Grandma was wrong about this

Growing up, my grandma, Barbara, lived next door to us. She was a character—loving, funny, self-deprecating, and wise. I was lucky enough to spend time with her daily, soaking up her advice (whether I wanted it or not!). And while most of her advice was pure gold, there was one thing she got wrong—something I later discovered through my experience in sports physical therapy.

When I’d come home slouching, she would lovingly tell me to “stand tall” by bringing my shoulders down and back so that “all the girls could see my handsome grandson.” She certainly helped boost the confidence of an awkward middle schooler with buck teeth and a terrible haircut, but when it comes to posture, her advice wasn’t quite right.

You’ve probably heard the same thing: “pull your shoulders down and back” to stand tall and improve your posture. It sounds good, but through my work in sports physical therapy, I’ve learned that this advice can be counterproductive to how your shoulders are designed to work.

The Problem with “Shoulders Down and Back”

In sports physical therapy, we often encounter athletes and active individuals who believe that pulling their shoulder blades down and back improves posture. However, doing so actually prevents your shoulder blades from moving the way they should. Your shoulder blades (scapulae) are designed to move away from the midline of your body—a movement called protraction.

Protraction is crucial for everyday movements like reaching, throwing a ball, and pressing weights overhead. Restricting this natural movement by pulling the shoulder blades together can cause upper back tension and limit mobility—issues that are frequently addressed in sports physical therapy.

Why This Matters for Athletes

If you lift weights or participate in sports like baseball, football, or basketball, maintaining proper shoulder mobility is key. Through sports physical therapy, we see how athletes benefit from training movements that allow the shoulders to move naturally. Pinning your shoulder blades back limits your ability to build strength in outstretched positions, which are crucial for both athletic performance and injury prevention.

Great athletes need fluid, strong movements with their arms in extended positions. Constantly pulling the shoulder blades together limits the opportunity to build the functional strength required for peak performance in sports.

3 Exercises for Better Shoulder Mobility & Strength

As a sports physical therapist, here are three exercises I recommend to help athletes and active individuals improve shoulder mobility and build strength in these outstretched positions:

1. Core Push-Up – Build strength around the shoulder blades by actively pressing them away from the midline, which is essential for shoulder health in sports physical therapy.

2. Bottoms-up Kettlebell Press – This overhead pressing exercise forces the body to stabilize a kettlebell while pressing overhead, improving both shoulder mobility and strength.

3. Shoulder Flexion PAILs and Liftoffs – Develop strength in overhead positions where it can be challenging to maintain proper form and stability.

These exercises are staples in sports physical therapy to help train the shoulders to move more effectively, enhancing performance in sports and everyday activities.

Have Questions? Contact us!

The rise of the “Dad bod”

In recent years, professional sports have witnessed an intriguing shift. Athletes like Patrick Mahomes and Luka Dončić are redefining what it means to succeed at the highest levels, demonstrating that elite performance is no longer solely tied to having a shredded, lean physique. Instead, a new focus has emerged on functional athletic physical therapy and performance-based training, which emphasizes improving sports-specific skills and recovery over aesthetic goals.

The rise of “dadbods” among some of the world’s greatest athletes marks a departure from the long-standing belief that athletes must conform to a particular body type to succeed. While these athletes may not fit the traditional image of being hyper-muscular or ultra-lean, their success lies in their ability to excel through explosive movements, agility, and endurance—qualities enhanced through a combination of performance training and specialized athletic physical therapy.

The Role of Athletic Physical Therapy in Modern Training

Athletic physical therapy has become increasingly important in optimizing the performance of elite athletes. This shift represents a growing recognition of the value of recovery, injury prevention, and the enhancement of functional movement patterns. Through tailored physical therapy sessions, athletes can address muscle imbalances, improve joint mobility, and rehabilitate from injuries in a way that supports their overall athletic performance.

For example, athletes who focus on building vertical jumps, sprinting speed, and endurance use power-based training methods that allow them to excel in their respective sports. These techniques are often complemented by physical therapy, which helps to minimize fatigue, prevent overuse injuries, and ensure that the body can handle the demands of high-intensity competition.

By integrating athletic physical therapy into their routine, athletes can maintain peak condition throughout a long season without the risk of burnout. This is in stark contrast to bodybuilding, where the focus is on muscle isolation and aesthetics, often at the expense of functional performance and injury prevention.

Functional Movements and Sport-Specific Training

Athletes design their training around the specific demands of their sport, focusing on compound, functional movements that replicate on-field actions. From ball throws to sled pushes, these exercises build dynamic strength, coordination, and stamina—key components of athletic success. In conjunction with athletic physical therapy, this approach ensures that athletes not only build the strength needed to dominate in their sport but also stay resilient against injuries.

Athletic physical therapy is particularly useful when addressing issues related to biomechanics. Functional movement screens are commonly used to identify any movement patterns that may predispose an athlete to injury. By correcting these through targeted physical therapy exercises, athletes can enhance their range of motion, improve posture, and ensure that they can perform at their best without sacrificing their long-term health.

While hypertrophy (muscle building) still plays a role in an athlete’s training, the primary focus is on developing muscle mass that supports agility, explosiveness, and the specific demands of their sport. Athletic physical therapy supports this process by ensuring that the muscles, tendons, and ligaments are properly conditioned to handle the stresses of athletic performance.

Evolving Nutrition and Conditioning Strategies

Nutrition strategies in professional sports have also evolved alongside the rise of performance-based training. While bodybuilders typically go through extreme bulking and cutting phases to achieve a particular physique, athletes prioritize maintaining a consistent body fat percentage that allows them to perform at their best. In this context, athletic physical therapy also plays a crucial role by ensuring that the body is adequately nourished and recovered, ready for the rigors of competition.

Athletes focus not on achieving a specific look but on sustained performance, allowing them to remain at their peak over extended periods. Similarly, their conditioning programs are designed to maximize cardiovascular efficiency and sport-specific endurance rather than simply burning fat. Whether it’s high-intensity interval training (HIIT) or tailored conditioning, their approach is centered on enhancing stamina and durability for the long season ahead.

A New Mindset in Athletic Training

The rise of athletes prioritizing performance over aesthetics sends a powerful message, particularly to youth athletes: skill development, functional strength, and injury prevention should always come first. Athletic physical therapy helps ensure that athletes can maintain their physical health while improving their performance, proving that chasing an idealized body image is less relevant to success in sports. Instead, mental resilience, recovery, and athletic ability are the true markers of success.

As more athletes embrace this mindset, the field of athletic physical therapy is expected to grow in importance, continuing to evolve alongside the training methodologies that emphasize performance and health over aesthetics. If you’re interested in finding the best athletic physical therapy and performance training solutions, contact us to learn more about our upcoming performance training groups, launching soon!

The most common sports injury in physical therapy right now

Physical Therapy for Fall Sports: Preventing Soft Tissue Injuries in High School Athletes

As fall sports kick into high gear, it’s no surprise that we’re seeing an increase in soft tissue injuries at our Bethesda and McLean physical therapy clinics. This trend is particularly noticeable among athletes involved in sports like football and soccer, where dynamic, multi-directional movements are essential. These activities often lead to soft tissue injuries, especially in the hip region, making physical therapy a crucial component of an athlete’s recovery and injury prevention strategy.

The Importance of Hip Muscle Balance in Physical Therapy

Field sport athletes rely heavily on their hip muscles to perform the various movements required in their sports. Unlike athletes who primarily run in straight lines, such as sprinters, these athletes need strong and balanced hip muscles to manage the demands of quick lateral movements, sudden stops, and directional changes. This is where physical therapy plays a vital role in maintaining muscle balance and preventing injuries.

The hip is controlled by four primary muscle groups:

– Glutes and Hip Flexors: Manage forward and backward movement.
– Abductors: Located on the outside of the hip, these muscles control side-to-side or lateral movements.
– Adductors: Found in the groin or inner thigh, these muscles also control lateral movement.

Sports that involve significant lateral movements, such as hockey and field sports, place additional stress on the abductors and adductors. If these muscles are not properly conditioned and balanced, overuse or strain injuries can occur, making physical therapy essential for maintaining strength and preventing injuries.

The Critical Strength Ratio in Sports Physical Therapy

One key aspect of physical therapy for athletes is ensuring a balanced strength ratio between the adductors and abductors to reduce the risk of groin injuries. Ideally, athletes should aim for a 1:1 strength ratio between these muscle groups. Research in physical therapy has shown that when the adductor-to-abductor strength ratio drops below 0.8, the risk of sustaining a groin strain increases by 17 times.

Maintaining this balance is crucial because an imbalance can lead to one group of muscles being overworked and more susceptible to injury. For instance, if the adductors are significantly weaker than the abductors, a common issue identified during physical therapy assessments, they may not provide adequate support to the hip during lateral movements, leading to a higher risk of groin injury.

Strengthening Exercises in Physical Therapy to Prevent Groin Injuries

To reduce the risk of groin injuries, athletes should focus on strengthening both the adductors and abductors through targeted exercises in their physical therapy routine.

1. Copenhagen Plank for Adductor Strength

– Objective: Strengthen the inner thigh muscles (adductors).
– How to Perform: Aim for 3 sets of 30-45 second holds.
– Why It Works: This exercise is highly effective at building up the adductor muscles, which are crucial for stability and control during lateral movements, a key focus in physical therapy.

2. DNS Side Plank for Hip Abductor Strength

– Objective: Strengthen the outer hip muscles (abductors).
– How to Perform: Try 3 sets of 12 reps.
– Why It Works: This exercise helps develop the abductor muscles, which are essential for maintaining balance and power during side-to-side movements, a critical part of physical therapy for athletes.

Ongoing Physical Therapy Assessment and Training

It’s important for athletes to regularly assess their hip strength throughout the season as part of their physical therapy routine. Hip strength can fluctuate due to the demands of the sport, making it essential to continually work on these muscles beyond regular practice sessions. Scheduling an assessment with a sports physical therapy specialist can provide valuable insights into an athlete’s hip strength and highlight areas that may need additional focus.

For athletes beginning fall sports, reducing the risk of groin injuries should be a top priority. By maintaining a balanced strength ratio between the adductors and abductors, and by incorporating targeted physical therapy exercises into their training routine, athletes can significantly decrease their risk of injury. This proactive approach not only helps prevent injuries but also enhances overall performance on the field or rink.

Remember, in sports, as in life, balance is key. By focusing on the strength and balance of your hip muscles through physical therapy, you’re setting yourself up for a successful and injury-free season.

If you or your athlete has suffered an injury at the start of this fall season, now is the time to take action. Contact us for a physical therapy assessment to understand the issue, address it effectively, and prevent it from escalating into a bigger problem that may keep you off the field longer.

This made physical therapist, Dr. Sneh, sad

Dr. Sneh, a great sports physical therapist and proud Minnesota native, is an avid Minnesota Vikings fan. This year, the Vikings drafted their quarterback of the future, JJ McCarthy, and the excitement among their fans is palpable. McCarthy has shown promising performance so far in the preseason—a time when rookies often struggle to find their footing.

Unfortunately, following his most recent preseason game, reports emerged that McCarthy had sustained a knee injury that would require surgery to repair a torn meniscus.

I commend the Vikings’ approach to handling McCarthy’s injury, as it offers valuable insights into how we should approach injuries in high school athletes.

The meniscus is a C-shaped piece of cartilage in the knee, acting as a shock absorber between the femur (thigh bone) and the tibia (shin bone). When an athlete suffers a meniscus tear that cannot be rehabilitated, they face three primary options:

Rest and Physical Therapy: This is the preferred option. The best surgery is the one that doesn’t need to happen, and that wisdom extends far beyond knee injuries. A skilled physical therapist, especially one experienced with athletes, begins by reducing pain, inflammation, and swelling, before moving on to restore range of motion and strength. Next, they guide the athlete through normal functional activities like walking and running, eventually progressing to sport-specific exercises.In addition, one of the most overlooked aspects of physical therapy is identifying the root cause of the injury. Why did it happen in the first place? Is there anything that can be done to reduce the risk of it happening again? A truly effective sports physical therapist has not completed their job until these questions are answered and addressed. It’s not just about returning to the “previous level of function”—sometimes, that may not be good enough!
Meniscectomy (Trimming the Torn Parts): In some cases, the meniscus tear cannot be repaired, and the damaged parts must be trimmed away in a procedure known as a meniscectomy. The upside is that recovery from this surgery is relatively quick, with athletes often returning to play in as little as 4-6 weeks, provided they receive proper post-operative physical therapy. However, the downside is that trimming the meniscus means there’s less cartilage left to protect the knee, which can increase the risk of early-stage arthritis and future knee discomfort.
Meniscus Repair (Fixing the Tear): If the meniscus can be repaired, this is generally the preferred option. During a meniscus repair, the torn pieces are stitched together, restoring the knee’s structure as closely as possible to its pre-injury state. This approach reduces the risk of early-stage arthritis and long-term complications but requires a lengthy rehabilitation process. Athletes often do not return to full sports participation until a year after the surgery.

McCarthy and the Vikings’ medical team chose to pursue a meniscus repair for his injury.

While Dr. Sneh was disappointed that he won’t be seeing his team’s promising young quarterback on the field this season, he was heartened by the team’s decision to prioritize McCarthy’s long-term health.

In professional sports, long-term health outcomes for players are often overshadowed by the immediate pressures to get back in the game. Historically, many athletes have opted for a meniscectomy—despite the poor long-term outcomes—because it allowed them to return to play faster.

During my time working with retired professional football players in Texas, I witnessed firsthand the consequences of these rushed decisions. Athletes who were at the peak of their careers just 10-20 years ago are now struggling with basic mobility. Many wake up in constant pain, even though they’re only in their 30s or 40s. I’ll never forget meeting a young man, someone I had watched on TV less than a decade earlier, who had already undergone a knee replacement.

While these are extreme examples, there’s much to learn from the Vikings’ approach to McCarthy’s injury.

The long-term health of young athletes must always be prioritized. It’s easy for a high school game or a college showcase to feel like the Super Bowl, but there will always be another opportunity.

We strive to instill this perspective in our athletes, though it can be challenging when an upcoming game or season feels like the most important thing in their world.

Prioritizing a young athlete’s long-term health may seem like common sense, but the reality can be complex. How can you be sure that an athlete isn’t risking their future by playing now?

That’s where we come in.

Many athletes seek our expertise for an assessment to determine if they’re ready to return to play without jeopardizing their long-term health and goals. If you have concerns about an athlete in your life this upcoming fall season, you know where to find us!

Don’t do what the pros do

As a passionate Boston Celtics fan, I’m thrilled to share that our team is up 2-0 in the NBA Finals! Just two more wins, and the Celtics will secure their 17th Championship. However, the excitement is tempered by the news that one of our star players, Kristaps Porzingis, recently suffered a rare foot/ankle injury towards the end of the latest game.

Porzingis had already been sidelined for over a month due to a calf injury, and he admitted he wasn’t entirely sure he was 100% healthy before the Finals began. This highlights a critical issue in professional sports: the risks associated with returning to play before fully recovering from an injury. Physical therapy plays a pivotal role in ensuring athletes like Porzingis can return to peak performance safely.

The Risks of Premature Return to Play

Returning to play before fully recovering can significantly increase the risk of re-injury or new injuries. When one part of the body is not operating at 100%, compensatory movements can stress other areas, leading to additional injuries. This scenario isn’t uncommon in professional sports, where athletes often face the difficult decision of whether to return to play early.

In the 2019 NBA Finals, former Golden State Warriors superstar Kevin Durant ruptured his Achilles tendon when he quickly returned to play after a calf injury. This tragic incident underscores the importance of proper injury management and the role of physical therapy in the recovery process. NBA medical staffs and the amazing athletes they work with are acutely aware of these risks.

Kristaps Porzingis: A Case Study in Risk Versus Reward

In Porzingis’ case, he deemed the risk worthwhile, having reached the pinnacle of professional basketball. This risk versus reward decision is one every athlete faces, but it’s crucial to manage it wisely. Physical therapy provides the tools and guidance needed to navigate this challenging landscape.

If you’re dealing with a nagging injury or planning to return to training post-injury, it’s essential to assess your risk versus reward scenario carefully. Unlike Porzingis, you might not have a championship at stake, and avoiding further injury is paramount. This is where physical therapy becomes indispensable.

The Role of Physical Therapy in Injury Recovery

Physical therapy is not just about addressing the injury itself but also about ensuring a comprehensive recovery that minimizes the risk of future injuries. A qualified sports physical therapist can assess your injury, identify any compensatory movements, and develop a personalized recovery plan. This plan will not only address the injury but also strengthen the affected area and improve overall body mechanics.

By consulting a physical therapist, you can ensure that your recovery is complete and that you’re fully prepared to return to your favorite activities safely. Physical therapy also educates you on injury prevention strategies, helping you maintain peak physical condition and avoid setbacks.

Take the First Step Towards Safe Recovery

To lower your risk and safely return to your beloved activities, consult a qualified sports physical therapist. They can assess your injury and guide you through a safe recovery process. Physical therapy is a critical component of sports medicine, providing the expertise and support needed for athletes and active individuals alike to recover fully and perform at their best.

If you’re managing your own nagging injury or returning to training after being hurt, don’t take unnecessary risks. Physical therapy can help you achieve a safe and effective recovery, ensuring that you can enjoy your activities without the fear of re-injury.

Schedule Your Physical Therapy Evaluation Today

Don’t let an injury hold you back. Contact us to schedule a sports physical therapy evaluation with our expert team. We’re here to help you get back in the game safely and effectively.

Common Myths About Physical Therapy – Debunked

Many people have misconceptions about physical therapy and those who have never experienced treatment often misinterpret what physical therapists can offer. The expertise of the physical therapy team at Cohen Health and Performance goes far beyond simple stretching routines. Here are 4 common myths about physical therapy that we hear at our Bethesda and McLean facilities.

Myth 1: “I Need a Doctor’s Referral to Go to Physical Therapy”

At least once a week I hear this one and I am always happy to shine a light on the most common physical therapy myth that we see. Thanks to legislation known as Direct Access, you can schedule an appointment with a physical therapist without needing a referral. The benefits of Direct Access are significant: faster treatment and less hoops to jump through. Instead of taking the extra time to see a physician, you can visit a physical therapy clinic and start receiving care immediately. This streamlined approach not only saves you time but also helps you address your pain or injury more swiftly.

Myth 2: “I can see another healthcare provider for physical therapy”

This is a dangerous misconception. Only licensed physical therapists are qualified to provide the specific care required in physical therapy. According to Move Forward PT, approximately 37 percent of people believe that any healthcare professional can perform physical therapy methods on patients. It’s crucial to understand that physical therapy requires specialized training and knowledge that other healthcare professionals do not possess.

Myth 3: “Physical Therapy Is Only for Injuries”

It’s a common misconception that physical therapy is solely for treating injuries. While treating injuries is a significant part of what physical therapists do, our scope of practice is much broader. Physical therapy can benefit a wide range of conditions and goals, from enhancing athletic performance to managing bone loss associated with aging. For example, at Cohen Health and Performance, we provide customized running analysis and training recommendations for runners looking to improve their performance or reduce future injury risk. Physical therapy is about improving overall well-being, not just recovering from injuries.

Myth 4: “Surgery Is More Effective”

Many people believe that surgery is the most effective treatment for pain relief. While, surgery is necessary in many situations, that is not always the case. Depending on the injury or health condition, physical therapy can be a more effective and less invasive option. For instance, conditions like low back pain or meniscus tears may respond better to physical therapy than surgery. Before opting for surgery, consulting with a physical therapist can help you explore all available treatment options. Physical therapy might offer a less risky and more holistic approach to pain management and recovery.

Unseen Benefits of Physical Therapy

Now that we’ve debunked these common myths, let’s explore the real benefits of physical therapy that often go unnoticed.

Enhanced Quality of Life

Physical therapists aim to improve your overall quality of life. This involves not just treating pain or injury, but also enhancing your physical function, mobility, and overall health. For athletes, physical therapy can optimize performance and prevent injuries, allowing them to excel in their sports.

Preventive Care

Physical therapy isn’t just reactive; it’s also proactive. Physical therapists work with patients to prevent injuries before they occur. Preventive care at Cohen Health and Performance often includes educating patients on proper body mechanics, developing strength and conditioning programs for sport, and providing ergonomic advice for work or daily activities. By addressing potential issues early, physical therapy helps you avoid future pain and injury.

Holistic Approach

Physical therapy takes a holistic approach to health and wellness. Physical therapists consider all aspects of a patient’s life, including their physical, emotional, and social well-being. This comprehensive approach ensures that the treatment plan addresses the root cause of the problem, not just the symptoms. For example, a physical therapist might recommend stress-reduction techniques or lifestyle modifications into a treatment plan to support overall health and recovery.

Personalized Treatment Plans

Each patient is unique, and physical therapists create personalized treatment plans tailored to individual needs and goals. This personalized approach ensures that the treatment is effective and aligns with the patient’s lifestyle and goals. Whether you’re an athlete looking to return to your sport, a senior aiming to maintain independence, or someone managing a chronic condition, your physical therapist will design a program that’s right for you.

Physical therapy is a dynamic and essential field that offers much more than most people realize. Physical therapists are highly trained professionals who provide comprehensive care that can improve your quality of life, prevent future injuries, and offer effective alternatives to surgery. By debunking these myths, we hope to shed light on the true value of physical therapy and encourage more people to take advantage of its many benefits.

So, the next time you’re dealing with pain, recovering from an injury, or looking to improve your overall health, consider seeing a physical therapist. You might be surprised at how much they can help.