Exercising too much might cause back ‘knots’

Q: My wife is 69 and in very good health, exercising at least two hours a day. She has suffered from “knots” in her back for more than 10 years. It is extremely painful, often bringing her to tears. It comes on suddenly at any time of the day or night. A glass of wine is the only reliable relief, and it lasts only a few hours. Is there any recourse to this condition?

A: The fact that it comes on suddenly, can be felt as tightness and gets a bit better with alcohol makes me strongly suspect she is having muscle spasms. These most often come on in the legs and feet, but they can affect the back, too.

Two hours a day of exercising sounds like a lot. She might be overexercising some muscles, and possibly not exercising others. This can lead to imbalances in muscle strength. Another common problem stemming from exercising is inadequate stretching. Stretching is the first place to start for many people with muscle cramps. A physical therapist or physiatrist might be of immense benefit, and she should explain in detail what her exercise regimen is. We are taught to think carefully of the mechanism of injury, and I am concerned that the exercise might be that injury.

Abnormalities in electrolytes (blood salts, especially potassium, sodium, magnesium and phosphate) are only rarely the cause, although many people write me that they have been helped by taking one or more of these. Primary muscle diseases, side effects from medications and inadequate hydration are possible, but also unlikely.

In absence of detailed knowledge about her exercise regimen, I’d recommend she try backing off a bit, maybe using ice after exercise, stretching the back under supervision and trying a hot bath or shower before bed.