Should You Train Through Pain? A Guide for Athletes and Parents

If you are an athlete or the parent of a high school athlete, you already know that pain shows up sooner or later. Soreness, stiffness, and the occasional ache are all part of training hard. But knowing when to push through pain and when to stop is where many athletes get stuck.

As a sports physical therapy team working with athletes in Bethesda and McLean, we see this problem every single day. Athletes often choose one of two extremes. They either ignore the pain completely and keep pushing or they shut everything down at the first sign of discomfort. Neither approach helps you perform your best or stay healthy.

There is a much better way to understand pain during training. We teach our athletes a simple and effective system that helps them stay safe, stay active, and stay on the field. It is the traffic light system for pain.

Understanding Pain Like a Traffic Light

Green Light Pain

Green light pain is mild, dull, and harmless. Sometimes your knee feels a little stiff when you start warming up or you notice a small ache when you first walk into the gym. Once you start moving, the discomfort fades. It does not change how you move and your body feels the same or even better the next day.
If this sounds familiar, you are good to keep training. This type of pain is extremely common in active athletes and often improves with movement.

Yellow Light Pain

Yellow light pain is more noticeable. It may slightly alter your movement or force you to compensate. It might get worse as you load the area or repeat certain exercises.
This is the time to modify your training rather than stopping completely. For example, if squats bother your knee at a certain depth, you might switch to split squats or use a machine based variation. You might also decrease the weight, reduce the number of reps, or shorten the range of motion.
The key is that whatever modification you choose should not make things worse during the workout or afterward.

Red Light Pain

Red light pain is a clear warning sign. This pain is sharp, intense, or unstable. It might come with tingling, catching, popping, or sudden weakness. It clearly worsens during exercise and forces you to move differently.
When you experience red light pain, you need to stop immediately and have it evaluated. Continuing to train through these symptoms can turn a small issue into a much bigger one.

The 24 Hour Rule Every Athlete Should Use

No matter what type of pain you feel, the next day is the real test. Symptoms should return to baseline or feel better within 24 hours of your workout.
If your pain is worse the next day, especially with yellow light pain, you need to modify further or choose a different exercise the next time. If symptoms continue to worsen, it is time to get assessed by a sports physical therapy specialist.

When to Seek Professional Help

If you are not sure whether your pain is green, yellow, or red light pain, or if you already know your symptoms are limiting your performance, you should have it evaluated.

Our physical therapy clinics in Bethesda and McLean work with athletes every day to help them understand their pain, train safely, and get back to the activities they love. Sports physical therapy is not just about treating injuries. It is about helping athletes stay in motion, stay strong, and stay confident.

If you or your athlete is unsure what the next step should be, we would love to help you figure it out. The right guidance can keep you out of harm’s way and help you continue progressing toward your goals.

Surgeon Says “You’re Cleared.” What That Really Means

At Cohen Health and Performance, we see this all the time.

A patient walks in excited because their orthopedic surgeon just told them, “You’re cleared.”

For the athlete or for a parent of a young athlete that sounds like great news. It feels like full steam ahead, time to get back to the field, the court, or the gym.

But being cleared by your surgeon doesn’t necessarily mean your body is ready for the demands of your sport.

That’s where our team at Cohen Health and Performance, providers of expert physical therapy in Bethesda, comes in.

What Your Surgeon Means by “Cleared”

When your surgeon clears you, it’s a medical milestone. It means:

The surgery was successful.
Imaging and MRI results look good.
Your range of motion has returned.
You’ve regained a basic level of strength.

In other words, your surgeon’s focus is on whether the surgical site has healed and whether you’re safe to start progressing again. Their job is to make sure the repair looks good, moves well, and passes basic checks.

But that doesn’t mean your body is fully prepared for the demands of your sport.

Why “Cleared” Doesn’t Always Mean “Ready”

Let’s take a closer look at what happens in those follow-up visits.

Your surgeon might test your strength by asking you to hold your arm or leg in a fixed position while they apply pressure. If you can resist them without pain or weakness, that box gets checked.

The problem? That’s not how sports work.

Sports are dynamic. You’re not holding a static position. You’re cutting, sprinting, jumping, landing, throwing, or reacting at high speed. Your body must not only produce force but also control and absorb it repeatedly and efficiently.

That’s where the real risk lies after surgery. An athlete may appear strong in basic tests, but when it’s time to decelerate from a sprint or land from a jump, their body might not yet have the capacity to handle those forces safely.

Without that preparation, the risk of reinjury or injury elsewhere in the body skyrockets.

How Physical Therapy Bridges the Gap

This is exactly where advanced sports physical therapy in Bethesda plays a critical role.

At CHP, our job isn’t just to make sure your range of motion and strength look good on paper. It’s to determine if your body can handle the high-speed, high-load, fatigue-driven conditions of your sport.

We use a combination of clinical expertise and advanced sports technology, including VALD Force Plates, A-frames, and dynamometers to objectively measure how your body performs.

Some of the key things we assess include:

Force production: How much power can you generate through your repaired side?
Deceleration control: Can you safely slow your body down after a sprint or jump?
Symmetry: Are you unconsciously favoring one side more than the other?
Fatigue performance: Do you maintain good control and power when you’re tired?

These metrics tell us whether your body is actually ready for competition—not just whether your surgery has healed.

Every Sport Has Different Demands

One of the most important things we teach our patients is that every sport has its own movement and performance prerequisites.

A swimmer’s shoulder rehab will look completely different from a soccer player recovering from an ACL surgery.

A tennis player’s shoulder must tolerate explosive, high-velocity end-range movements.

A football player must absorb and redirect massive amounts of force.

That’s why at CHP, no two return-to-sport plans look the same. We build individualized programs that mirror the specific stresses and skills of your sport, helping you return not just healthy, but stronger, faster, and more resilient than before.

Fatigue: The Hidden Factor Behind Re-injury

Another key area we focus on is how your body performs when tired.

It’s easy to look great when you’re fresh but most injuries don’t happen during warm-ups. They happen when fatigue sets in late in the game, when your muscles and nervous system are under stress.

That’s why we test your ability to maintain strength, stability, and control under fatigue.

If your repaired side starts to fail once you’re tired, your risk of reinjury increases dramatically.

By building up work capacity and fatigue tolerance, we help you finish strong, no matter the score or the quarter.

The CHP Difference

At Cohen Health and Performance, our approach to physical therapy in Bethesda is centered on one goal: helping athletes safely and confidently return to the activities they love.

We combine one-on-one care, advanced testing technology, and individualized programming to make sure every athlete we work with is truly ready, not just medically cleared.

If you’ve been cleared by your surgeon but want to be confident that your body is ready for the next step, we’d love to help.

Contact us at Cohen Health and Performance today to learn more about our individualized physical therapy programs in Bethesda and McLean designed to help athletes move, feel, and perform at their best.

ACL Physical Therapy: How We Determine When It’s Safe to Return to Sport

Guest Post by Dr. Ethan Lennox, ACL Rehabilitation Specialist at Cohen Health and Performance (CHP)

One of the toughest challenges athletes face after ACL surgery is knowing whether they are truly ready to return to play. Getting this wrong can have serious consequences, not only a higher risk of re-tearing the repaired ACL, but also the possibility of injuring the other knee or sustaining a completely new lower body injury.

If you’re an athlete, parent, or coach navigating the ACL recovery process, this guide will walk you through the objective criteria that determine readiness for a safe return.

Why Time Alone Isn’t Enough

A safe return to sport after ACL surgery isn’t about simply waiting 6, 9, or 12 months. At CHP, our ACL physical therapy program goes beyond the calendar. We use specific benchmarks for strength, movement quality, knee health, and confidence.

For athletes in cutting or pivoting sports, we typically recommend at least 9–12 months before full competition, as research shows that early return carries a much higher risk of re-injury. Our goal is not just to “clear” an athlete, but to build a durable return that lasts.

What Really Determines Readiness?

1. Strength

Strength is the foundation of ACL physical therapy. But it’s not just about moving heavy weight in the gym. The question is:

Can the athlete produce strength quickly in the chaos of sport?
Can they tolerate the workload of practices and games?

We focus heavily on restoring quadriceps strength to sport-specific demands, not just symmetry between legs. A common benchmark is ≥ 3.0 Nm/kg of knee-extension torque relative to body weight. Symmetry matters, but hitting an absolute strength threshold is what keeps knees safe during high-speed stops and cuts.

2. Force-Plate Testing

Traditional field tests often miss hidden deficits. At CHP, our ACL physical therapy program uses force-plate technology to analyze how each leg produces and absorbs force during jumps, landings, and change-of-direction tasks. To learn more about our forceplates, check out this link.

We track asymmetry (aiming for ≤10%) and test both when athletes are fresh and fatigued. This helps us individualize rehab, catch weaknesses before they become injuries, and make safer clearance decisions.

3. Movement Quality

Numbers matter, but how an athlete moves under fatigue is just as critical. During ACL rehab, we look for:

Controlled deceleration
Proper knee and hip alignment
Strong trunk stability
Quiet, efficient landings at game speed

By combining movement analysis with force-plate data, we ensure athletes are not just strong on paper—but resilient in real game conditions.

4. Knee Health

A successful ACL recovery also depends on the joint’s response to load. Non-negotiables include:

Full, pain-free range of motion
No swelling or irritation after training
Zero “giving way” episodes

If the knee flares up as we increase intensity, we scale back. Just because the calendar says “9 months” doesn’t mean the knee is ready.

5. Confidence

Physical readiness means little without mental readiness. At CHP, our ACL physical therapy program uses validated questionnaires like the ACL-RSI (Return to Sport after Injury) to track confidence. Scores in the mid-60s or higher, paired with strong physical metrics, usually indicate safe readiness.

We also coach mindset—helping athletes rebuild trust in their body is just as important as rebuilding strength.

Clearance Does Not Mean Full Game Readiness

“Cleared” to return to sport means an athlete can begin practicing. It does not mean they’re ready for full minutes or their pre-injury role. Building back to game-day fitness requires another 6–12+ weeks of gradual progression:

Non-contact practice and controlled drills
Controlled contact with planned rest
Increased intensity and practice density, monitoring workload
Gradual introduction of limited game minutes

This measured progression is how we prevent setbacks and ensure long-term success.

How CHP Puts It All Together

At Cohen Health and Performance, our clearance testing includes:

Strength testing with precise benchmarks
Force-plate assessments for braking and propulsion
Movement quality reviews under fatigue
Knee health evaluation for calm, stable joints
Confidence tracking for mental readiness

From there, we design a stepwise return-to-play plan that gradually increases training load and game minutes while monitoring next-day knee response.

Our philosophy is simple: earn the right to do more, then prove you can repeat it.

If you or your athlete is recovering from ACL surgery, don’t settle for a clearance based only on time or basic hop tests. A true ACL physical therapy program should integrate strength, force-plate data, movement analysis, joint health, and confidence.

At CHP, our ACL specialists are committed to helping athletes not only return safely, but come back stronger than before.

If your athlete is working toward a safe, confident return to sport, our ACL rehabilitation team would love to guide the process. Contact us here.

What Your Patient Experience Tells You About Your Provider

When I first moved to the DC area, I had to find a new dermatologist. With pale skin and a bald head, I knew I needed someone I could rely on. What I didn’t expect was just how different the experience of healthcare could be from one provider to the next.

My first attempt went something like this:
I called the office, asked for an appointment, and was told the soonest available was six weeks away. When I explained that I had a conflict, I was told it would actually be six months before I could get in. Not exactly encouraging but I made it work.

When I finally arrived for the appointment, no one looked up from behind the desk, no one greeted me, and I was handed a clipboard without so much as a “thank you.” When the doctor did see me, it was for maybe three minutes. He seemed rushed, didn’t answer my questions, and was clearly just trying to get to the next patient.

Unfortunately, this kind of experience is all too common in healthcare.

Later, I found another dermatologist, and the difference was night and day. The staff answered the phone with warmth, greeted me by name when I arrived, and the doctor took the time to listen. She didn’t spend tons of time with me, but she was present, thorough, and made me feel valued.

The way you’re treated during the process often reflects the quality of care you’ll receive.

How We Approach Care at Cohen Health and Performance

At Cohen Health and Performance (CHP), we’ve built our model of care around the kind of experience every patient deserves. If you’re looking for physical therapy near you in Bethesda, here’s what makes us different:

Here’s what makes us different:

One-on-One Sessions: Every appointment is a full hour with your Doctor of Physical Therapy—no bouncing between patients, no rushing.
Personal Connection: We know your name when you walk in, and we take pride in making every patient feel welcome.
Full Presence: During your session, our entire focus is on you. We answer your questions, explain the “why” behind your program, and adjust as needed.
Between-Session Support: Need something outside of your appointment? Our team is available through our patient portal or a quick call to make sure you’re supported every step of the way.

Whether you’re an athlete recovering from injury, an active adult wanting to stay strong, or a parent helping your child navigate youth sports, your experience matters just as much as the treatment itself.

Choosing Physical Therapy in Bethesda

If you’re looking for physical therapy in Bethesda, we encourage you to ask yourself:

Do they listen to me?
Do they treat me like a person, not a number?
Are they invested in my success inside and outside the clinic?

At CHP, our answer to all three is a resounding yes.

So if you want a healthcare team that’s truly in your corner—committed to your goals, your progress, and your overall experience—we’d love to help.

Maybe You Don’t Need Rotator Cuff Surgery After All…

When someone hears the words “rotator cuff tear,” the first thought is often surgery. But many people with rotator cuff tears (even full-thickness ones) get better without ever going under the knife. At Cohen Health & Performance, we see this every day, and the latest research continues to back it up.

What the Research Says About Rotator Cuff Tears

At the Mid-Atlantic Shoulder and Elbow Symposium, Dr. John Kuhn of Vanderbilt University presented a study following nearly 500 patients with rotator cuff tears. His team found that 75% of patients improved with physical therapy alone—even when the tears were large or full-thickness, as long as they were atraumatic (developed over time, not from a sudden injury).

Even more impressive? These results held up over 10 years. Many patients regained shoulder function, reduced their pain, and returned to the activities they enjoyed, without surgery.

Other studies show that even when rotator cuff repairs are performed, the repaired tissue often re-tears. Surprisingly, many patients still feel better functionally after rehab. This suggests that the real difference-maker may be the physical therapy and rehabilitation process, not just the surgery itself.

Why Rotator Cuff Physical Therapy Works

So how does physical therapy help when the rotator cuff itself is damaged? At CHP, our shoulder physical therapy programs focus on much more than just the torn tendon. We work to strengthen and coordinate the entire shoulder complex, including:

Rotator cuff strengthening: Targeted exercises to build resilience in the cuff itself.
Scapular control: Training the muscles around the shoulder blade to support the shoulder joint effectively.
Trunk and core integration: Teaching your body how to move as a unit so your shoulder isn’t overloaded during sports or daily activities.

By improving strength, mechanics, and control, we help the shoulder function more efficiently, reducing pain and restoring performance, even in the presence of a tear.

When Surgery Still Makes Sense

Of course, surgery isn’t off the table for everyone. In cases of traumatic injury (like falling directly on the arm), or when physical therapy fails to provide relief, surgical repair may be the right option. But in many cases, trying shoulder physical therapy first is the safer, more effective, and less invasive choice.

Should You Try Physical Therapy Before Surgery?

If you have shoulder pain or a diagnosed rotator cuff tear, you don’t have to rush into surgery. The best next step is often a structured program of shoulder physical therapy.

The worst-case scenario? It doesn’t solve the issue, and surgery becomes necessary.
The best-case scenario? You avoid surgery altogether and get back to the activities you love—stronger than before.

If you are ready to take the next step, contact us and schedule your evaluation to solve your shoulder pain and return to the activities that you love.

Shoulder Pain Physical Therapy: Understanding and Managing Shoulder Instability

In just a couple of weeks, I’ll be part of a panel at the Mid-Atlantic Shoulder and Elbow Society Conference, sitting alongside several orthopedic surgeons as the lone physical therapy representative. Our panel topic: shoulder instability—a complex condition that affects many active adults and young athletes.

Why Shoulder Instability Matters

Shoulder instability is a challenging issue because it can be caused by a variety of factors and present in several different ways. The shoulder is the most mobile joint in the human body, but that same mobility makes it the most unstable.

With great mobility comes great responsibility. When the ligaments and tendons that normally stabilize the shoulder can’t provide enough support, the demand shifts to our muscles and nervous system to keep the joint under control. This is where physical therapy becomes essential.

How Physical Therapy Helps with Shoulder Pain and Instability

A well-designed rehab program for shoulder instability doesn’t just treat pain—it addresses the underlying mechanics that protect the joint and restore performance. Proper physical therapy can:

Improve ribcage and shoulder blade control – helping reduce stress on the shoulder joint.
Strengthen the rotator cuff – allowing it to more effectively stabilize the joint during activity.
Integrate improvements into movement strategies that carryover to sport – ensuring athletes and active adults can safely return to the demands of their sport or daily life.

Rehab vs. Surgery: Making the Right Choice

While there are times when surgery is necessary, physical therapy for shoulder pain and instability can often help determine whether non-surgical care is a viable option. The best surgery is the one you can avoid. Once a shoulder has been operated on, it’s never quite the same—the tissue has been altered, and function changes over time.

That’s why early intervention is so important, especially for young athletes such as baseball players who place high demands on their shoulders. Addressing pain and instability early can make all the difference in avoiding long-term damage and reducing the likelihood of surgery.

Take Action Early

If you or your athlete is dealing with shoulder instability or persistent shoulder pain, don’t wait. Getting evaluated by a skilled physical therapist can help you understand the cause, create a personalized plan, and in many cases, avoid the need for surgery.