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Stretch PT's Kim Nartker — Part 2: Why Do I Have Back Pain?

Published December 21, 2017

This is part 2 in a series of 3 written by Stretch PT's Kim Nartker about why we develop back pain and how to treat your painful symptoms. Read part 1 here.

Kim Nartker is the founder, and CEO of Stretch Physical Therapy and class president of the Physical Therapist Assistant program. Since the inception of her physical therapy clinic, she has opened two others all with the goal to sincerely help patients diagnosed with chronic back pain disorders. Take it away Kim.

Last month, I spoke about symptoms, testing, and treatment options for patients diagnosed with a herniated disc because, in order to properly diagnosis and treat the painful areas, you need to be tested by a physician or specialist in order to learn where the cause of the pain is coming from. We can't fix what we don't understand.

Now, the second most common cause of back pain and sciatica is a group of three conditions that normally appear as a result of one another.

These conditions include:

  1. Arthritis
  2. Degenerative Disc Disease (DDD)
  3. Spinal Stenosis

Here I will break down those three conditions.


We are seeing more and more arthritis in the 35 and older age group than ever before. Typically, symptoms begin as stiffness in the morning, which goes away as the patient begins to move. This is easily fixed, if caught early. If a person already has Degenerative Disc Disease (DDD) then it gets a little more complicated, but it's still fixable.

Degenerative Disc Disease

DDD is a disc, typically L4-L5 that has less fluid due to age and joint force over time. I tell my patients that when they are young the disc in your spine is similar to a fresh grape. When it is degenerative, it's more like a raisin causing the space between the spinal bones (vertebrae) to shrink is due to the degeneration causing pressure on the nerve. Usually, arthritis (bone growth and inflammation) has set in with this so the joint L4-L5 is restricted and is no longer moving in the directions that it should. Physical therapy can help, however, if left untreated, it can cause other spinal issues.

Spinal Stenosis

Stenosis is typically found in people ages 50 and older. It's a narrowing of the foramen, which is the space between the spinal cord where the nerve comes out. Arthritis and DDD narrow the disc causing the nerve to be pinched and makes it difficult for the patient to stand upright without pain.

The patient with stenosis has pain while standing tall and walking. Usually, they have to lean on the grocery cart to take the pressure off of the nerve. This too is fixable.

A successful treatment would use a hands-on joint mobilization of the L1-L5, hips, as well as the thoracic spine to make sure all restrictions are addressed. Then, you need to re-fire the hamstrings, glutes, and a series of muscles that are attached to the spinal column known as the multifidus muscles in order to stabilize the spine. A proper maintenance program is necessary to keep things moving and to avoid surgery. Decompression alone is not an effective treatment program.

And we need to take spinal stenosis seriously because — apart from a herniated disc — it's actually the number one reason people get surgery. Plus, surgery is not 100 percent effective because it scrapes the disc and fuses the area, which can cause the other joints to get arthritis and DDD. This essentially starts a bigger spiral for more surgeries.

A spine specialist and a physical therapist can work with you to find the root cause while fixing your discomfort without the need for surgery.

Kim Nartker working a patient's lower back.Caption: Here you see me working on a patient's lower back as I perform hands-on joint mobilization to the affected area.

For more information, resources, and exercise examples, you can visit my website under the “back pain” tab for a free self-test to see if you have stenosis, which you can find here,

Stretch Physical Therapy & Total Wellness takes a systematic approach to physical therapy. Focusing on finding the cause of your pain and providing a proven solution that will help you live pain-free as you age is their mission. They offer physical therapy, personal training, weight loss, effective stretching in a group or one-on-one sessions that are designed to get the best results.

Nartker is from Plains, Georgia, and has resided in Ohio since 2004. If any of you Backers happen to reside in that area too, feel free to stop by. And, if you don't live close, please don't hesitate to reach out to her directly.

Office Phone Number: 513-874-8800
Personal Email: [email protected]
Address: 4851 Wunnenberg Way, Suite D West Chester, Ohio 45069

Updated: January 27, 2019

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  • Lumbar spinal stenosis is a narrowing of the spinal canal that puts pressure on the spinal cord and its surrounding nerves. Stenosis can be caused by scoliosis, age, obesity, or trauma.