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Debunking the Bone on Bone Myth

“Best Walking Shoes for Knee Pain for Women” by gm.esthermax is licensed under CC BY 2.0

I’m sure you’ve heard someone say it before:

“My knees are in such bad shape. It’s pretty much just bone on bone down there.”

Although this is a commonly held belief, athletic physical therapy speaks to the truth: “bone-on-bone is largely a myth.

Many patients complain of knee pain because they are “bone-on-bone” assuming there is nothing they can do but get surgery.

Fortunately, this common misconception just isn’t true. If a person is experiencing joint pain, one of the first treatment measures is X-rays or another imaging study of the joint. If the joint damage on the X-ray is severe, you may be told you are “bone-on-bone.” However, all that term means is that there is some amount of cartilage loss in the joint.

As the cartilage deteriorates, there is less cushioning between the ends of the bone that form the joint. This “rubbing” of bones against each other with less cushioning causes pain and discomfort. However, rarely, if ever, is the cartilage of the joint completely destroyed.

A doctor at the Core Medical Center in Blue Springs, MO, conducted more than 1,000 knee X-rays and discovered only one case where the cartilage of the knee joint was completely destroyed. The other 999 cases were simply deterioration of the cartilage, but it remained intact and functioning.

The truth is that “bone-on-bone” is just a fancy way of saying the cartilage is slowly deteriorating. Very seldom does it ever completely disappear. This term is used by doctors and physical therapists to better describe the situation to patients and the severity of their pain points.

If you’re experiencing joint pain or discomfort, our injury rehabilitation clinic in Bethesda/Chevy Chase can help! Whether you’re looking to overcome a recent injury or sick of joint pain preventing you from enjoying an active lifestyle, our team of physical therapists can help!

How Professional Athletes Are Addressing Their Mental Health

“File:20140101 Kevin Love (cropped).JPG” by TonyTheTiger is licensed under CC BY-SA 3.0

Health is a word that has a variety of meanings. Although physical health often comes to mind, mental health is equally important. Quality performance training and injury rehabilitation includes activities that improve both your physical and mental health to improve performance in sport.

What is Mental Health?

According to The Center for Disease Control, “Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices.”

Mental health is important at every stage of life, from childhood through adulthood. Positive mental health allows people to better cope with stress, work productively, realize their full potential, and make more meaningful human connections.

Mental illness, such as depression, increases the risk for many physical health problems, particularly long-lasting conditions like diabetes, stroke, and heart disease. Furthermore, the presence of chronic conditions can increase the risk for mental illness.

Put simply — mental health is an aspect of overall health and well-being that cannot be overlooked.

The Impact of Mental Health On Performance

Mental health not only improves your quality of life, but it also improves performance — both in sport and in the workplace.

According to the CDC, poor mental health can negatively affect job performance, productivity, communication, physical capability, and job function. For example, someone could be in elite physical shape, but if their mental health is lagging, their performance will ultimately suffer.

Psychologists and mental health experts aren’t the only ones preaching the importance of mental health. Kevin Love, a professional basketball player for the Cleveland Cavaliers, has been very public with the mental health issues he’s dealt with throughout his career.

To help people strengthen their mental health, Love founded Koa, an online learning experience with therapist-led emotional fitness classes and 1:1 therapy. This growing community is helping people taking on real-life challenges and better prepare for the stresses of life.

“Mental health is an invisible thing, but it touches all of us at some point or another. It’s a part of life,” said Kevin Love of his struggle with mental health. Mental and physical health are equally important components of overall well-being. Love understands that to perform at the highest level, both his physical and mental health must be properly trained.

What Is Blood Flow Restriction Training? Can It Help You Overcome Your Injuries?

“Running by Coolidge Corner” by jpo.ct is licensed under CC BY-NC-ND 2.0

Since the beginning of performance training, athletes have searched for the most effective training methods out there. Although there are countless strategies available, blood flow restriction training, or BFR for short, has been used for more than 20 years in physical therapy and performance training.

What Is Blood Flow Restriction Training?

Blood flow restriction is a training technique that involves performing exercises with a reduced amount of blood flow to the arm or leg. Using a cuff or strap placed tightly around the limb, blood flow is reduced to that specific area. BFR training combines low-intensity exercise with blood flow restriction to produce similar results to high-intensity training.

In recent years, blood flow restriction training has become popular for both athletes and patients recovering from injuries. Mike Reinhold, a leading physical therapist, describes the various benefits as:

  • Provides a great workout with smaller weights and fewer reps or time
  • Can help with rehab from injuries
  • Improve strength for clients with physical limitations
  • Pain reduction after ACL surgery or knee osteoarthritis
  • Relieve pain and treat functional scores for older patients

Is BFR Training Right For You?

Much like anything, it’s important to educate yourself before trying any new training method. For example, blood flow restriction training is commonly used in performance training and physical therapy because it allows patients to develop strength and stability without requiring a lot of weight. 

Although it is within the scope of practice for physical therapists and athletic trainers, our PTs at CHP are certified specifically in blood flow restriction training. If you’re returning from a recent injury or want to learn more, contact us to set up an initial consultation

Why the Frequency of ACL Injuries are on the Rise

“Bellamy Knee Injury” by joncandy is licensed with CC BY-SA 2.0.

Over the past month, our physical therapy clinic in Bethesda has seen an increase in the number of people recovering from ACL injuries and repairs. Although this is a sign that sports are returning to normal, there are some important things to keep in mind when dealing with an ACL injury.

The ACL, also known as the Anterior Cruciate Ligament, is the tissue found in the knee joint that connects the thighbone (femur) to the shinbone (tibia). These ligaments run diagonally in the middle of the knee, controlling the back and forth motion and provide rotational stability.

ACL injuries commonly occur in sports involving sudden movements or changes of direction, such as soccer, football, or basketball. The anterior cruciate ligament can be injured in several ways, including:

  • Rapid changes in direction
  • Sudden stopping movements
  • Slowing down while running
  • Incorrect landing from jumping
  • Direct collision or contact, such as a tackle in football.

Depending on the severity of the ACL injury, treatment can include rest and rehabilitation exercises to regain stability and strength. In severe cases, surgery may be required to replace the torn ligament.

According to Mike Reinold, a leading physical therapist, there are a few important steps to take after surgery:

  • Diminish pain and swelling after surgery using compression wraps, ice, and compression machines.
  • Restore full knee extension through a variety of range of motion and stretching exercises.
  • Gradually improve knee flexion with further stretching and functional movements such as mini-squats and lunges.
  • Maintain patellar mobility with soft tissue mobilization around the knee.
  • Restore volitional quad control using neuromuscular electrical stimulation (NMES) on the quad following the ACL surgery.
  • Restore independent ambulation by improving the ability to walk without limitations or a limp.

Although ACL injuries are impossible to avoid, a proper training program can help to reduce the risk of an ACL injury. If an injury does occur, our performance training and physical therapy clinic in Bethesda will get you back to normal in no time!

Why Some Warmups Aren’t Useful

As performance physical therapists in Bethesda and Chevy Chase, we work within a very knowledgeable and active community.  Our clients and patients understand the importance of warming up.

Warming up is commonly touted as essential for anyone wishing to avoid injury during exercise, performance training, or running.

We agree with this statement; however, warmup routines are often implemented in a non-productive way.

There is a time and place for everything, however this does not mean that you need to stretch, roll around on the ground, and perform “activation” drills prior to being ready for exercise.

In addition to increasing total body temperature, a warmup routine should prepare the body for the specific workout that is going to take place. For this reason, we call warming up “movement preparation.” The body is being prepared to move!

Movement preparation should include drills that train the skills necessary for the day’s workout. Many times, these drills will look similar to the exercises within that day’s work out.

If you are getting ready to run, perform activities that practice things necessary to run effectively. If you are going to lift weights, practice movements similar to the lifts you are going to perform (ie. If you are going to squat, then squat in your warmup!).

This advise applies regardless of whether you are healthy, injured, in performance physical therapy, or training for performance.

Below are 2 drills that we often use during movement preparation prior to running. Each drill practices single leg balance, the ability to shock absorb on one leg, and trunk rotation. These are all attributes necessary for running.

Single leg knee to chest
Forward lunge with cross connect

Furthermore, if you have been sitting at a desk for the majority of the day, you may need a more comprehensive warmup. On the other hand, if you have an active job requiring you to move in a variety of different ways then your warmup may not need to be as comprehensive.

Movement preparation is necessary, however it is essential to be purposeful, rather than mindlessly performing the same thing before every workout.

2 Simple Drills to Improve your Running Times

As a dedicated runner you likely have suffered an injury at some point. Perhaps it forced you to seek performance physical therapy. Whether you realized it or not, this injury limited your ability to train effectively.

At CHP, we consistently help runners in Chevy Chase and Bethesda overcome injuries that otherwise would limit their ability to train, ultimately causing disappointing results.

There is not a one size fits all solution to helping all runners; however, we often discover that runners are limited by their hamstrings.

Are you concerned that hamstring stiffness or weakness could be limiting your performance?

Your hamstring is responsible for keeping your heel close to your bottom during the heel recovery phase of the running cycle. This portion of the cycle occurs as you bring your leg back underneath your body to prepare it to strike the ground again. The closer you can keep your heel relative to your bottom, the better! This allows you to efficiently move your leg faster through space, resulting in faster times. Below is a drill we prescribe to many runners to improve this attribute.

 

 

When running the hamstrings also need the ability to lengthen as the thigh is in front of the body. This should be achieved without drastically changing the position of the pelvis. Many runners struggle to maintain control of their pelvis as the hamstring lengthens. This increases the stress placed onto a variety of soft tissues through the lower body and alters foot strike position. Below is a drill to improve these capabilities.

 

 

A thoughtful and more scientific approach to training, specifically designed for runners is likely all that you need to drastically improve your running performance. It may not even require you to train any harder, just smarter!