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!

Your Tools to Recovery: What Actually Works?

When it comes to sports recovery, athletes today have access to an overwhelming number of tools—foam rollers, ice baths, saunas, compression boots, and more. But what’s actually worth your time? And what recovery methods truly make a difference?

Our physical therapy team at Cohen Health and Performances work with athletic adults, college and high school athletes every day, helping them overcome injuries and perform at their best. Let’s break down some of the most popular recovery methods and see which ones are worth incorporating into your routine.

Foam Rolling

Foam rolling is one of the most common recovery techniques used in gyms, both before and after workouts. You may even have a foam roller at home that you use on recovery days.

The Science Behind Foam Rolling

The research on foam rolling is mixed. Some studies suggest that it can reduce short-term muscle stiffness and improve flexibility by increasing blood flow to the muscles. However, other research indicates that it may not have a significant long-term impact on recovery.

Should You Use It?

Yes, if… You feel a benefit from it—less tightness, improved movement, or reduced soreness.
Skip it if… You’re just doing it because someone told you to, and you don’t notice a difference.

Like with most recovery tools, if it helps you feel and move better, keep doing it. But if you’re not noticing any changes, it’s probably not a must-have in your routine.

Ice vs. Heat: Which One Should You Use?

One of the more common questions we hear in physical therapy is:
Should I use ice or heat for recovery?

When to Use Ice (Cold Therapy)

If you’re recovering from a recent injury, such as a sprained ankle or muscle strain, icing can help reduce swelling and inflammation. Ice can also be useful after high-intensity activities—like a basketball game or heavy leg day—to prevent excessive soreness and irritation.

When to Use Heat (Heat Therapy)

Heat is great for relaxing tight muscles and improving blood flow. It can be especially beneficial before workouts to increase mobility or on recovery days to relieve stiffness.

Key Takeaway:
Both ice and heat have their place, depending on your needs. If you’re unsure which is best for your recovery, consult with a physical therapist to help you create a plan tailored to your sport and training level.

Compression Therapy: Is It Worth the Hype?

Compression therapy, such as Normatec boots, has become increasingly popular among elite athletes. These devices work by pumping air into different chambers of the boot to promote circulation and reduce muscle swelling.

Does It Work?

📖 Research suggests that compression therapy can help reduce muscle soreness/inflamation and speed up recovery. However, it’s not necessarily a must-have for most athletes.

Should You Invest in Compression Boots?

Use them if… You have access to them and feel they help with your recovery.
Not necessary if… You don’t want to spend money on expensive recovery tools when other free methods (like active recovery) work just as well.

My Favorite Recovery Method: Active Recovery

If there’s one recovery tool that every athlete should use, it’s active recovery.

Instead of sitting on the couch after a tough workout or game, the best thing you can do is get moving.

Try this simple active recovery routine:
✔️ 10-15 minutes of light cardio (stationary bike, walking, or rowing)
✔️ Mobility exercises targeting sore or stiff areas
✔️ Basic bodyweight movement drills to promote blood flow

Why It Works:
Active recovery flushes out waste products from your muscles, reduces soreness, and helps prepare your body for the next workout.

Pro Tip: Professional athletes often dedicate 20-30 minutes on recovery days to movement-based sessions that include light cardio and flexibility work. Implementing this in your routine can boost recovery and prevent injuries.

The 90% Rule

While tools like ice baths and compression boots can be useful, they won’t make a difference if you’re neglecting the basics.

Nutrition – Fuel your body with enough protein, carbs, and healthy fats to support muscle repair.
Sleep – Prioritize 7-9 hours of quality sleep to maximize recovery.
Consistent Training – Train smart and take a thoughtful approach to your programming
Stress Management – Too much stress (physical or mental) can slow down recovery, so make sure you’re managing it effectively.

The basics account for the majority your recovery results. The best recovery tools in the world can’t replace proper sleep, nutrition, and training habits.

Final Thoughts: What Should You Prioritize?

Recovery is not one-size-fits-all. The best approach is the one that helps you feel and move better.

Key Takeaways:

Foam rolling: Use it if it works for you, but it’s not essential.
Ice vs. heat: Ice for recent injuries, heat for stiffness and mobility.
Compression therapy: Helpful, but not a must.
Active recovery: The most effective and accessible recovery tool.
Focus on the basics: Sleep, nutrition, and smart training are 90% of the equation.

If you’re struggling with muscle soreness, an injury, or just want to optimize your recovery, physical therapy can help.

Contact us today to get a personalized recovery plan designed for your sport and training needs!

Don’t Be an Alligator

One of the most fascinating lessons I ever learned came from a course taught by a Louisiana native. He opened by describing how to wrestle an alligator—not exactly what I expected in a physical therapy context. But as he unpacked the metaphor, it turned out to be a great analogy for human movement and performance.

Here’s how it goes: When wrestling an alligator, you want to jump on its back, grab its snout, and make it arch and extend. Why? Because when the alligator arches, it can’t do its death roll. And if you get caught in that roll, it’s game over.

What does this have to do with physical therapy? As human beings, we’re surprisingly similar to the alligator in this regard. When we arch and extend excessively through our spine, we lose the ability to rotate effectively. This limitation has huge implications for activities that require rotation, such as golf, baseball, tennis, running, and even walking. Rotation is a foundational movement pattern that keeps us functional, efficient, and injury-free.

Avoiding the Alligator Trap

So, how do we avoid becoming the human equivalent of an alligator? It all starts with understanding how to stack our ribcage and pelvis properly.

Imagine a snowman with three balls stacked on top of each other:

Top ball: Your head
Middle ball: Your ribcage
Bottom ball: Your pelvis

For optimal movement, these three “balls” need to be aligned. When your ribcage and pelvis are stacked, your spine has the freedom to move in all directions—rotation, side bending, and flexion/extension. This alignment also allows you to build strength in functional positions, which has the greatest carryover to sports and everyday activities.

Practical Application: The Role of Load Placement

One key way we apply this concept in physical therapy and training is by being mindful of where the load or weight is placed relative to the body. Let’s take the squat as an example.

The traditional barbell back squat—where the barbell rests behind your head on your shoulders—often pushes the body into an arched and extended position. This makes it difficult to maintain a stacked posture, limiting your rotational capacity and potentially leading to back discomfort.

Instead, we recommend exercises where the load is placed more in front of the body. Two great options include:

Goblet Squat: Holding a kettlebell in front of your chest helps keep your ribcage and pelvis stacked.
Safety Bar Squat: A safety bar shifts the weight slightly forward, promoting better alignment.

A good indicator that you’re doing these exercises correctly is feeling your abs engage rather than your lower back. This feedback ensures you’re maintaining a stacked position and avoiding the “alligator trap.”

How Physical Therapy Can Help

If you’re experiencing pain, struggling with movement, or simply looking to optimize your training, physical therapy can provide tailored solutions. At Cohen Health and Performance, we ensure that your programming carries over to the activities that matter most to you. Whether you’re a golfer, runner, tennis player, or just someone who wants to move better, we’re here to help.

Don’t let poor movement patterns hold you back. Contact us today to take the first step toward pain-free, efficient movement—and remember, don’t be an alligator!

Core Training Reimagined

When I create training programs for our physical therapy or performance training clients here at Cohen Health and Performance, one of the most common requests I hear is, “Hey Zac, can you add more core training?” Or, “Can you give me a core circuit to put into my routine?”

But here’s the thing: Most of us don’t train our core as effectively as we could—at least not in a way that matches how our core is designed to function. Let’s rethink core training together.

What Does Your Core Really Do?

Your core—your trunk—is so much more than just a six-pack waiting to be revealed. Its primary function is to manage internal pressure and support your body against gravity. Think of it as your body’s central stability system.

To help you visualize this, imagine the iconic wacky waving inflatable tube man you see outside car dealerships. That tube man is held up by air pressure. If you fill it with maximum pressure, it stands tall and firm. But if you let some air out, it becomes more flexible and moves with the wind. Let out too much air, and it collapses entirely.

Your core operates in a similar way. When you need maximum stability—like lifting a heavy object—you brace hard to build internal pressure, stabilizing your spine and supporting the load. On the flip side, for everyday activities, you rely on just enough core engagement to keep you upright and mobile, without overexerting yourself.

Core Training: Beyond Crunches and Planks

So, how does this translate into smarter core training? It starts with understanding that the core’s role goes beyond traditional exercises like crunches or static planks. Instead, think of your core as a dynamic stabilizer, adapting to different demands in sport, exercise, and daily life.

During physical therapy or performance training at Cohen Health and Performance, we focus on exercises that challenge the core’s ability to:

Reposition the pelvis. For example, certain drills help align the pelvis in an optimal position for athletic performance or functional movement.
Maintain pressure and support the spine. Exercises like the body saw are excellent for this. The body saw challenges your abs to prevent your belly from sagging toward the ground—a movement gravity constantly encourages. The stronger your abs, the better they counteract this pull, giving your spine the support it needs.
Engage during full-body movements. Did you know that a perfectly executed squat or deadlift can give your abs a serious workout? Core engagement is critical during these exercises to stabilize your trunk and prevent injury.

One of the biggest mistakes I see in gyms is improper technique during “core” exercises. For example, take the plank. Many people let their belly sag toward the ground, leaning on their lower back for support instead of engaging their abs. Over time, this can lead to discomfort and even injury.

Proper core training requires awareness of your body’s position and the intent behind each movement. That’s why we incorporate a variety of drills in our programs—not just for the sake of variety but to train the core in ways that reflect its real-life function.

Ready to Elevate Your Core Workouts?

If you’re looking for inspiration, check out the exercises on our YouTube page. You’ll find everything from pelvis-positioning drills to challenging moves like the body saw. And remember, core training isn’t just about isolating your abs. It’s about integrating them into your movements—squats, deadlifts, and even overhead presses can be incredible core exercises when done correctly.

So, the next time you think about adding core work to your routine, ask yourself: Am I training my core to look good, or am I training it to function well? The best part? You don’t have to choose one or the other. With intentional training, you’ll get both.

Let’s build that pressure, stabilize that spine, and transform the way you think about core training.

Break Free from Desk Stiffness: Physical Therapy Tips for Active People

Do You Feel Stiff After Sitting All Day?
If you’re like many of our physical therapy patients, you spend hours sitting at a desk for work or school. Whether you’re locked into meetings, answering emails, or studying for exams, long periods of sitting can leave your body stiff, sore, and uncomfortable. Sound familiar? You’re not alone!

Hopefully, you had a chance to break the cycle over the holidays, but now that you’re back in your routine, you might be feeling that tightness again. Don’t worry—there’s good news. Today, we’re going to share strategies we use with our physical therapy clients to help reset the body and get you moving comfortably again.

Why Sitting Can Make You Stiff
Think about what happens when you sit for hours on end. Your posture often slumps forward, and the muscles in the front of your chest stay in a shortened position. Over time, this can make them feel stiff and restrict their movement. And when those muscles don’t move as they should, they’re not prepared for activity later—like hitting the gym after work.

Picture it like taking a car that’s been idling all day and suddenly flooring the gas pedal. That’s a recipe for poor performance—or even injury. But don’t worry—there are simple ways to reset your body before you train, and we’re here to help!

The Role of Breathing in Mobility
Breathing may seem simple, but it plays a huge role in how your body feels and moves. Your rib cage is designed to expand and compress like an accordion with every breath. When you sit slouched for hours, your rib cage can’t expand fully. That leaves the muscles around it—especially in your chest, back, and neck—stiff and unable to move properly.

Good breathing mechanics not only improve mobility but also help your muscles reset, making you better prepared for activity. Let’s go over two quick breathing drills we often use with our clients to unlock stiffness and get their bodies ready for action.

Drill 1: Hook-Lying Overhead Reach

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Lie on your back with your knees bent and feet flat on the floor.
Roll your pelvis slightly underneath you so your lower back gently flattens against the ground.
Reach your arms overhead without letting your ribs flare up.
Focus on deep inhales that expand your chest and exhales that compress it back down.

This drill teaches your rib cage to expand and compress properly, reducing tightness in your chest and shoulders. Do 2-3 sets of 5 deep breaths before upper-body workouts.

Drill 2: Crab on Elbows

Sit on the floor with your knees bent and your hands behind you, resting on your elbows.
Press your chest up slightly, creating a gentle stretch in your pecs.
Inhale deeply, directing the breath into the front of your chest, and then exhale fully.
Focus on slow, controlled breathing, feeling your chest expand and compress with each breath.

This position exaggerates the stretch in your chest muscles, helping to reset them for movement. Aim for 2 sets of 5 breaths before workouts or whenever you feel stiff during the day.

Ready to Feel Better? We Can Help.
These drills are great for giving your body a quick reset, but if you’re dealing with ongoing aches, pains, or stiffness, a more customized approach might be what you need. At our clinic, we specialize in helping active people get back to doing what they love—pain-free.

Visit our website to learn more about how we can help you tackle your specific challenges. Whether you’re recovering from an injury or just want to move and feel better, we’re here to help you reach your goals.

Don’t let stiffness hold you back—take the first step toward feeling your best today and contact us!