Nov 16, 2022
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Dr. Yoni Rosenblatt: Welcome to the True Sports physical therapy podcast. Super excited to have Zachary Cogen on. Zachary is currently the head and director of rehabilitation at DC United. Generous with his time here to share a little bit about what got him to where he is, and then also to dive in a little bit clinically. So Zachary, tell us your professional history.
Dr. Zachary Cogen: Yeah, first of all, thank you for having me on. Excited to get to speak to you and your audience today. Yeah, so I started out, went to PT school in New York, New York Institute of Technology, graduated in 2017 and went directly into a sports residency program out in Los Angeles at Adventist Health Glendale. Shout out to that facility. It was outstanding experience. Great mentors, great colleagues, learned a ton, and directly catapulted into Division One sports PT fellowship with USC, which the program was designed to have the clinical experience happen at UCLA Athletics. So I worked as a physical therapist there worked with outstanding athletic trainers. My mentor, who is the director of rehab, is a PT AT, had a great experience over there really getting to work with the elite athlete, getting used to that population.
Dr. Zachary Cogen: Whereas, in my residency, it was more becoming a generalist in the sports PT world. And moved on from there to work with Exos where I spent a few years. I worked as the physical therapist for the Los Angeles facility, where the Galaxy played, so they shared a facility at Dignity Health Sports Park. And when COVID hit unfortunately things didn't work out and the facility actually closed and ended up getting relocated down to the San Diego facility in Carlsbad, so North County San Diego where I continued my roles as a PT for Exos and worked with them for another year, year and a half, and then I got offered this gig to fly back out to the East Coast where I'm originally from, in New York, and it was nice to... The opportunity to step forward into the pro sports world and also to be close to home, family, friends, and I just kind of everything kind of melded together and pieces fit nicely.
Dr. Yoni Rosenblatt: Love it. Yeah, welcome back to the best coast. A couple of things that you...
Dr. Zachary Cogen: A lot of people say best coast West Coast.
Dr. Yoni Rosenblatt: I know, I know they do. Okay, so a couple of things that you conveniently glossed over. Number one, where are you from in New York?
Dr. Zachary Cogen: I'm from Long Island.
Dr. Yoni Rosenblatt: Where are you from in Long Island?
Dr. Zachary Cogen: So I grew up in a town called Bellmore. And yeah, I lived there my entire life until I jumped over to LA, so it was definitely a culture shock and a big move for me, but that move was so huge for me not only in my career but just personally and personal growth. The amount that I grew as a human being was just exponential. So I owe a lot to, where I am today with the experience of just being a human and living away from home and then just needing to figure things out.
Dr. Yoni Rosenblatt: Okay, awesome. Thanks for sharing that. Even more poignantly before you get accepted into graduate school, how long does that take?
Dr. Zachary Cogen: Great question, 'cause that's even more...
Dr. Yoni Rosenblatt: I'm just asking. I ask everyone this.
Dr. Zachary Cogen: No, it's even more significant in my story. Graduating undergrad, I was unable to get into PT school for three years. I took the GRE five times. My GPA, so I wrestled in college, and I admittingly, my GPA was not great in undergrad, and I had a difficult time taking tests, standardized tests were just not my thing, and I had several schools tell me that I wouldn't be able to handle the workload, that I wouldn't be able to pass the tests, I wouldn't be able to handle the amount on my plate based on what my scores were, what they saw my grades were, even though I tried to show some sort of progression. In my junior year in undergrad, I really started to pick it up a lot, and I showed that I was able to get better grades, there just wasn't the consistency that most of them needed to see. So after all that a school, New York Institute of Technology took a chance on me, and it was... Didn't look back since then.
Dr. Yoni Rosenblatt: I love that, and it's I think one of the reasons so many listeners said you got to get Zachary on because he's got a great story and he's doing something really cool. It also resonates with me I'm not also the best... I am also not the best student and I feel like between you and I, we've helped a few people right and so it seems like they're just testing for the wrong things in terms of what denotes in a successful PT. What do you think?
Dr. Zachary Cogen: Yeah. And it's 100%, and I think that a lot of it has to do with there's more to being a PT than studying what's in a book and learning information and getting a score in a test. There's a certain level of emotional intelligence that goes into being a professional in this in this world and being able to connect with the person in front of you, being able to communicate and listen to the person in front of you. And I think that those skill sets can be more powerful than understanding information which obviously holds its own weight and merit, and I think that's extremely important for what we do. But if you're able to connect with somebody that is that... I believe is one of the more powerful tools that we can harness as a clinician.
Dr. Yoni Rosenblatt: I totally agree with that. Now, in your role I assume you're you're doing some hiring and you've done some supervision and some management, so how can someone who maybe doesn't have the most outstanding GPA, how do they get across to you that they have what it takes?
Dr. Zachary Cogen: It's a great question. And I think it's more about the experiences that they've had. What type of person are you outside of the classroom? If the classroom isn't your thing, and it's just, it's a challenging thing for you, are you making the effort in other ways? Are you doing volunteer opportunities? Are you shadowing people? Are you attending lectures, and are you attending courses and are you educating yourself in other ways that maybe someone else next to you isn't? So what exactly are you doing that's a little different that could help you stand out next to somebody who maybe has better grades but isn't doing the types of things that you are doing from a volunteer standpoint, networking standpoint, so on and so forth.
Dr. Yoni Rosenblatt: What did you do? What were some of your experiences that set you apart?
Dr. Zachary Cogen: Well, outside of the sports world, I worked as an aide for a long time and that was my first introduction. I went to physical therapy as a high school athlete, as a collegiate athlete, and I think most of us who are in the sports PT world did at some point and I think that's what eventually... The gateway into there. And being an aide obviously it exposed me to learning how a clinic works, learning what the day-to-day really is, learning basic corrective exercises and programming and things like that. So I think that was my first exposure and experience into that world. And working there for three years, I definitely learned a lot along the way, for sure. And outside of that, I had one special experience to me that I really kind of just I put my head down and tried to grind and find myself in a situation where I would be able to volunteer somewhere that would help me stand out, and one of those places was the United States Olympic Training Center in Colorado Springs. As a wrestler growing up, I wrestled in high school and college, the highest you really can get in wrestling in that circuit is Olympic wrestling and Olympic level, and that was my dream before I was even in PT school, was to be a physical therapist for Team USA Wrestling.
Dr. Zachary Cogen: So as a student, I thought, wow, that would be amazing to be able to do that type of thing, and I was lucky enough to send some emails to the right people, send a well-written email to the right people and come across the right person's desk to read it and really say, hey, this guy took this time to write this great email, well-worded, you can definitely tell that I spent a long time on it because I definitely self-checked that thing at least 10 times. I do remember that and eventually got a hit back.
Dr. Yoni Rosenblatt: I love that. Zach, everyone volunteers at a PT place, right? Everyone's been a tech that is probably listening to this pod. Don't make me drag that story out of you. That's clearly what did it but even more so, what the hell was in that email? And I guess what I'm better asking is how do I get a guy like Zach Cogen to respond to an email if I'm a student, saying I'm dying to work in professional soccer?
Dr. Zachary Cogen: I grew up and were exposed to things that taught me about drive, motivation, passion, character, and those were the types of things that I got across in that correspondence, in that piece of email, and specifically passion. And I believe that passion will help drive a lot of the things for an individual to be successful as a professional because it helps you to listen better, it helps you to communicate better, it helps you to want to learn more and learn from the others around you. That kind of thing really sets you up to be able to jump off the page, for lack of a better word. And I think that was what I was trying to at least instill. So for somebody sending an email to somebody else, trying to have that type of opportunity, really paint a picture for who you are because that person doesn't know what you look like, they don't know the tone of your voice, but really try to get across some sort of emotional component to hopefully light a switch up in their head to be like hey, something to catch their eye, and say, hey, this is a little different than what I typically see.
Dr. Yoni Rosenblatt: That's great advice. Some of my best hires at True Sports have been not based on resume. I still ask for cover letters because of that, exactly because of that.
Dr. Zachary Cogen: Yeah.
Dr. Yoni Rosenblatt: I want to hear passion. Everyone's been volunteering at a PT clinic, everyone's tried to vary that experience of volunteering. I think that you hit a nail on the head. I think it's about that passion. By the way, I think that's what leads to success in a session. If you can show that athlete that you really give a damn, that the number one thing to you, the therapist, is that they reach their goals, they're just going to freaking love you and most likely do better in terms of trying to attain their goals. So thanks for bringing that to light. Tell me about the interview process otherwise at DC as you got that job there.
Dr. Zachary Cogen: Yeah, so I inquired, I sent an application out and heard back a few weeks later and got a call from the director of performance at the time who was also an Exos, a former Exos employee and recognized the place where I worked and were interested in somebody with a background from the Exos world, specifically due to the education that's given based on movement interventions and on-field types of progressions and things like that, bridging a gap between the rehab world and performance world and the experiences that the clinicians get who work in the performance centers, being able to relate to working with other interdisciplinary professionals such as a strength coach, a dietician, those types of things.
Dr. Zachary Cogen: So he found value in that, and he reached out to me to gauge my interest and see why I sent an application out, why DC United, why soccer, why professional sports and really just learn about me. And then from then on, it kind of just snowballed into an interview, another formal interview with him, the director of performance and the head athletic trainer at the time. And then...
Dr. Yoni Rosenblatt: What did they ask you? And by the way, you show up, you go from California to DC for this?
Dr. Zachary Cogen: Yeah. So this was in the weird gray area of COVID times. I feel like in a non-COVID world, I probably would have been there in person, but we did have a Zoom virtual type of interview. First one was the phone call with him and then we did have a Zoom and then another subsequent Zoom with the general manager after that.
Dr. Yoni Rosenblatt: Did you wear a tie?
Dr. Zachary Cogen: I did.
Dr. Yoni Rosenblatt: Okay. You wore a tie.
Dr. Zachary Cogen: I did. I did.
Dr. Yoni Rosenblatt: And what did they ask you?
Dr. Zachary Cogen: That is always my go-to for any interview, no matter where it is or who it's with.
Dr. Yoni Rosenblatt: Jacket?
Dr. Zachary Cogen: I just went with it. So yeah, I just went with a tie.
Dr. Yoni Rosenblatt: Just a tie?
Dr. Zachary Cogen: And a buttoned-up shirt. I did. I know.
Dr. Yoni Rosenblatt: That's how I know you're a physical therapist. We don't know how to dress. We're terrible dressers.
Dr. Zachary Cogen: Yeah, I just didn't suit up for that one.
Dr. Yoni Rosenblatt: Okay. So what did they ask you?
Dr. Zachary Cogen: To start off with, you expect the typical answers that they said... 1the typical questions they say at first, tell us about yourself, who you are, where you're from, what do you do. And then it moved into what are your experiences working with athletes? What are your experiences working with professional athletes? What are your experiences working with soccer professional athletes and soccer elite athletes? Tell us about a time when you had to work with a soccer athlete who had said soft tissue injury. And then I went down a clinical road of talking about how I would manage a grade one or a grade two hamstring strain, grade two adductor. They went through asking about my experience working with other professionals, working with a head coach and my experiences of communicating with a head coach about return to play, about availability status, things of that nature.
Dr. Yoni Rosenblatt: Dude, these are easy questions. So if they ask that to anyone who comes out of Exos, anyone who comes out of any type of residency, they're going to give... I assume they're given the same answers. I would hope, somewhat similar. What did you say in the interview that they're like, Jesus, we got to get Zach. And if they're in the building, just bring them on to camera, and I'm happy.
Dr. Zachary Cogen: No, it's off season right now. So actually, I'm the only person here today.
Dr. Yoni Rosenblatt: Thanks for coming in.
Dr. Zachary Cogen: So I got no one else to drag in here, unfortunately. Yeah, that's a tough one 'cause it's quite possible that people gave the same exact answers as me, and there's no way for me to know that. But I really just went through my answers, and I typically approach those trying to show how objective I am during those types of processes, whether it's communicating with somebody who's not in our discipline, maybe somebody who doesn't necessarily understand our language and being objective with those types of conversations, being objective with other professionals, maybe a performance coach or a strength coach or being objective while I'm speaking to an athletic trainer. And those types of conversations are obviously different with different people and trying to get that across that you're able to tailor your expectations and your communication and outcomes in different language.
Dr. Yoni Rosenblatt: Yeah. Well, that's awesome. And that was probably not spoken about by everyone. So I bet you that that jumped out at them, if I had to guess. What, did they shock you with anything? Any crazy question? They tried to trip you up.
Dr. Zachary Cogen: To be completely honest, all transparency, I don't really remember if I was tripped up on much.
Dr. Yoni Rosenblatt: Which is why you got the job.
Dr. Zachary Cogen: You know, I probably was. You know, I feel like every interview that I've had, because I've certainly had interviews for pro sports teams that I haven't gotten or been offered that position. And I can confidently say that in every interview, I've been surprised or just a little, had to think a little harder for certain answers, for sure. So I can almost guarantee that I was given one, but I just can't recall off the top of my head right now.
Dr. Yoni Rosenblatt: Yeah. No, that's all right. And then in any other interviews, just for the sake of people listening, saying, hey, I want to work in pro sports, is there any curveball that does jump out at you that you're like, you know what, if they hit me with that again, I would have handled it differently or anything like I would have prepared differently for the various pro sports interviews?
Dr. Zachary Cogen: Yeah. So I remember a question in an interview that I had, and I believe that once you're in the pro sports world and you've been in the day-to-day and you understand how the week rolls around, you understand how the season schedule rolls around and what each day entails, what in the soccer world we call it match day minus three, match day minus two, match day minus one, and that type of language, what actually takes place on those days, what you do the day before a game, two days before a game, three days before a game, at least in this role is pretty standard. And being able to communicate in the language of a day-to-day and a weekly schedule for an athlete rehabbing, trying to put it in a language that's more so in the pro sports world rather than the outpatient orthopedic world, if that makes sense. And I think that was the number one thing that... And there's no way for me to really understand that, unless I was in the pro sports world already. And I think that's one of the reasons, I believe that's one of the reasons why a lot of the opportunities in the pro sports world, they're looking for people with experience in professional sports. So they understand how that type of thing works and the dynamic works within the league and within each team.
Dr. Yoni Rosenblatt: Yeah, I think that's a great point. I think it's unbelievable to me, like as I work with pro athletes and work with... From an outside, from the private sector, just how different that language is and the different goals and the different... It's almost... Baseball, we call it feel, where it's, hey, like you just don't say certain things or you do say certain things. And just understanding that rhythm, I think does go a long way. If I'm not coming from a pro experience, how do I gain that? How do I gain that?
Dr. Zachary Cogen: Great question. And the best way to gain that is to network and talk, talk to people. If there's anything I've learned from being a PT and a young PT, I'm not saying for the majority, I'm not saying everybody is like this, but I'm lucky enough to... That the people that I've reached out to, even candidly, have been friendly enough and kind enough to want to communicate openly with me and answer questions that I may have. Them being a professional in the sports world for 10 plus years, they recognize that I'm somebody trying to get my foot in the door, and I just want to learn from them. And whether that's at conferences like CSM, whether that's connecting through social media, LinkedIn, networking from that type of outlet or that platform, that holds value and those conversations are powerful, and you never know what you'll learn from those types of experiences. So I think that something like that has definitely helped me as well 'cause that's certainly something that I did quite frequently and still do.
Dr. Yoni Rosenblatt: And you brought that up a few times in this conversation, like you getting into that Olympic wrestling situation was by virtue of the fact that you sent the email. The school did not set that up for you. You made that connection, right? And then you begin networking through Exos and you take it upon yourself to get into the USC world. And I think that sometimes gets lost. No one's going to do it for you. I also really appreciate your school, your graduate school, letting you do that. One of my struggles was I was dying to be in sports, and I went to my graduate school, and they're like, okay, here's the list of affiliations. And I'm like, none of this. I don't want to do any of this crap. I want to work with freaking athletes. They're like, well, okay. And I wasn't allowed to reach out. And I love that your institution did allow it. So kudos to you.
Dr. Zachary Cogen: Yeah. I was definitely lucky enough. And it was also, which I kind of breezed over, but in my residency, one of the reasons why I was drawn towards my program that I completed was there was something called resident-directed learning. And essentially what that was is you got to kind of figure out how you wanted to check off the box of X amount of hours in that bucket. And I coordinated again with the training center. I reached out to colleagues and the professionals I met over there. And I went over there for another month when I was in my residency as well. And really helped out with some data science and analytics stuff within the sports med, the sports med group. So it was... Again, what I did in school really helped set the stage for some other opportunities in the future too.
Dr. Yoni Rosenblatt: And you're clearly so self-motivated. I mean, GRE is five times, setting up all this stuff. That's really awesome. That's the secret to how you got where you are, I think. I mean, it's pretty amazing.
Dr. Zachary Cogen: I can't tell you how many times I was asked what my plan B is and when I was going to give up, when I was going to stop, what else I had in mind. Because after the second time I didn't get into school, people were starting to be like, hey, what's the deal here?
Dr. Yoni Rosenblatt: Yeah, so it's amazing kind of where you've gotten. So now that once you get the DC role, you walk in, what else is a piece of this role? How would you list out your responsibilities?
Dr. Zachary Cogen: Yeah, so I'm director of rehab here and physical therapist for the first team. And so essentially my responsibilities and roles, I work alongside three other athletic trainers, one head athletic trainer and two assistants, who are outstanding professionals, all three of which have extensive experience in soccer, in Division I soccer, in professional soccer, and really understand the ins and outs of the sport to a T, especially from a medical standpoint. So lots of pearls to be learned and still learning from them. And so working alongside them, I work alongside a director of performance and an assistant performance coach as well. And we make up the high performance in sports medicine division or department within our organization.
Dr. Zachary Cogen: And myself in general, specifically working with the athletes who are rehabbing. Long-term rehab specifically will be under my care and my watch throughout the entire process, mainly our post-ops or anything typically longer than a week and a half to two weeks, will be on my table and be working within my plan of cares I will create. And outside of that, being able to collect data and baseline testing for movement screens to any anthropometric or strength power metrics that we want to collect. So we have those baselines if need be, if they need to go through a rehab type of continuum. Or, in the pre-season, as we create their injury risk reduction programs. Notice how I said risk reduction programs...
Dr. Yoni Rosenblatt: Oh I noticed.
Dr. Zachary Cogen: Not prevention programs.
Dr. Yoni Rosenblatt: Yes.
Dr. Zachary Cogen: Utilizing things that maybe jump off the sheet to us and being able to create risk reduction programs for our athletes so they don't end up on the table or needing an extensive course of rehab. Yeah, so those are the two main roles and responsibilities that I encompass outside of I will be performing pre and post practice manual interventions, going through, like I said, the risk reduction programs, going through their corrective exercises that are prescribed by me before and after practice for individuals based on whatever their needs may be. And yeah, so that's essentially in a nutshell.
Dr. Yoni Rosenblatt: And what has been the biggest struggle, what's been the biggest challenge coming in in the last year?
Dr. Zachary Cogen: Well, first and foremost, is just the overall idea of being in pro sports. It's just a different world than it is in orthopedic outpatient.
Dr. Yoni Rosenblatt: Tell me how. Tell me how.
Dr. Zachary Cogen: Listen, treating an athlete is treating an athlete. So you're being objective, you're going through your progressions gradually, but you have a lot of other variables at play. There are a lot of other pieces to the pie and a lot of other hands on deck in this setting. So you have your athletic trainers, you have your performance coaches, you have your front office, you have your general managers, your head coach, your assistant coaches. You have the athlete who's getting paid X amount of money and is X priority to this team. So you have all of these other variables that weigh into the decisions you make, the conversations you have, the progressions that you make and the regressions you make and things like that. So it's just a different context. The contextual environment is just completely different than somebody paying to come see you versus this athlete is being paid by the club to see you. So it's just a different dynamic.
Dr. Yoni Rosenblatt: There's so much psychology there. That's really interesting. It's crazy. How do you reconcile that? So you have number one player on the roster, you have the guy last on the roster, they both tear their ACL. Listen, I know as well as you do that you're dying to help both of them. Like you said, one of them comes first. How do you reconcile that?
Dr. Zachary Cogen: Well, I wouldn't say that one of them comes first.
Dr. Yoni Rosenblatt: I knew you would correct that.
Dr. Zachary Cogen: Yeah.
Dr. Yoni Rosenblatt: Good correction.
Dr. Zachary Cogen: I hear what you're saying, but I wouldn't say that one of them comes first because listen, and I say this all the time to people, human beings first, athletes second. To me, it's a human being in front of me, not an athlete, not somebody making a paycheck of X amount of dollars. What I see, first and foremost, is this is an individual who needs my help. And it's my job to get them back onto the field safely in a progressive manner and making sure that I'm communicating their progress along the way. Approaching that, I feel helps me to give the best quality of care because once you start to prioritize certain people over others and you give them more of your time, then you start to maybe rub people the wrong way and you lose respect of individuals and things like that. It's more so about when you have an athlete who is more of a priority to upper management, the management may want different things at different times, ask you more questions about an individual. They may be more, not breathing down your neck, but being more persistent. That kind of thing, it changes just the overall temperature and the overall outlook of how much people may press.
Dr. Yoni Rosenblatt: Sure. Yeah.
Dr. Zachary Cogen: If it makes sense.
Dr. Yoni Rosenblatt: Yeah. Yeah. I could totally see that. What's your best advice, I would say, you're dealing with an athlete, and I deal with this all the time even in the private sector where you're dealing with an athlete, they're about ready to return to sport but maybe not all the way there, coach comes and says, hey, need him tonight? How do you handle that?
Dr. Zachary Cogen: Yeah, and that is where the difference between the priority athlete versus maybe the not so priority athlete really jumps into play, is when you're in a situation where a member of the coaching staff, the head coach, whoever it is, general manager comes to you and says, hey, we need this person. You say, hey... And I'm just going to go a little side note here. I like to think of myself, and we joke and the athletic trainers also say this, we feel like we're injury risk advisors. We're advising on our best advice as to what is the risk of this athlete being successful. Are they... Physiologically, are they safe and ready and strong enough to handle the capacities required of them? Being able to communicate those types of things to the coach, saying, hey, athlete A looks great. They passed all their tests. They've been in practice at full unrestricted, full contact, no issues, haven't complained of anything for a good enough amount of time that we feel comfortable that, hey, they're good to go.
Dr. Zachary Cogen: Or, this person is still working, like they're still progressing through their things. They have a couple of boxes still left to check off. They still need a little more time for their tissues to adapt. They've only had X amount of practices under their belt that were full, unrestricted, full contact. Could they potentially get through a game? Yes. Are they a risk? Yes. So if you're giving them an idea of what the risk is in that scenario, because ultimately it's not my decision to say, hey, you are playing or you aren't playing. I'm trying to help guide this process to get that athlete on the field, whether it's the coach's decision right away to do it or the athlete saying, no, I want to play. As long as those individuals understand the risks that are in front of them, that's how you proceed through that. And this goes back to just a general idea of thinking about the return to play decisions. And you asked before, I mentioned the pro sports environment, all the different people at play. Think of like a Venn diagram. This is the BGSM consensus statement for return to play from, jogging my memory right now, Berlin.
Dr. Zachary Cogen: And there's a Venn diagram in that paper that always stood out to me. And it's essentially has athlete in the middle and it has a bunch of different professionals that point off of that athlete. And the athlete's in the middle, but you have the head coach, you have the sports scientist, you have the nutritionist or dietician, you have the physical therapist, you have the athletic trainers, you have all of these people front office coach and all of these people are weighing in the decision. And you're just a one piece and one small part of that. And understanding your role in that is very important when it comes to that. So sorry, a little sidebar on that.
Dr. Yoni Rosenblatt: No, that was great. Really know your role. You need to put chief risk advisor on your business card because that's an awesome title. And by the way, I feel like it'll come with a raise if you're a chief risk advisor, but that's a great way to look at it. It also speaks to our need as a profession to be objective, to get objective data. Hey, here's the QI, here's their force plate analysis, here's all of those things. They paint a beautiful picture, which it kills me when a doctor says, hey, you're nine months out. So back to the pitch, right? Like it is so much more than that.
Dr. Zachary Cogen: Yeah. And it goes back to the first thing. One of the first things I mentioned was being objective and numbers are pretty universal language.
Dr. Yoni Rosenblatt: They don't care about your feelings.
Dr. Zachary Cogen: If you put it in a language that the head coach can understand and a dietician can understand, you're kind of setting yourself up for success 'cause you just want to... You have to provide them with something tangible. Instead of just saying it out loud, show them, in whatever way you want to.
Dr. Yoni Rosenblatt: That's really powerful. And I think there's so many nuances and specifics that come out of that conversation that can be totally worthwhile to both a new grad as well as a vet PT. And I think really getting that great objective data in a sporting environment is what makes a great sports PT and takes you, you know, just in a different world than your gen pop. So that makes a lot of sense. Let's get a little bit more clinical. I would love to hear what it looks like, say your star athlete pulls a hammy, comes off the pitch. You see them the next day. A Zach Cogen evaluation looks like what?
Dr. Zachary Cogen: So typically next day, maybe two days after, depending on, you know, what actually occurred, the severity of this. You know, there are some diagnostics that typically are done, whether it's imaging, musculoskeletal ultrasound, really understanding the severity of the tissue that is involved. Whether it's grade one, two, three, obviously you're going to manage those a little differently and understanding that some of the interventions maybe for your grade twos and grade threes, we may be moving forward with a PRP injection, those types of things to hopefully accelerate the process, allow for some better healing potential and properties. So it really depends whether it's day one, two, or three, but eventually coming across the table and being able to connect with that athlete really just understanding where they're at at that point in time. You know, before you even see the athlete, you kind of have an idea, okay, is this... Are they a repeat offender? Do they have a history of hamstring injuries? And obviously we know as clinicians that you're more at risk for a soft tissue injury or hamstring injury if you've had one in the past.
Dr. Zachary Cogen: So the subsequent injuries are more common to happen and you have an idea of what they've been dealing with. Is this their 10th? Is this their second? Is this their first? So obviously your communication with that athlete is going to be a little different for your first timers or even for your 10ths. So understanding that and really kind of understand, hone in on your subjective and your communication to them and what the process is going to look like, how the progression is really going to look. These athletes, this is their job, this is their occupation and they're very driven individuals, most of them. So giving them a clear picture of what the road looks like ahead is very important to them or I believe is very important to them. And so that's the first thing I like to do, is really get them to understand what the process is going to look like, especially if they haven't worked with me before.
Dr. Yoni Rosenblatt: Okay. Love that. So you mentioned grade two or three and we're talking hamstring here, potentially you're going to PRP injection. How quickly do you do that?
Dr. Zachary Cogen: So usually the athletes within... If they're deemed appropriate to be receiving a PRP injection, usually within, I'd probably say the day after they get an MRI or two days after they get an MRI. So it's usually as soon as possible. Yeah.
Dr. Yoni Rosenblatt: Okay, and then how long do you shut them down for? If that's a piece, I don't mean to assume.
Dr. Zachary Cogen: Yeah, so after the PRP injection we're able to work on other things globally, understanding their deficits and impairments, whether it's mobility, control, strength, other things in their chain that we're able to intervene on, we're obviously working on, but locally at the site of the injection, we're typically shutting down 48 to 72 hours. Let that intervention, let the PRP soak into the tissue like a sponge, let it kind of do its thing and then really take your time with reloading that tissue and progressing them from there and understanding that that PRP is still kind of sitting there a little bit. So you want to make sure it's doing its thing and not prescribing anything even after that 72-hour mark-ish that we're still diligent about avoiding things that may flush that extremity excessively, any contrast types of things, intermittent compression modalities, any ischemic preconditioning, BFR, even starting regular BFR, knowing the vasodilation that happens afterwards globally, you may be opening up those vessels and really just flushing out what you really, the medication, quote, unquote "that you put in there."
Dr. Yoni Rosenblatt: How long do you wait for that?
Dr. Zachary Cogen: So that one, I believe also it could depend based on the size and the amount that was used, but usually we've seen around 7 to 10 days before any of those types of things to pump out.
Dr. Yoni Rosenblatt: Okay. Now, a little bit nitty-gritty, let's say this is a hamstring, let's say it's a gray tube, let's say they had PRP, you're going to give them 48-72 hours before you start getting into the direct site of the tissue that was damaged. Are you doing glute stuff? Does that preclude you from doing glute stuff? Does that preclude you from doing prone hip extension? How far away do you need to be? Are they in a brace? Are they on crutches? Give me a great picture of what they actually look like. It's amazing how much gray there is, right?
Dr. Zachary Cogen: So many different variables and so many different variations, and I'm sure the clinician standing next to me would probably say something a little different.
Dr. Yoni Rosenblatt: I would say exactly what you're going to say. Go ahead.
Dr. Zachary Cogen: So from a loading perspective, let's say 72 hours has gone by, usually starting at the site of the tissue, whether it's glute, whether it's hamstring, whether it's quad, I'm looking to protect that area for a solid chunk of time. So thinking about our tissue healing phases, I'm not looking to load that hamstring tissue until at least day 10.
Dr. Yoni Rosenblatt: Day 10. Go ahead.
Dr. Zachary Cogen: At least day 10 before significantly loading with any external load.
Dr. Yoni Rosenblatt: So you're good with body weight?
Dr. Zachary Cogen: So I am good with body weight, very, very light isometrics, almost like getting the light switches to turn on again.
Dr. Yoni Rosenblatt: Stim?
Dr. Zachary Cogen: I don't necessarily utilize stim. I'm sure someone can, but I don't utilize that modality for that particular scenario. But getting them to feel that tissue turn on or feel some sort of fatigue or activation in that area without symptoms. So we're looking to avoid symptoms, and that's, I think, is the most important thing, is being able to load it without setting off a nociceptive response and creating an environment where the athlete... Obviously every athlete is different, but you could almost turn that athlete off and make them a little more fearful to move forward through said intervention.
Dr. Yoni Rosenblatt: For sure. Okay. So that gets you through day 10. Then what? Give me your principle as to how this person gets back on the field.
Dr. Zachary Cogen: Sure. Progressive and gradual overload of the tissues. Understanding the tension that's in the tissue, how much force with tension is being put through that tissue with the intervention that you give them. Understanding that an eccentric type of contraction, there is more of a demand on that musculature versus a isometric or a concentric. So understanding when you're starting to implement those things, when you're able to get them into a position that requires the tissue to be a little more on length versus in more of a shortened position. Right? And this obviously tapers to which hamstring muscle is the injured tissue. So is it more proximal? Is it more distal? What was the mechanism? So you have to understand those principles too and how to reload those things that were the cause of the issue to begin with. Was this a follow-through of a kick? Was this a linear top end speed type of thing as they were at max acceleration and just maintaining their speed, did they feel it on their stride leg, on their front side mechanics? So it really just depends on that, and understanding that that is something that we want to get back to and how you're going to move forward towards there.
Dr. Zachary Cogen: So starting with our isometrics, then getting into our slow concentrics, adding some weight with those slow concentrics and maybe having pauses of isometrics within those slow concentrics. Then starting our gentle slow eccentrics and then progressively adding more resistance to those types of things, more velocity to those types of things and thinking about your force velocity curve. Obviously, we want faster speeds at the end, slower speeds at the beginning. And that's kind of it in a nutshell without going through specific interventions to kind of get down to the nitty-gritty of it.
Dr. Yoni Rosenblatt: But I think that gives you an awesome rubric to work through, and I think those are awesome principles to highlight, and it's important to note that you're really starting to talk like a great strength coach. And that's where so much of this rehab is going, right? Like being able to understand what happens in a weight room, when to load, how to load, eccentric, concentric, isometric, etcetera.
Dr. Zachary Cogen: Yeah, and that's what I find, is probably... I mean in those phases after day 10, when you're starting to able to progressively load this tissue, that's the most important thing on how to get the athlete in a more robust state than hopefully they were in before they stepped on the pitch the day they got hurt. Because that's always the goal, and that's usually my communication to the athletes, that, hey, listen, our goal is going to be not to get you back where you were but better than where you were the day you got hurt, the moment that you got hurt. And we want to get you into a better spot than that.
Dr. Zachary Cogen: Yeah, so thinking about that. And everybody may do it differently, but there is a point in time in their rehab when their rehab program turns into more of a strength block type of thing. Block A, block B, Block C with foundational lifts and accessory lifts in there as well with some sort of ESD or energy system development component added in there as to what their tissue can handle at that point in time.
Dr. Zachary Cogen: Day 3 through 10 doesn't mean you can't do any sort of aerobic component. You still have upper extremity modalities at your advantage, you have other different things that you can give the athlete, med ball, whatever you feel is appropriate to load that tissue, and it's not loading it too much where you can hurt it even more and making sure it's protected. So avoiding the site when you need to, target the site when you need to in a progressive way.
Dr. Yoni Rosenblatt: Yeah, love that. So they move all the way through that, they're doing really good, really well. When do you introduce plyometric activity? When do you introduce a box jump?
Dr. Zachary Cogen: I want... Well, we have to think about what are the requirements for a plyometric and what type of plyometric are we talking about? Because plyometric, we can define in so many different ways. We can define a plyometric as just a drop to base. Are you just absorbing or are you just jumping up and then stepping down?
Dr. Yoni Rosenblatt: What comes first? What do you do first? This is your world, you're in charge.
Dr. Zachary Cogen: Yeah, so in the continuum that I mentioned prior as the thinking about force velocity, different types of tissue lengths, things of that nature, what I'm usually targeting is isometric, concentric, then eccentric and those in that order, thinking about our landing component as more an absorption type of practice versus a concentric movement. Up onto a box is more of a force production type of principle. So potentially starting with an up before a down is usually where I may start. But it also depends. Is this a lower grade one where they were pretty asymptomatic the entire time and can they tolerate something a little quicker? And everybody responds and heals differently, and it's matching symptoms up to also clinical exam. We're lucky enough to have a doctor's clinic weekly, bi-weekly where a doctor will bring in an MSK ultrasound, so we can actually see what the tissue looks like. We can see the scarring that's happening. We can see the actual defects filling in, in real time. So it's kind of nice to see and match their clinical presentation and their irritability based on what we see on a scan. So obviously, not using one or the other but meshing both together is what I feel is a more objective approach.
Dr. Yoni Rosenblatt: Yeah, I think that's a great way to look at it. I think you have this ladder of progression and scaling and you just kind of see what that athlete can handle and be comfortable kind of progressing them accordingly. I think one of the bigger mistakes that I see with inexperienced or newer clinicians is running comes way, like they need to prove that they can go up to a box, down from a box, over a hurdle repetitively. How many ground contacts are we looking at before we go back to run? Do you agree with that?
Dr. Zachary Cogen: Sure. I mean running is a series of hops from leg to leg. So you have to be able to believe that an athlete can withstand the physical capacities of running or broken down to actually run. So then you're really thinking about some of the other objective ways we can measure muscle performance because, soft tissue injury, we're most concerned about hamstring performance in the adjacent segments and the whole chain as a whole. So we have other tools at our disposal to be able to measure those types of capacities, whether it's isometric strength, whether it's concentric or eccentric strength, and being able to look at what their forced output would be in Newtons compared to the other side. Is it symptomatic? Is it not symptomatic? Are they going 70%, 80%? Are they able to do 100% max effort isometric with no pain at 30 degrees, 60 degrees, 90 degrees, 0 degrees, 15 degrees? So you're having these testing parameters almost daily, maybe every other day in a certain way, maybe not one muscle group every single day, but you're looking at what they're coming in like. So you have a really good idea at how their body's responding to each session that you're having and really basing your decisions on what you want to do on that day based on how they're presenting.
Dr. Yoni Rosenblatt: What they look like. Yeah, you got to see what that athlete looks like on your table. I just had an NFL player come in with a grade three biceps femoris tear. I got the MRI before I saw the guy. He walks into the clinic. I thought he was going to be a mess. He's weak as hell in knee flexion, in prone knee flexion specifically.
Dr. Zachary Cogen: Sure.
Dr. Yoni Rosenblatt: Asymptomatic. I'm like, how? I was just shocked by that. And it just goes to show you cannot treat that MRI. Now, we got to load him up because he's asymptomatic, and he's really weak, and he's able to get through all of these progressions without pain. But I thought I'd be spending time working on soft tissue stuff. But the guy was basically fine. So you just never know what you're going to see, I guess is my point.
Dr. Zachary Cogen: Absolutely. Everybody's different. Everybody's different. Everybody responds differently. But I also do have conversations with athletes quite often about just because you are asymptomatic doesn't mean that your tissue is done healing. And we still do have to protect it to some degree. So we have to be controlled in how we do this type of thing. And that's sometimes hard for the athlete to understand because if they don't feel pain, they feel like they're fine.
Dr. Yoni Rosenblatt: Yeah. And I think that's why you see the hamstring go over and over and over because I think that pain goes away long before we have motor control, let alone, just the robustness of the tissue to withstand the force that go through it. So I think...
Dr. Zachary Cogen: Absolutely.
Dr. Yoni Rosenblatt: I think you have to understand that progression and move them through it accordingly. Now, people are going to move through at different speeds. So just to keep in mind, it's really cool to talk through and think about. Okay, so that's an isolated tissue injury. When that person comes in to see you, how much are you looking at those adjacent segments? Like how much are you looking holistically?
Dr. Zachary Cogen: Looking everywhere. Looking everywhere. And that's... That is one of the most important parts of, I believe, a soft tissue injury, like a hamstring strain. Globally, what is going on in their system and how their body is communicating and synchronizing together to achieve movements on the field, whether it's kicking, sprinting, decelerating, change direction, so on and so forth. And what are the requirements for that to allow the hamstring to function optimally and safely? And using that acute stage where maybe we're a little limited in the interventions that we can do and the time we do spend on the hamstring tissue, addressing those other areas that are important.
Dr. Zachary Cogen: So for instance, what is our hip mobility looking like? What is our hip flexion and internal rotation looking like? What is our dorsiflexion looking like? And thinking about that triple flexion pattern on our front side mechanic. What does our thorax look like? How is our thoracic rotation? Can we feed into that side? Can we feed away from that side? Can we explode out of that side and rotate opposite? So what does our upper extremity look like? What is our scapula...
Dr. Yoni Rosenblatt: Jesus, how quickly do you get up to that, right? Because they come... You're focused on the hamstring. How quickly do you jump to thorax versus looking at adjacent segments?
Dr. Zachary Cogen: I believe that everything lives together and jumping pretty quickly up to it... And I think that's one of the reasons why I guess it goes so quickly there is because everybody obviously changes throughout the course of the season. But there are baseline evaluations done that I do in the beginning of the season. So I have an idea of how each athlete works and how their body moves and being able to almost profile them as to what their potential deficits look like. Right? So do they have a directionality deficit of not being able to rotate towards their right or their left or vice versa. So having an idea of what this athlete looks like before them coming onto the table I think is an advantage to me because it helps me to just be able to program and you know, hit the ground running with them. And you know, also understanding that they have a whole corrective program that they're already doing. So it's almost a continuation of that type of thing. Just being able to work with me a little more independently. Just being able to look a little more under the microscope to hopefully pick up some things that maybe I didn't pick up initially or you know, give them some cues to help them do it a little more effectively.
Dr. Yoni Rosenblatt: Yeah, that's really interesting. What is that preseason screen? Like how do you get that movement pattern or that movement identity?
Dr. Zachary Cogen: So we're looking at movement. We're looking at a movement screen. So it's a lot of it. They function in closed chain and these athletes move in closed chain through space. So we're doing a movement assessment in closed chain. And then we're looking...
Dr. Yoni Rosenblatt: How do you measure it? What do you do?
Dr. Zachary Cogen: Yeah, so we're looking... We're doing a gait analysis. We're doing... And it's not different for each athlete, but it... And it's not a specific like school of thought or, hey, we're doing just the top tier SFMA or we're doing just 3D maps or we're doing just this and just that. It's almost a concoction that I feel are important requirements for each athlete to have who is a soccer player and taking a little bit and piece of different movements, whether it's a lunge from the 3D maps or, you know, a multi-segmental rotation or multi-segmental flexion, a pistol squat. We're looking at different lunge patterns. Like I said, gait analysis, running analysis, kicking analysis, leg swing mechanics. And we're getting this on film and we're able to revisit it when we need to. And we are doing these movement assessments throughout the course of the season as well.
Dr. Yoni Rosenblatt: And you're extrapolating hard movement patterns. What's the objective data that's coming out of your 3D maps?
Dr. Zachary Cogen: So objectives... So these are, this is more of a qualitative assessment. This is more of a qualitative assessment. We do have a more of a kind of like a fine-tooth comb... I'll take range of motion measurements with an actual goni before... Like on the table, like very old school. And each athlete has a, we'll call it, I call it objective data sheet. It's titled as and for whatever athlete's name and it's in his own file. And you know, that's also used if somebody needs to go in for surgery, we have their baseline range of motion measurements. Maybe it's not exactly where they were at that point in the season when they got hurt, but it's a rough estimate baseline of what they were at a different point in time.
Dr. Yoni Rosenblatt: Have you thought about using Fizzy Max or one of the motion capture analysis tools, a DARI screen, things where you can quickly put them into place, have them rotate and you get an objective measurement. I know you have Zach, what do you use and tell us?
Dr. Zachary Cogen: We have thought about using those types of things. Obviously we have a budget and we utilize...
Dr. Yoni Rosenblatt: You're in the pros. There's no budget. There's a budget?
Dr. Zachary Cogen: Yeah. We all have budgets, and you know, we only have so many... When you're talking about resources, we definitely have more resources here than I've ever had in my career. Let's put it that way, a lot more, and a lot more ways to be objective about what we're doing. And when it comes to the different types of tech that we do use, we felt that some of those systems we liked, one of the systems that we're using a little more than the others for the actual, the potential capabilities that we can gain from it. So we use something called iMeasureU. And iMeasureU is a... They're a wearable sensor. It's basically, it's like a little rectangle like that small, and they go on inside a little strap, and it can go around your ankle.
Dr. Zachary Cogen: And essentially it's... It has an accelerometer, magnetometer, and a gyroscope, and it will collect data for you in real time. And we believe that we would like to collect data and be objective about soccer-specific movement on the field and understand what is happening during an instep pass, what is happening during a shot, what is happening when they're changing direction or running, approaching, approaching a dead ball or approaching a moving ball and striking the ball. So we want to know what their body's doing through space, how fast it's doing it through space and what are those impact loads with the ground and the interface with the ball in space.
Dr. Zachary Cogen: So we pick, like, DARI's great. I've used it before. I've seen it been used before. I've seen motion capture with Noraxon. I've worked with those types of things before, and I've always felt that qualitative, you know, being able to look at it and then match it up on the table, you can kind of get a general idea of it. And we wanted to be able to utilize that kind of bucket in a different way, if that makes sense.
Dr. Yoni Rosenblatt: Yeah, yeah. A budget bucket, is what you're talking about, and that does...
Dr. Zachary Cogen: Correct.
Dr. Yoni Rosenblatt: Yeah, yeah. That makes sense.
Dr. Zachary Cogen: And that weighs into... In this world, you got to pick your budget. You can't always have every... I mean, in other markets, in the NBA and the NFL, you definitely have a lot more budget at your disposal to spend as you wish. But, you know, every market comes with different obstacles. And, you know, we try to maximize our budget in the way that we feel is most appropriate.
Dr. Yoni Rosenblatt: What's up guys. It's Yoni from True Sports Physical Therapy. We are always looking for awesome sports PTs. Our practice is super unique. We are in network with insurance, but we spend one-on-one time for 45 minutes every single session with our athletes. We are housed in state of the art facilities, high ceilings, big open turf spaces, racks, barbells, weights. It is a performance facility with the world's best sports physical therapist housed within them. And we want to add to our team and grow our team of awesome sports physical therapists. We offer awesome salaries, great benefits, more importantly, the ideal setup to provide the highest levels of care to the highest levels of athletes. We have awesome continuing education benefits. We have career ladders. We designed this practice to suit both the patient and the athletic patient as well as the sports PT. So if you're interested in joining an awesome growing company, reach out. You can send us an email at pod@truesportsPT.com. You can find us on all social outlets @truesportsPT. We would love to hear from you. We want to hear how we can make your career even better.
Dr. Yoni Rosenblatt: Obviously, that's smart. I have seen in response to like the NFL comment, I've seen NFL facilities totally decked out. Like with everything that you and I just mentioned in the last 60 seconds, every tool, and I have seen it collecting dust in the corner and not being utilized and the athlete having no idea about... So it's about the way you use it. And it seems like you're pretty economical about that.
Dr. Zachary Cogen: Sure. And I mean that's, you know, that's just one tool in our toolbox. We do have several things that we use from a return to play standpoint, from a baseline obtaining standpoint. So we use Catapult GPS to collect external load metrics as well, which our baselines, are usually collected based on their match efforts and their match distances and what they do as a collective or as an individual in each match and knowing what their metrics they need to be at to be in game form, if that makes sense. Using heart rate monitors to know what their max heart rate is during a match and how long they maintain that max heart rate so on and so forth. You know, we have multiple vault suite devices. So we have our force decks, our force frame, we have the NordBord, we have a dynamo. So different things that we can measure muscle performance with and different performance, power outputs, things like that, and physical properties to get a pretty comprehensive idea of how this athlete moves and performs.
Dr. Yoni Rosenblatt: But when you're measuring thoracic rotation, you're standing above them using a goni and watching them rotate.
Dr. Zachary Cogen: Correct.
Dr. Yoni Rosenblatt: I love it. It's a good thing you went to graduate school.
Dr. Zachary Cogen: Watching them rotate and then, you know, obviously... What'd you say?
Dr. Yoni Rosenblatt: It's a good thing you went to graduate school.
Dr. Zachary Cogen: You know, and from a reproducibility standpoint, I'm the person who, I know that I'm the rater or I'm the tester that's going to be testing these every single time. So regardless, if I use a goni or I don't use a goni, I know where they're standing, there's a specific X on the floor with your feet in the same exact spot and the same exact spot on the table. I've felt it before. You know, I'm moving you through. If you think about the SFMA, like you're in an almost kind of a modified child's pose position. You're looking at thoracic extension rotation with the arm behind their back. Like we're looking at thorax rotation in multiple different ways. And you know, with a goni or without a goni, it's both qualitative and quantitative. So quantitative... Although quantitative is good, I think qualitative is just as important as well. Because I think we, as physical therapists and movement professionals, we see movement in a different way. And I think it's important to use our eyes as one of the tools in our toolbox.
Dr. Yoni Rosenblatt: Somewhere Gray Cook is smiling. That is for sure. I love it. Okay. So I've heard you talk in the past about a communication and a non-communication of adjacent segments and how well they're talking to one another. Tell me how you test that and what those words mean to you.
Dr. Zachary Cogen: First, we start with breaking it down in their component parts. And we're understanding what are the foundational principles to absorbing force and producing force. And that's kind of how I see it in us as human beings. We move through space with gravity acting upon us. And we are asking our bodies to absorb ground reaction force and thus produce force to move whatever direction we want at a certain speed and velocity.
Dr. Yoni Rosenblatt: Zach, I wish that there was a test that could tell us how good we are as practitioners at doing exactly what you just said, because that's the entrance exam to physical therapy. Not the GREs. It's that test.
Dr. Zachary Cogen: The GRE, I want to be politically correct on here.
Dr. Yoni Rosenblatt: Not on the True Sports Podcast, you don't need to be politically correct.
Dr. Zachary Cogen: That exam, let me tell you, man, that exam had not even like 0.01% to do with...
Dr. Yoni Rosenblatt: Exactly.
Dr. Zachary Cogen: What I did in PT school. I think that was the biggest waste of time and money. Yeah. That's just a little sidebar.
Dr. Yoni Rosenblatt: Well, I love that. And that's the last time I'll bring up GRE during this conversation.
Dr. Zachary Cogen: Gets me heated.
Dr. Yoni Rosenblatt: Yeah. I see it. But okay, so let me get you back. So breaking it down, breaking down those movements, understanding how to produce force, receive force, and then talk to me more about that communication or lack thereof.
Dr. Zachary Cogen: Yeah. So those principles, absorption, force production, and what is happening in the body when we're doing that? What's happening in closed chain? What's happening in open chain? Which direction are we rotating towards or away from? What is happening in the foot at a very micro scale? Because there are a lot of different parts of the foot. It's not just a pronatory supinatory joint. There are different dissociated properties to it. Are we dorsiflexing, plantar flexing? What's happening at the foot when we're plantar flexing and dorsiflexing? And then what's happening, what should be happening subsequently up the chain at the knee, the hip, the pelvis, lumbar spine, thorax. They kind of live together a little bit. And then up the chain, what's happening at the arms, contralateral arm actions, opposites, things of that nature. And when you understand what those shapes look like, movement begins to make a little more sense. And it's just the more I started to watch how people move, the more I understood how the human body moved.
Dr. Zachary Cogen: And that was kind of what it really was drawn down to. And watching someone do a pistol squat, a reverse lunge, and maybe doing kind of spinning over a fixed leg to see how well their pelvis moved over a fixed femur. Getting an idea of what their body looks like to get a better understanding of, oh, this kind of looks funky. It looks like they're may be avoiding a little bit of their hip, their knees bowing out maybe a little too much. What does their hip IR look like? Maybe they're diving. These aren't bad things, but it's just giving an idea of where we may want to look next. So it's tough to really dial it down, and it's kind of from based on what you see.
Dr. Yoni Rosenblatt: And I think the ability to assess movement like that sometimes actually gets muddied by introducing the technology. But it sounds like what you're doing by honing in on those understanding norms, and then honing in on a given, perhaps deficit, measuring that deficit to really confirm whether it's there or not, maybe correcting that deficit and seeing what that does to the movement pattern. I think that really summarizes what an outstanding evaluation should be.
Dr. Zachary Cogen: Definitely. And one of the hardest parts about that in a sport like soccer or baseball, all human beings are asymmetrical in their own right. And specifically in soccer, at the professional level, these athletes have been playing some of them their entire lives. And a right-footed player is a right-footed player, unless you're purely gifted and you're just as good with your left than you are with your right. But a right-footed player and you play in the same position on the same side of the field, you're going to be asymmetrical because your training age is however long it's been since you've been a novice, amateur, professional, whatever it is, you're going to be asymmetrical. So you have to be careful not to pull somebody out of that asymmetry too much and create something that's an environment that they're not successful in.
Dr. Zachary Cogen: Because they've gotten to this point in their career because of the way that they are. Now there's a lot more that goes into that. Okay, what's their injury history? Do you need to maybe focus into that asymmetry a little more and communicate with it and get their brain to understand it more than the average person who doesn't really have that much of an injury history? But that's really where individualized care comes in and really understanding the individual in front of you. But just because you see an asymmetry and imbalance doesn't mean it's a bad thing. And I think that's a really important concept and takeaway to just to understand from this.
Dr. Yoni Rosenblatt: I think you've highlighted a plethora of very important concepts to take away from an evaluation, to understand the progression of hamstring pathology and how we load them appropriately and get them back on the field, as well as touching on what it's like in pro sports versus what it's like in general population and maybe where those two worlds merge. So if you had one last piece of advice to all the sports physical therapists that are hanging on every single word that you just shared, it would be what, Zach?
Dr. Zachary Cogen: There's a lot to learn from the people around you, whether they're physical therapists or not physical therapists in the sports world. I can't tell you how much I've learned from other professionals that aren't physical therapists. And I have learned so many things that have made me a better physical therapist and better at my job, understanding the different worlds and little things that I just may not have picked up on. And I think that's really important. And we just spoke about return to play, for a large portion of this, understanding the world of performance coach in soccer, because eventually there's a handoff that happens where the athlete will return in a progressed manner to an integrated practice environment, non-contact, whatever it is, and understanding what they're doing, what they need to do, so you can set the athlete up for success to get to that next stage with that performance coach. I think that's a part that we didn't really speak about. As part of that's important for this setting too, is that handoff that happens and getting them back onto the practice pitch. But that being said, listen and talk to the professionals around you who are physical therapists but also who aren't physical therapists, because you're going to learn a lot more than you think.
Dr. Yoni Rosenblatt: That's awesome advice. Zach, where can all these sports physical therapists find you?
Dr. Zachary Cogen: My only social media platform I really use is on Instagram. So you can find me on Instagram, handles @thesportsphysio_. Feel free to DM me on there, pepper me with questions. My email link is on there as well. So if you have any questions and you feel like you want to email me as well, go for it. I'm all ears.
Dr. Yoni Rosenblatt: I love it. And Zach, the way we got you on this podcast is hearing from the listeners at email@example.com. We love feedback. I love that, Zach, your name came up in kind of those discussions and back and forth, and you'll always get a reply from us. So Zach, thank you so much for your time, for your knowledge, for being so open and professional. I really think you made the world of sports PT a better place with this interview. So thanks so much for your time.
Dr. Zachary Cogen: Yoni, thanks a lot. I appreciate it. Thank you to the listeners who want me to have on. I'm humbled and I'm excited to hopefully for people to take something away from this.
Dr. Yoni Rosenblatt: Absolutely. Keep it up. See you soon.
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