Most acute low back pain results from injury to the muscles, ligaments, joints, or discs. The body reacts to injury by mobilizing an inflammatory healing response. While inflammation sounds minor, it can cause severe pain. There is a significant overlap of nerve supply to many of the discs, muscles, ligaments, and other spinal structures, and it can be difficult for the brain to accurately sense which is the cause of the pain. Muscles and ligaments heal rapidly, while a torn disc may or may not. The time course of pain helps determine the cause.

Basic remedies applied at home can be effective for treating mild or acute pain from muscle strain, as well as reducing the effects of chronic, severe pain. Self-care is administered by the individual and can easily be adjusted. These methods can include:

  1. Short rest period – many episodes of lower back pain can be improved by taking a break from strenuous activity for a few days
  2. Modify your activities – avoiding or minimizing activities and positions that worsen the pain will help prevent or reduce painful back spasms and allow for a better healing environment.
  3. Ice/Heat therapy – Ice or cold packs can be used to reduce swelling and inflammation for the first 24 hours after an injury. Then heat can relax tense muscles and improve blood flow bringing nutrients and oxygen that muscles need to heal and stay healthy.
  4. Over the counter pain medications – Aspirin, ibuprofen, and naproxen are anti-inflammatory medicines which alleviate low back pain caused by a swollen nerves or muscles. Acetaminophen works by interfering with pain signals sent to the brain.
  5. Returning to activities – apply heat before activities to help relax muscles allowing for better flexibility and mobility. Apply ice after activity to reduce the chances of an area becoming irritated and swollen from exercise.

If you suffer with low back pain that lasts longer than a couple of weeks, your doctor will probably refer you to a physical therapist. A physical therapist will tailor an individualized plan that meets your needs and constraints. Your treatment plan will include a range of both passive and active modalities to provide relief from back pain. Passive modalities are when the therapist treats you with massage, heat, ice, electrical stimulation, and manipulation. Active modalities are when you take a more active role and do exercises and stretches to improve your range of motion and relieve pain. By following this treatment plan, you’ll find that physical therapy can reduce or totally eliminate your back pain.

The goal of medical treatments is to reduce pain, but these treatments do not change the underlying source of pain. A doctor will typically prescribe medical treatments alongside a physical therapy program or other regimen.

  1. Muscle relaxants. This medication acts as a depressant of the central nervous system and increases mobility of tense muscles, relieving pain from muscle tightness or spasms. Muscle relaxants have no role in chronic pain management.
  2. Narcotic pain medications. Narcotic medications, also called opioids or painkillers, alter one’s perception of pain by weakening signals sent to the brain. Narcotic medications are most often used for treating intense, short-term pain, such as acute pain after an operation. Narcotics are rarely used to treat long-term pain, as they have many side effects and can easily become addictive.
  3. Back braces. Some patients find that a back brace can be used to provide comfort and possibly reduce pain. There is some evidence that use of an inelastic corset-style brace, worn daily, in combination with a physical therapy exercise program, can speed healing and reduce pain.
  4. Epidural steroid injections. This injection involves a steroid administered directly into the outer part of the dural sac, which surrounds the spinal cord. A live x-ray, called fluoroscopy, is used to guide the needle to the correct area. The goal of the injection is to temporarily relieve pain by reducing inflammation around a compressed nerve root.
  5. Manual manipulation. A chiropractor or other healthcare provider makes physical adjustments to the spine with the goals of improving mobility and reducing stiffness, discomfort, or pain.
  6. Acupuncture. Based in ancient Chinese medicine, acupuncture stimulates points on the body thought to correct the body’s “qi,” or life force. It is believed that proper qi decreases pain and discomfort in the body. During a session, thin needles are placed in the skin for about an hour.
  7. Massage therapy. Applied to the low back, massage therapy can relieve the muscle spasms that usually contribute to low back pain. Massage also increases blood flow to the low back, which speeds up healing by bringing nutrients and oxygen to damaged muscles.
  8. Mindful meditation. Meditation may be helpful in reducing the perception of pain, and can reduce depression, anxiety and sleep problems that commonly occur with chronic pain. Meditative techniques for pain reduction include everything from deep breathing exercises to an altered focus approach.

It is reasonable to consider spine surgery if the pain has not diminished after months of non-surgical treatment, if pain does not respond to medication or if you’re unable to complete basic daily activities. Some surgery options are minimally invasive (microdiscectomy for a  herniated disc) and allow for quick recovery, while other types of surgery (a posterolateral fusion for degenerative disc disease) are more extensive.

We are all different regarding our pain tolerance, fitness, job activities, out-of-pocket costs and concomminent medical problems. There are many treatment options and combinations for back pain. You should have a personalized plan of action that you’ve discussed with your family doctor so you can enjoy an active, healthy and pain-controlled life.

From StatNews: COVID-19 and your heart
An example of incorrect information spread by the media

After a year of frightening headlines, widespread concern, and countless retweets that the virus that causes Covid-19 may attack the heart more aggressively than any other viral illness, the verdict is in…It doesn’t.

report published last week in the journal JACC: Cardiovascular Imaging made that verdict blatantly clear. It’s time to set the record straight on Covid-19 and the heart, and to consider the lessons for how science is communicated to the public. Here’s how incorrect COVID-19 information from the media can scare the general public:

  1. An early report that set in motion fears of a Covid-heart disease connection was published in JAMA Cardiology on July 27, 2020. The German study concluded that 60% of recently recovered Covid-19 patients showed signs of inflamed heart muscle, a condition known as myocarditis.
  2. Those astonishing numbers were covered in nearly 400 news outlets.
  3. Soon after its publication, the paper was criticized for statistical and methodologic errors and underwent a “quiet correction” that indicated that many of the abnormalities were only marginally more common among those recovering from Covid-19 than among similar control individuals who had not had Covid-19.
  4. A few weeks later, on Sept. 11, 2020, a study out of Ohio State University showed that 15% of competitive athletes who had recovered from Covid-19 had abnormalities on cardiac magnetic resonance scans. This study, of just 26 athletes, was entirely lacking in controls and in fact found similar abnormalities among elite athletes without Covid-19.
  5. But the news coverage and social media posts continued at a frenzied pace. College sports nearly stopped
  6. In January 2021, University of Wisconsin researchers studied 145 student athletes who had Covid-19 and found myocarditis in only 1.4% of them, none of whom required hospitalization.
  7. In March, a group of sports cardiologists also reported on nearly 800 professional athletes who had tested positive for Covid-19. Less than 1% of these athletes had abnormal findings on cardiac magnetic resonance scans
  8. To sum up: The issue of Covid-19 induced cardiac problems was massively overblown.

The pandemic injected fear in big doses – The most fear-inducing aspect of Covid-19 is its unpredictability. During the pandemic, the timeline from receipt to publication of medical studies was eight times faster than the year before and Covid-19 related articles were also of significantly lower scientific rigor. 

We can take away two lessons from the Covid-19 myocarditis story:

  1. SARS-CoV-2 can sometimes, though rarely, cause heart inflammation — just as many other viruses do.
  2. Science communication in times of crisis must keep a level head. The public and decision-makers need properly controlled studies instead of early sensational reports.

So people who have recovered from Covid-19 have no special reason to worry about their hearts. Instead, we should all worry about the incentives in the modern media world and why we got so far ahead of ourselves..


  • COVID-19 deaths in the U.S. have dipped below 300 a day for the first time since the early days of the disaster in March 2020. The drive to put shots in arms also approached an encouraging milestone Monday: 150 million Americans fully vaccinated.
  • The coronavirus was the third leading cause of death in the U.S. in 2020, behind heart disease and cancer, according to the Centers for Disease Control and Prevention. But CDC data suggests that more Americans now are dying every day from accidents, chronic lower respiratory diseases, strokes or Alzheimer’s disease than from COVID-19.
  • On Tuesday, the clinic at the Pennsylvania Convention Center offered two Phillies tickets to anyone who got a shot. The result was one of the busiest days at the clinic in weeks, and the 1,000 tickets were all claimed by the end of the day. Hispanic recipients got 30% of the tickets, and 23% went to Black Philadelphians. The Health Department is partnering with Wawa and the city’s professional sports teams to continue offering prizes for people who get the shots. A lottery also allows anyone who gets vaccinated to be eligible for cash prizes from $1,000 to $50,000.
  • As of this week, 70% of Philadelphia adults have received at least one dose of a COVID-19 vaccine, city officials announced Monday. Just under 56% of Philadelphia adults have been fully vaccinated. At least 693,885 Philadelphians have been fully vaccinated, and at least 874,278 have received one dose. With the rise of new variants of the coronavirus, including the “delta variant” causing case spikes in the United Kingdom and Portugal, health experts have stressed the importance of getting a second dose to ensure adequate protection.
  • Health experts are worried about the spread of the highly contagious Delta variant“In the areas where they have large pockets of unvaccinated people, we can surely expect to see surges in cases, in some situations challenging the health care capacity of that local area,” said leading Infectious Disease expert Dr. Michael Osterholm on “CBS This Morning” In Springfield, Missouri only 32% of the surrounding county is vaccinated, and COVID-19 hospitalizations are up more than 210% since June 1. Perhaps most alarming—90% of all COVID samples being sequenced from that county are testing positive for the Delta variant and almost every COVID patient is unvaccinated. “The Delta variant is clearly going to be another wave. If you decide not to get vaccinated, this virus will still find you,” Osterholm said.
  • At least 70% of adults in the Commonwealth of Virginia have received at least one Covid-19 shot, and 60% of adults are fully vaccinated, Gov. Ralph Northam announced in a press briefing Monday. Northam added that Covid-19 case numbers, hospitalizations, and deaths from Covid-19 are the lowest they have been since the “early days of the pandemic” and the percent positivity is less than 1.5%.
  • The Foo Fighters rocked Madison Square Garden on Sunday night, with unexpected guest Dave Chappelle. It was The Garden’s first concert since the coronavirus pandemic shuttered venues in New York City in March 2020. The show was only for vaccinated fans and was the first 100% capacity concert in a New York arena since the start of the pandemic.
  • Flu cases nearly disappeared during the pandemic but it wasn’t the only winter bug affected by pandemic-related distancing and hygiene measures. Wisconsin researchers reported Monday they found a range of respiratory infections significantly down during the 2020-2021 flu season. Winter seasonal viruses (influenza, respiratory syncytial virus, and seasonal coronavirus) currently average 12 per month compared with 4,800 per month in previous seasons. Prescriptions for antibiotics fell by 79%.
  •  Border restrictions on nonessential travel between Canada and the U.S. will be extended until July 21, Canadian officials said Friday, as the country works to get a higher percentage of Canadians fully vaccinated. Canada’s Public Safety Minister Bill Blair said the move has been made in coordination with the U.S., where there are growing calls to open the border for nonessential travel like tourism. “We’re still seeing cases across the country and we want to get them down,” Canadian Prime Minister Justin Trudeau said.
  • Seeking to dispel fears, researchers at the University of Miami conducted a study to assess men’s fertility after COVID-19 vaccination and found no negative effects on their sperm. From Dec. 17, 2020, to Jan. 12, 2021, they recruited 45 healthy volunteers ages 18 to 50 who were scheduled to get the Pfizer or Moderna vaccine, according to the study published in JAMA Network. “It was an unknown area that was making guys nervous to get the vaccine,” said study co-author Jesse Ory, urology fellow in infertility/andrology at the University of Miami Miller School of Medicine.
  • The Biden administration plans to send 55 million COVID-19 vaccine doses overseas. The U.S. will distribute about 41 million through the U.N.-backed global sharing COVAX initiative which includes sending 14 million doses to Latin America and the Caribbean, about 16 million to Asia and about 10 million to Africa. The rest of the 55 million doses will be sent directly to specific countries including Colombia, Argentina, Haiti, other Caribbean community countries, Afghanistan, Bangladesh, Pakistan, Indonesia, South Africa, Nigeria, Egypt, Iraq, Yemen, Tunisia, West Bank and Gaza and Ukraine.
  • Tokyo 2020 announced on Monday that it will allow spectators at the Olympics this year amid the pandemic, setting a 50% cap at venues, up to a maximum of 10,000 people. Organizers did however warn that it could restrict the number of fans in the event of a state of emergency or amid any other restrictions to curb the rise of Covid-19 infections. Those attending the postponed Olympics will have to abide by a number of protocols aimed at stopping the spread of cases.
  • The Transportation Security Administration screened 2.1 million people at airports across the country on Sunday, the most since March 7, 2020.  The new pandemic record marks the fifth day this month that air travel figures have exceeded 2 million passengers, about 75% of a normal day for the airline industry pre-pandemic.  But carriers are struggling to keep up with the crush of passengers. American Airlines canceled 6% of all flights on Sunday. The airline cites labor issues with both its own crews and contractors and says it is rebooking passengers on new flights in advance through mid-July
  • All Italian regions, barring Valle d’Aosta, are entering the low-restriction “White Zone” category for Covid-19 social distancing measures starting Monday. The low-restriction “white zone” allows the regional authorities to drop most of the remaining coronavirus restrictions earlier than planned under the national roadmap for opening. To enter the “white zone,” a region must have fewer than 50 coronavirus cases per 100,000 inhabitants for three weeks consecutively.
  • Evidence suggests, even with the Delta variant, that serious versions of Covid will continue to be extremely rare in children. As you can see below, some common activities — and several other diseases — have caused significantly more childhood deaths than Covid has:

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Please stay safe and be smart,
Dr Bralow

Dr. Vicki Bralow
834 South Street
Philadelphia, Pa 19147