From the Guidelines
Steroids can contribute to muscle weakness, including back muscles, through several mechanisms when used long-term, particularly with prolonged use at higher doses. Corticosteroids, such as prednisone, dexamethasone, or cortisone, can cause muscle atrophy and weakness as a side effect, leading to muscle wasting over time 1. This occurs because corticosteroids promote protein breakdown and inhibit protein synthesis in muscle tissue, affecting muscles throughout the body, including the back. Additionally, corticosteroids can cause bone loss (osteoporosis), which may indirectly affect back health by weakening vertebrae and increasing fracture risk.
Some key points to consider:
- The effect of corticosteroids on muscle weakness is dose-dependent, with higher doses and longer durations of use associated with greater risk of muscle atrophy and weakness 1.
- The impact of corticosteroids on body composition can be profound, resulting in central deposition of adipose tissue and a catabolic effect on bone and muscle 1.
- Anabolic steroids, such as testosterone, typically increase muscle mass rather than decrease it, but abrupt cessation after long-term use can lead to temporary muscle weakness as the hormonal system readjusts.
- To minimize muscle-weakening effects when corticosteroids are medically necessary, doctors typically prescribe the lowest effective dose for the shortest duration possible, sometimes recommending weight-bearing exercise and physical therapy to maintain muscle strength.
It is essential to weigh the benefits and risks of corticosteroid use, considering the potential for muscle weakness and other adverse effects, particularly in patients with pre-existing muscle or bone conditions. Regular monitoring and adjustments to treatment plans can help mitigate these risks and optimize outcomes for patients requiring corticosteroid therapy 1.
From the Research
Steroids and Back Muscles
- The use of corticosteroids has been associated with various adverse effects, including toxicity to articular cartilage and numerous systemic side effects such as increases in blood glucose levels, a reduction in immune function, and an increased risk of infections 2.
- Prolonged, high-dose corticosteroid use has been linked to complications including avascular necrosis, gastrointestinal bleeding, myocardial infarction, heart failure, cerebrovascular events, diabetes mellitus, psychiatric syndromes, ophthalmic complications, tuberculosis reactivation, and bacterial sepsis 3.
- There is no direct evidence in the provided studies to suggest that steroids specifically weaken back muscles.
- However, muscle relaxants may be useful for acute low back pain, and their utilization varies for the treatment of acute and chronic pain 4, 5.
- For acute low back pain, muscle relaxants and NSAIDs may be superior to placebo for reducing pain, but the effects of opioids, antibiotics, and antidepressants are unknown 6.
Treatment of Low Back Pain
- Pharmacologic management of acute pain should be tailored for each patient, including a review of treatment expectations and a plan for the time course of prescriptions 4.
- Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatment options for most patients with acute mild to moderate pain 4.
- NSAIDs may have a role in managing acute and chronic low back pain, with cautious use in people who may be at greater risk of experiencing adverse events 6.