulder pain, knee pain, back pain, or simply trying to stay healthy, the quality of your corrective exercises matters.

A shorter program performed with focus, proper technique, and appropriate intensity will often outperform a longer program that is rushed and completed with minimal effort.

This is something we emphasize frequently in physical therapy because consistency and execution often determine whether a maintenance program succeeds or fails.

How Physical Therapy Bethesda and McLean Can Help

If you’ve been performing mobility drills, corrective exercises, or a home program without seeing the results you expected, it may be time to take a closer look at how the program is being performed.

At Cohen Health & Performance, our team helps athletes and active adults identify the exercises that will have the biggest impact, determine the appropriate level of intensity, and ensure every exercise serves a specific purpose.

Whether you’re looking to stay healthy, recover from an injury, or improve your performance, the right plan can make all the difference.

If you’re looking for physical therapy in Bethesda or physical therapy in McLean, our team would love to help you build a program that actually works.

If you’ve been lifting weights for years, there is a good chance you’ve experienced shoulder pain at some point.

Maybe your shoulder feels irritated during bench press. Maybe overhead pressing has become uncomfortable. Or perhaps pull-ups leave your shoulder feeling cranky for the rest of the day.

The good news is that shoulder pain does not always mean you need to stop training.

One of the goals of effective shoulder pain rehab in Bethesda is helping athletes and active adults continue progressing toward their goals while reducing unnecessary stress on the shoulder joint.

Why Shoulder Pain Develops in Lifters

Shoulder pain is often multifactorial.

When evaluating someone for shoulder pain rehab in Bethesda, we may assess:

• Rotator cuff strength and function
• Shoulder blade control
• Mobility limitations
• Rib cage and trunk positioning
• Training volume and recovery
• Exercise technique and movement patterns

All of these factors can influence how the shoulder handles stress in the gym.

While addressing the root cause is important, we can often make simple training modifications that allow athletes to continue training while their shoulder recovers.

Shoulder Pain Rehab Bethesda: Rethinking Overhead Pressing

Traditional overhead pressing requires significant mobility and control throughout the shoulder complex.

For many lifters dealing with shoulder discomfort, moving directly overhead can increase irritation.

A great alternative is the landmine press.

Because the arm moves slightly in front of the body rather than directly overhead, the shoulder often has more room to move comfortably while still allowing you to build strength and muscle.

For many athletes, this modification provides many of the benefits of pressing with significantly less irritation.

Pull-Up Modifications for Shoulder Pain

Pull-ups are another exercise that can sometimes aggravate shoulder symptoms.

One simple adjustment is switching from a pronated grip, where the palms face away from you, to a neutral grip, where the palms face each other.

This position is often more shoulder-friendly and allows many athletes to continue training without discomfort.

If pull-ups remain painful, exercises such as half-kneeling lat pulldowns can provide a similar training stimulus while placing the shoulder in a more comfortable position.

Bench Press Adjustments During Shoulder Pain Rehab

Bench press is one of the most common exercises associated with anterior shoulder pain.

Often, the issue occurs when the elbows travel too far behind the body at the bottom of the lift, increasing stress on the front of the shoulder.

One simple modification is limiting the range of motion.

Using a foam pad, bench block, or other spacer can reduce how far the bar travels without significantly affecting strength or muscle-building benefits.

Even reducing the range of motion by an inch can make a noticeable difference for some lifters.

The Goal Is Not to Avoid Exercise

A common misconception is that shoulder pain rehab means avoiding challenging exercises.

In reality, the goal is often the opposite.

Effective shoulder pain rehab in Bethesda focuses on identifying why the shoulder became irritated in the first place while finding ways to keep you active and progressing toward your goals.

Sometimes that means strengthening the shoulder. Sometimes it means improving mobility. Sometimes it means making temporary modifications to your training.

Most often, it involves a combination of all three.

Get Help With Shoulder Pain Rehab in Bethesda

If shoulder pain is limiting your workouts, sports performance, or daily activities, you do not necessarily need to stop doing the things you enjoy.

The right assessment and treatment plan can help identify the root cause of the issue while providing practical strategies that keep you moving.

At Cohen Health & Performance, we help athletes, lifters, and active adults overcome shoulder pain and return to training with confidence. If you’re looking for shoulder pain rehab in Bethesda, our team would be happy to help.

Recovery is a critical part of staying healthy, performing well, and avoiding injury.

At our clinics offering physical therapy Bethesda and physical therapy McLean, we often see athletes and active adults putting a lot of effort into recovery. But not all recovery strategies are as effective as they seem.

In some cases, they may even be working against your goals.

The Problem With Popular Recovery Trends

There is no shortage of recovery tools and trends today. Cold plunges, anti-inflammatory medications, and other quick fixes are everywhere.

While some of these can feel helpful in the moment, they may not always support long-term progress.

For example, cold plunges can reduce soreness, but when used immediately after strength training, they may limit the muscle-building response your body is trying to create.

Similarly, frequently using anti-inflammatory medications after workouts can interfere with the natural healing and adaptation process.

At both our physical therapy Bethesda and physical therapy McLean locations, we help patients understand when these tools may be appropriate and when they may not be the best choice.

What Actually Works for Recovery

The most effective recovery strategies are often the simplest ones.

Instead of relying on quick fixes, focus on the fundamentals that truly support healing and performance:

• Light, active recovery sessions such as easy cycling or movement-based workouts
• Promoting blood flow without overloading the body
• Consistent, high-quality sleep
• Proper nutrition to support tissue repair
• Smart training progressions that match your body’s capacity

These foundational habits are the primary drivers of recovery, whether you are an athlete or simply trying to stay active.

Where Advanced Recovery Tools Fit In

There are additional recovery methods that can provide benefits, such as sauna use or other emerging therapies.

However, these should be considered secondary. They make up a small percentage of the overall recovery picture.

If the fundamentals are not in place, these tools will not make a meaningful difference.

In physical therapy Bethesda and physical therapy McLean, we guide patients to focus on what will have the greatest impact first before layering in additional strategies.

The Role of Physical Therapy in Recovery

Physical therapy is not just about treating injuries. It is about optimizing how your body adapts to stress and recovers from it.

A personalized approach to physical therapy can help you:

• Understand what your body actually needs to recover
• Avoid strategies that may slow your progress
• Build resilience and reduce the risk of future injury
• Improve overall performance

The Takeaway

Recovery does not need to be complicated.

Before adding new tools or trends, make sure you are consistently doing the basics well. That is where the biggest results come from.

If you are unsure whether your current routine is helping or holding you back, our teams providing physical therapy Bethesda and physical therapy McLean are here to help guide you toward a smarter, more effective approach.