If climbing the stairs, getting up from a low chair, or lifting a bag of groceries has become harder since you started steroids, you are far from alone. Muscle weakness is one of the side effects other Sam visitors talk about most, and it can feel like your body has quietly changed without asking you first.
As Caroline Donovan of the Lupus Research Alliance puts it:
"Several have spoken about their experiences with weakening bones, fragile skin, muscle deterioration, weight gain, and cataracts. All of this has greatly impacted their quality of life and how they view their future."
The encouraging news is that muscle can come back. Here is how to rebuild muscle strength at a pace your body can handle, whether you're taking prednisone or similar steroid medicines, like prednisolone, methylprednisolone, and dexamethasone.
What to expect as you recover
Steroids speed up muscle breakdown and slow how quickly your body builds new muscle. The large muscles around your hips, thighs, and shoulders are usually affected most.
Strength tends to return as your steroid dose comes down, though it takes time. Some days you will feel stronger than others, and that is normal. If you are still tapering, aches and tiredness can also come from your body adjusting to a lower dose Avoiding the pain of additional side effects when reducing your steroids.
Build up a little at a time
Muscles grow stronger when you ask them to do slightly more than they are used to, and then give them time to recover. That might mean one extra sit-to-stand, a slightly firmer resistance band, or a few more minutes of walking each week.
A physical therapist is the best person to set your starting point and decide how quickly to progress. They can take your condition, your bones, and your energy levels into account.
Most people do well with strength work two or three times a week, with rest days in between.
Feeling better is a good sign. It’s also the moment to build up slowly.
Look after your tendons
Tendons connect muscle to bone, and steroid tablets can make both more fragile. In one large study, people taking oral steroids every day had around three times the risk of a tendon tear, mostly in the Achilles tendon at the back of the heel. The risk was higher at larger doses and fell after treatment stopped. Inhaled steroids did not raise the risk.
A few simple habits help protect your tendons:
- Warm up slowly and increase effort gradually, especially with jumping, running, or climbing.
- Stop and contact your doctor if you feel sudden pain, a snap, or swelling at the back of your heel or calf.
- If you are prescribed an antibiotic such as ciprofloxacin or levofloxacin, mention that you take steroids. Taking the two together raises the risk of tendon problems, so your doctor may choose a different antibiotic.
Fuel your muscles with protein
Muscles need protein to rebuild. A common guideline for older adults is around 0.45 to 0.54 grams of protein per pound of body weight each day, or about 68 to 82 grams for someone who weighs 150 pounds. Eggs, fish, chicken, beans, yogurt, and tofu are all good sources, and spreading protein across meals can make it easier to reach your target.
If you have kidney disease, please check with your doctor first, as some people need to eat less protein.
What about creatine?
Creatine is a popular supplement for building strength. In one small study of people with myositis who were taking steroids or other immune-calming medicines, creatine combined with home exercise improved physical function more than exercise alone, with no serious side effects.
There is one important thing to know before trying it. Creatine raises creatinine levels in your blood, one of the main tests doctors use to check your kidneys. The kidneys themselves may be unaffected, but the result can look worrying on paper. If your kidneys are monitored as part of your care, talk to your doctor before you start so they can read your results correctly.
When to ask for a physical therapy assessment
Ask your doctor about a referral if you are struggling with stairs, getting up from chairs, or feeling unsteady on your feet. A physical therapist can measure your strength, check your balance, and build a plan that grows with you.