Low back pain is classified as acute (lasting less than 4 weeks), subacute (lasting 4-12 weeks) and chronic (lasting 12 weeks or more). Even though 84% of adults will develop back pain at some point in their lives, it is reassuring that for only 1% is life threatening systemic conditions.

The risk factors for developing low back pain are smoking, age, obesity, gender(being female), both sedentary lifestyle and physically strenuous work as well as psychologically strenuous work.

The red flags (this is the terminology that physicians use to signify things that should alert the physician that something serious may be causing the back pain) for low back pain are: new onset urinary retention, fecal incontinence, significant muscle weakness, having a history of cancer, fever and malaise. Other significant risk factors to be considered contributory are obviously severe trauma, presence of contusions and abrasions and prolonged use of corticosteroids, such asPrednisone and Methylprednisolone.

As serious as these symptoms may seem, the majority of patients will have ”nonspecific” low back pain, which means patients will have back pain that is not due to any specific underlying condition. Most of these cases are due to musculoskeletal pain that will improve within a few weeks.

As a result of these findings, radiological imaging is rarely needed unless the symptoms continue for more than 4 weeks or progress at any time. An additional consequence to imaging is that it may show abnormal findings that turn out to be not significant, but may lead further imaging or testing that was unnecessary, albeit warranted once the process is started. Interestingly enough, patients who have significant findings on radiology studies often times are asymptomatic. Patients who have seen me in the office often hear me say, that “medicine is not an exact science” and this is a clear example of this.

So, if you experience low back pain, when should you call in for an appointment to my primary care office? Certainly if you are having symptoms that significantly decrease your daily movement, contribute toloss of strength, loss of balance and fevers associated with lower back pain, you should certainly schedule an appointment with our office as soon as possible. Signs that things may be more serious and would warrant an ER visit would include fevers that are not improved with Tylenol or Ibuprofen, paralysis, inability to hold your urine or control your bowel movements and significant trauma. If ER physicians do not encounter any of these symptoms, patients may not even get a plain x-ray while they are in the ER and will be directed back to their PCP for further recommendations.

When low back pain persists for 4-6 weeks, plain x-rays can be used to show fractures, compression fractures, osteoarthritis, scoliosis and spondylolisthesis. Symptoms that are progressive or involve nerves may require an MRI, if plain x-rays are not conclusive. If a patient is unable to undergo an MRI, then a CT is ordered. There are additional imaging studies used to evaluate lower back pain, but they are used less frequently.

Thankfully, even though, there are very serious causes of lower back pain, the majority of cases can be treated in the primary care office with or without imaging. Most cases of lower back pain resolve within 4 weeks and do not proceed to become a chronic condition. More serious symptom certainly warrant a ER evaluation.

We may recognize that it is October by the smell of pumpkin spice, but if you look carefully, you should also see the pink ribbons of breast cancer awareness month. We wanted to take the opportunity this month to go over preventative measures and risk factors, screening recommendations and signs of the disease that hits close to home for so many of our patients.

Preventing Breast Cancer

While there is no sure way to completely prevent breast cancer, there are lifestyle recommendations which can help decrease your risk of developing it.  Many of these recommendations may sound familiar; they are the same as the ones our providers counsel our patients on at annual wellness exams!   These include:

  • Alcohol:  Some studies have shown a link to an increased risk in breast cancer, as well as many other cancers, when women consume alcohol excessively.  For this reason, The American Cancer Society recommends that women drink no more than 1 alcoholic beverage a day.
  • Weight:  Research has shown that women who are overweight after menopause or women who carry more excess fat around their waist may increase their risk of breast cancer. Therefore, it is recommended that all women try to maintain a healthy weight by regularly exercising and maintaining a balanced diet.
  • Exercise:  Regular physical activity, especially after menopause, has been shown to decrease one’s risk of breast cancer.  The amount of physical activity to decrease this risk is not clear, but The American Cancer Society suggests at least 150 minutes of moderate exercise a week.
  • Children:  Women who have never had children or have their first child after age 30 may have a greater risk of certain breast cancers.
  • Breastfeeding: Some studies support that breastfeeding can decrease the risk of breast cancer.
  • Birth Control:  Research has shown that there may be a small increased risk of breast cancer in women who take contraceptives containing hormones compared to those who do not; these include birth control pills, the shot, and IUDs.  This risk seems to decrease after stopping the medication.  The choice to start or continue all forms of birth control are taken very seriously and weighed against other risk factors and benefits and should be discussed individually with your healthcare provider.
  • Hormone Replacement: Combined hormone therapy which contains estrogen and progesterone that is used for the treatment of menopause and osteoporosis has been linked to a risk of breast cancer.  This risk can decrease after 5 years of stopping the medication.

Early Detection and Diagnosis

Many women never have symptoms before the diagnosis of breast cancer, making screenings one of the most vital components of early detection and treatment.  The American Cancer Society recommends the following screenings for women at average risk of breast cancer:

  • Mammograms: Age 40-44 may choose to start annual mammograms.  Age 45-54 should get annual mammograms. Age 55 and older may switch to every other year mammograms or continue with annual mammograms, and should continue for as long as a woman is in good health or expected to live for at least another 10 years.
  • Clinical and self breast exam: There has been little evidence to support that physical breast exams by a clinician, or individually, can detect breast cancer earlier than Mammograms.  However, it is recommended that women be familiar with their breasts in how they feel and look, so they may detect any changes as soon as possible.

Breast Cancer Signs and Symptoms

Like mentioned previously, self and clinical breast exams should not replace screening mammograms since screening tests can detect breast cancer before symptoms appear.  However, here are a list of symptoms that would warrant further evaluation:

  • A new lump or mass, especially if it is painless, hard, or has irregular edges
  • Swelling to part or all of a breast
  • Skin dimpling or changes including redness, thickening, or scaling of the breast tissue or nipple
  • Breast or nipple pain
  • Nipple retraction or nipple discharge

As October is Breast Cancer Awareness Month, we wanted to take the opportunity to remind all of our patients that there are many opportunities to decrease your risk of breast cancer or detect it early so that treatment is initiated swiftly and effectively. We encourage you to continue to maintain your healthy lifestyles of limiting alcohol to one serving a day, maintaining a well balanced diet, exercising at least 150 minutes a week, mammograms (for those in recommended age brackets) and self breast awareness.  As always, please schedule an appointment with one of our providers if you have any new symptoms or concerns.

What is the O-Shot®?

The O-Shot® is a non-surgical, minimally invasive procedure that can help improve a woman’s sexual desire and orgasm, decrease urinary incontinence and treat a chronic skin condition called lichen sclerosus. Up to half of women experience low sexual desire and many others experience issues with arousal, lubrication and orgasm. The O-Shot® uses platelet-rich plasma (PRP) that contains growth factors from the woman’s own blood, and is injected into the clitoris and vaginal wall. This increases the blood flow, nerve sensitivity and collagen formation in the area, leading to improved sexual function.

What are the benefits of the O-Shot®?

This injection can increase a woman’s sexual desire and arousal, as well as improve the number or quality of her orgasms. In addition, this procedure can help with

  • Leaking urine
  • Painful sex
  • Vaginal dryness
  • Decrease symptoms and long-term consequences of lichen sclerosus

How is it performed?

Blood is drawn from the patient and then using a special double-spin process the red blood cells are removed, leaving the plasma which is full of growth factors. Numbing cream is then placed onto the areas that will be injected, and a lidocaine injection is performed to ensure there is minimal to no discomfort during the procedure. The PRP is then injected into the clitoris and vaginal wall. The procedure takes less than an hour.

What are the risks?

Some women experience spotting from the location of the injections, as well as temporary soreness. Infection or significant bleeding is unlikely. While most women tolerate the procedure well, there are reports of women with prolonged numbness of the clitoris or hypersexuality after the procedure. If this happens, it typically will resolve within the first few days.

What is the recovery?

There is no downtime after the procedure, you can immediately resume all physical activity and even intercourse that same day. The full effect of the O-Shot® is reached around 3-4 weeks after the procedure. Depending on the reason for the injection, the results can last for more than a year with a single injection. Women with lichen sclerosus will often need additional treatments to continue its benefits.

Is it right for me?

If you suffer from low sexual desire, unsatisfactory arousal, lubrication, orgasm, urinary incontinence or lichen sclerosus, then the O-Shot® may be for you. At Rittenhouse Women’s, our gynecologist and women’s health nurse practitioners are trained to address these issues and determine if this procedure is your best option for treatment.

It is important to discuss all concerns with your provider, as they may also be signs of other medical problems.


On average, women spend roughly $75-$100 on skin care products a month, and some over $250 a month! This probably doesn’t sound surprising to all of those Ulta and Sephora addicts out there. Whether it’s for clear, wrinkle-free skin, shiny hair, strong nails or a healthy glow, we are constantly looking for the next best skin care product.

Rather than focusing so much on what we put on the outside of our bodies, we should also focus on what we’re putting inside our bodies. What you eat has a lot to do with your appearance – not just your waistline. Nutrients that we get from whole foods can have several benefits for our skin. Antioxidants such as vitamin C and E can help prevent wrinkles and increase elasticity in our skin. Did you know that tomatoes contain a chemical called lycopene which has been shown to improve our skin’s natural SPF and protects it against sun damage?

However, the food we eat can also do the opposite. Refined white products such as sugar, salt and highly processed foods, can increase stress hormones that cause breakouts. A diet high in saturated fats promotes the production of free radicals that can prematurely age skin. On the other hand, healthy fats such as omega 3’s that we get from salmon and flax seeds can help strengthen skin cells and reduce inflammation. Other fats that are essential for healthy skin include avocado, olive oil, and a variety of nuts and seeds. Minerals such as zinc promote healthy skin turnover; on the contrary a zinc deficiency can cause abnormal pigmentation along with stunting hair and nail growth. Last but not least, one of the most important nutrients that we can include in our diets for a beautiful complexion and healthy glow is water!

Take a look at what you are eating (and what you aren’t) and try to make some changes to improve your diet! You may start seeing changes right away and be able to cut back on some of those cosmetic expenses by simply changing your eating habits. And of course, if you need help sorting through the different foods that can help your skin look its best, you can always make a nutrition appointment with us. We look forward to helping you look and feel your best!

Need a pick me up? Many of us may be looking for a caffeine fix to help with getting a jump-start on the day or to help us power through the end of the day.  Whether it’s a cup of coffee, tea or an energy drink – they all share one common ingredient: Caffeine. More people are relying on caffeine to increase energy levels than ever before. Overall, caffeine consumption in moderation can improve concentration, make the brain more alert and can also help you live longer.

You will be pleased to know that your “cup of joe” may be providing you with more than just an energy boost – it can also provide important health benefits too! Research suggests that black coffee consumption may be protective against type 2 Diabetes, lower incidence of Parkinson’s, liver and heart related diseases, as well as cancer. Most of the studies done on coffee have been based on observational research – so while it does not provide exact evidence, we can conclude that the benefits appear to outweigh the risks.

Keep in mind – drinking too much caffeine can be harmful and could increase risk for anxiety, restlessness/impaired sleep, nausea and an upset stomach.  Up to 400mg of caffeine a day appears to be safe for most adults but can vary based on age, gender,  weight and overall health. Pregnant women should limit caffeine intake to less than 200mg per day. The amount of caffeine in a cup of coffee can vary greatly – assume that an 8oz cup of coffee contains around 100mg of caffeine. Remember that caffeine can be found in other food products such as soft-drinks, chocolate, nuts and seeds.  Some companies choose to provide the caffeine content of products, voluntarily.  See below for a list of foods with the average caffeine content to determine if you might consuming too much!

Food/Drink Average Caffeine Content (mg)
8oz Instant Coffee 95
8oz Espresso 60
8oz Green tea 25
12 oz Cola 40
1 oz Milk Chocolate 6
1 oz dark chocolate 20
Starbucks Grande (16oz) 330

This Summer, Philadelphia is a mecca of outdoor fun. It’s appeals to the masses, and new outdoor trends are picking up fast. As a coach, I love being outside. I host my boot camps outside, I walk to my clients and love running before the hot sun hits to kick my days off on the right foot. Thanks to the endless list of activities coming up over the next few weeks, it looks like we won’t have a shortage of ideas to keep us out and about.

One of my favorite places is the Spruce Street Harbor. You can get lost looking out over the water, or gazing up at the bridge! The entire Harbor is place to visit, let alone enjoy. Strap on your roller-skates for some old school fun at the city’s only outdoor rink and enjoy a variety of food trucks too!

Up the way, they’re hosting FREE yoga at the Race Street pier this year which I can’t wait to get to. There’s morning yoga and twilight yoga – all you need is a mat! Read about their full schedule here.

I love light and fresh treats during the Summer months. My suggestion; map out a fresh juice bar hop! I’ve fallen in love with the watermelon energy juice at Snap Kitchen, and of course, everything at Sip N Glo Juicery in Rittenhouse is perfect. Need ideas on where to hop to?Check out this list of juice bars and try something different at each place. Your friends will be jealous you went!

I mentioned earlier that I host outdoor classes, so add them to you list this Summer. Every Monday night at 630, Tuesday at 12n, and Friday at 630am we meet to workout together at Julian Abele park on 22nd & Carpenter. All the details are here. You’ll need a mat & water! Fees apply.

Need motivation to get your running game on or want to meet people who love running? I suggest the RUN215 group. Their weekly schedule is robust and the community is strong. There’s a run planned every single day, in multiple locations throughout the city, offering distances to suit everybody’s training requirements. They often have happy hour runs so you can mingle and meet new friends post workout! Visit their website and plan your next run.

We all need a city break from time to time, which is why The Circuit Trails are an underrated, hidden gem for us adventurers to explore. Greater Philadelphia is the proud home of the Circuit Trails, a vast regional network of hundreds of miles of multi-use trails that is growing in size each year. Pack some snacks, grab your best friend, and set out for an adventure! Plan your next trail experience here.


As women, we are at a higher risk than men for developing the age-related bone density disorder, Osteoporosis. Osteoporosis causes our bones to become thinner and more porous. This makes us less able to support our own body weight. Osteoporosis can affect our quality of life as well as limit our ability to be independent. Bone density loss happens rapidly after menopause, and by the age of 50, about half of all women and men will break a bone because of Osteoporosis.

Don’t worry, there are a few things you can do to help reduce your risk of developing Osteoporosis. A diet full of calcium and vitamin D is helpful, as well as participating in physical activity. Studies show weight bearing exercises not only prevent bone density loss but also encourage bone growth. Shoulder, wrist, and hip joints as well as your spine are common sites where bone density loss occurs. These are great areas to strengthen through exercise.

If you have Osteoporosis, consult a physician before beginning an exercise program. If you are hoping to reduce your risk, be sure to start slow and work with someone who can show you the proper way to work out.

An ideal work out would include aerobic weight bearing exercises, resistance training, and flexibility exercises. It is important to note that these exercises should be done to improve muscle strength, therefore conserving bone mass, and should not generate joint pain. Exercises should be performed at low to moderate intensities.

If you have any questions or want to start reducing your risk of Osteoporosis, call and make an appointment with one of our fitness specialists today!


Spring has finally arrived and it is the perfect time to spring clean your workout routine. After the long winter months, this time of year is great to reevaluate and revitalize your workout! Here are some of the best and easiest ways to make sure you are getting the most out of your routine.

1. Footwear: First and foremost, make sure you are wearing the proper footwear for your workout. Depending on your goals, there are many sneakers to choose from nowadays. The best choices are lightweight and flexible. Make sure you are not wearing a shoe that is too heavy as it will tire you out and slow you down a lot sooner than a lightweight shoe selection. You should also purchase your workout sneakers at least ½ size larger than your regular shoe size as this will allow you to have more flexibility and decrease any strain on your toes.

2. Plan your workouts: One of the main reasons people give up on working out is due to lack of planning. Each week you should draw up what your workout for the entire week will look like. Be sure to plan at least 3-4 days of cardio lasting for 30-45 minutes during each session. Incorporating weights is key. Strength training helps to build lean muscle and boosts your resting metabolic rate so that you will burn calories for hours after your workout!

3. Incorporate Interval Training: If you don’t already, you should incorporate interval training into your routine. By alternating your speed every few minutes helps to build cardiovascular endurance, improves speed and burns tons of calories. Before trying interval training, be sure to speak to your physician about the benefits and risks of this workout regimen.

4. Stop Spot Training: Exercising a specific area of the body with the expectation to eliminate fat in that particular location is almost impossible. Every person is an individual and has different genetics. To attack problem areas, many factors need to be considered including hormonal imbalances as well as diet. In order to properly tackle those problem areas, you must use a total body approach. You need to assess your exercise routine as well as nutritional intake and genetics. The more you know about these 3 things, the more you will see a change in those problem areas.

5. Cool Down: After a long workout the last thing most people want to do is a cool down. Cooling down your body is very important. It helps to bring your heart rate down and relax your muscles. It also helps to alleviate feeling sick afterwards. Be sure to stretch! Stretching also relaxes muscles but also helps to speed circulation to your joints.


In today’s day and age most of us hold a position within a company where we are mostly sedentary the entire day and sit in front of a computer screen. According to the U.S. Department of Labor, the average American typically works more than 40 hours per week. Let’s think about that: most of us are sitting for 8-9 hours per day without much movement! In order to break this vicious cycle of the sedentary work life, here are some daily exercises that can be done in the office to get moving!

  1. Morning Commute: Each morning we usually take public transportation or drive into the office. In order to burn some early morning calories, park a few blocks away from the office so that you can get in a quick walk. Bike to work if you are in biking distance and if you take public transportation, get off at an earlier stop than usual and walk the remainder of the commute.
  2. Glute Seat Squeeze: While sitting at your desk, you are able to get in a silent glute workout in without anyone even noticing! To start, simply squeeze the buttock, hold for 10 seconds and release. Repeat 3-4 times. This one is a lot harder than expected!
  3. Triple “T”: Tone Those Thighs: If you are looking to tone your inner thighs, grab an extra ream of paper lying around the office, place between the inner thighs and squeeze in for 30-60 seconds and release. This office exercise will have those inner thighs in shape in no time!
  4. The Rolling Stone: During those winter months, it is very hard to get outside and walk around during your lunch break. Until then, take a break every 2 hours or so and walk around the office. Catch up with a team member in person rather than sending that long email you had written or walk over to a  new employee and welcome them to the office.
  5. Lunch time Crunch Time: Right as your lunch break starts, you have plenty of time to work on some desk crunches. Yes, I said it: desk crunches. It’s possible, believe me. Place both elbows on your thighs and curl your chest in towards your legs but be sure to resist with the arms. Hold for at least 10-15 seconds, release and repeat 8-10 times.


The cold and flu season is in full swing and you’re doing everything in your power to ward off pesky viruses but you still don’t feel 100%. You have been getting plenty of sleep, eating healthier, and received your annual flu shot. However, have you been exercising regularly? Recent studies have shown that moderate exercise can help boost your immune system.

Exercise: An Immune Booster

Your immune system is the body’s natural defense against infection. It helps fight viruses and diseases that you are exposed to regularly.  Exercising for 30 to 45 minutes a day can improve your chances of warding off viruses such as colds and may lower your risk of developing heart disease and certain types of cancer. According to the U.S. National Library of Medicine, exercising regularly can help to flush bacteria from the lungs.

For example, during moderate exercise, the body increases the amount of macrophages, which are the cells that attack bacteria, temporarily. During exercise, the body also circulates immune cells throughout your system more efficiently. After exercise, the immune system returns to normal, but habitual exercise may be able to make these changes long lasting.

Everything in Moderation

Working out at an intense level (such as marathon running or intense gym training) is okay from time to time, but is not recommended for daily practice.  Intense training may cause a decrease in the amount of white blood cells circulating in the body which in turn will make you more vulnerable to contracting a cold or virus. Remember, the body needs a period of time to recover from workout routines.

Exercising when you are sick is okay if your symptoms are mild, but pushing too much can be dangerous especially if your symptoms are more severe.  Be sure to always consult with your primary care provider to learn what level of activity is safe.

Let’s Get Moving

To improve you’re immune system and decrease your chances of getting sick it’s important to incorporate the right amount of exercise into your daily routine. Light to moderate exercise a few times a week can be useful, while intense workouts can be detrimental. Talk to your doctor about what level of physical activity is right for you, especially if you are feeling under the weather.

Now, let’s get moving!


1632 Pine Street
Philadelphia, PA 19103
Phone: 215-735-7992
Fax: 215-735-7991


Monday – Friday:  8am – 8pm

Saturday: 9am – 2pm

Sunday: Closed

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