Hamstring Strains: A Sports Physical Therapy Guide to Recovery & Injury Prevention

Hamstring strains are among the most common injuries for athletes, especially those involved in sprinting, jumping, or cutting movements. If you’ve ever felt that sudden pull in the back of your thigh, you know how frustrating and limiting a hamstring strain can be.

At Cohen Health and Performance, we specialize in sports physical therapy designed to help athletes recover from injuries efficiently and come back stronger. In this blog, we’ll break down why hamstring strains happen, how to rehab them properly, and what you can do to reduce the risk of reinjury.

Why Do Hamstring Strains Happen?

Hamstring injuries most often occur when an athlete is sprinting or decelerating. The primary reasons include:

✔️ Fatigue – Tired muscles are more prone to injury.
✔️ Poor lumbopelvic control – Weak core and hip stability put excess strain on the hamstrings.
✔️ Lack of eccentric hamstring strength – The hamstring must absorb force while lengthening during sprinting, making it vulnerable to injury.
✔️ Previous hamstring strain – A history of injury significantly increases the risk of another strain.

Understanding these risk factors allows us to customize sports physical therapy programs that target weak points and prevent future injuries.

Early Rehab: What to Do (And What NOT to Do)

The first instinct after a hamstring strain might be to stretch it out—but this is a common mistake that can slow recovery. Instead, follow these steps:

🚫 Avoid aggressive stretching in the early stages. Stretching an injured muscle too soon can aggravate the strain.
✅ Control pain and inflammation with rest, ice, and gentle movement.
✅ Maintain blood flow through pain-free activity to speed up recovery.

At this stage, a sports physical therapy approach focuses on reducing pain and preserving mobility while preventing further irritation.

Rebuilding Strength & Function

Once the pain and inflammation have decreased, it’s time to gradually load the hamstring to restore strength and function.

At Cohen Health and Performance, we use the Nord Board, a state-of-the-art tool that measures eccentric hamstring strength. This allows us to:

✅ Compare the injured leg to the healthy leg
✅ Assess an athlete’s risk for future hamstring injuries
✅ Develop a personalized strength program based on objective data

The Phases of Hamstring Rehab in Sports Physical Therapy

A structured rehab program moves through progressive phases:

🔹 Phase 1: Isometric Exercises – These exercises activate the hamstring without movement, minimizing strain while building early strength.
🔹 Phase 2: Eccentric Strengthening – Once tolerated, we introduce slow, controlled lengthening exercises to mimic the hamstring’s function in sprinting.
🔹 Phase 3: Velocity-Based Training – To fully restore athletic performance, we gradually add speed, agility, and explosive movements to rebuild elasticity and power.
🔹 Phase 4: Sport-Specific Drills – The final step is returning the athlete to high-level sport movements like sprinting, cutting, and jumping. This is often the most neglected phase, but skipping it can lead to reinjury.

Preventing Hamstring Strains: The Key to Longevity

The best way to avoid a hamstring strain is to ensure your body is strong, mobile, and well-conditioned. In our sports physical therapy programs, we focus on:

✔️ Eccentric hamstring training to build resilience
✔️ Core and pelvic stability work to reduce unnecessary strain on the hamstrings
✔️ Sprint mechanics coaching to improve movement efficiency
✔️ Individualized risk assessments using tools like the Nord Board

Ready to Recover Stronger? Let’s Get Started!

If you’ve suffered a hamstring strain or want to reduce your risk of injury, our expert team at Cohen Health and Performance is here to help. Our sports physical therapy approach ensures you recover the right way—so you don’t just heal, but return to your sport stronger than before.

📩 Contact us today to schedule an evaluation and start your journey back to peak performance!

Orthotics: Do You Really Need Them? A Physical Therapy Perspective

When it comes to orthotics, one of the most common questions we get in physical therapy is:

“Should I use orthotics — or not? Will they help, or could they make things worse?”

The short answer?
It depends.

As frustrating as that may sound, orthotics are not a universal solution. At our physical therapy clinic, we talk with patients daily about whether orthotics are right for them — and it’s never a black-and-white answer. Let’s break down why.

How Orthotics Really Work — And Why It’s Not So Simple

Many people think orthotics are designed to “push” the foot into a better position — like boosting a flattened arch or correcting a high arch that’s rolling outward. It sounds logical, right? Almost like fixing a building or a machine.

But here’s the problem with that approach:
➡️ Our bodies aren’t buildings.
➡️ Our feet are dynamic, not static.

As physical therapists, we understand that your body is constantly adapting to its environment. Take walking, for example — the way pressure shifts through your foot as you step is always changing. Your body responds to those shifting pressures by adjusting muscles, joints, and posture up the chain (think knees, hips, and back).

Flat Feet vs. High Arches — Why You May or May Not Need Orthotics

If you have high arches (like me), you may not feel the ground well, which can make you feel unstable. Your body senses that instability and often tenses up — creating stiffness in other areas. For people like this, a small arch support can sometimes help them “find” the ground better, improving balance and movement efficiency.

On the flip side, if you have flat feet, your weight may be dumped onto the inside edge of your foot. In that case, a different type of orthotic might give some gentle lift to the arch, helping distribute weight more evenly and improving the way the whole body moves.

But here’s the catch — it’s never just about the arch.

What Physical Therapy Teaches Us About Orthotics

At our physical therapy practice, we evaluate how each person moves — not just how their feet look. Some people with flat feet move beautifully and don’t need orthotics. Others with “perfect-looking” arches may have pain and need extra support.

And sometimes, the right shoe can make all the difference — no orthotics required.

So… Do You Need Orthotics?

The answer is unique to you. That’s why working with a physical therapist who understands biomechanics, gait, and functional movement is crucial before jumping into orthotics.

If you’ve ever wondered:

“Do I need orthotics or just better shoes?”
“Why do my knees/hips/back hurt when I walk or run?”
“Can orthotics help my performance in sports?”

➡️ We can help you figure that out.

Ready to Take the Next Step?

If you want personalized help to figure out whether orthotics are right for you — or you’re struggling with pain related to your feet, knees, hips, or back — contact us today for an evaluation.

We’re here to help you move better, feel better, and get back to doing what you love.

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!

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!