How steroids affect your muscles

If you’ve been prescribed a moderate or high dose of glucocorticoid (steroids), you may find that some everyday activities such as walking up stairs or lifting your arms above your head become more difficult. Sometimes these impacts are subtle, but at other times they can alter your ability to perform daily activities.

This condition is known as steroid-induced myopathy - from the Greek "myo", meaning muscle, and "pathy", meaning pathology or problem. In the context of steroid use, myopathy refers to muscle weakness caused by the loss of fast-twitch muscle fibers that can lead to weakness in the shoulder and hip muscles. It does not typically affect other muscle groups.

In people who are critically ill, such as in an intensive care unit, glucocorticoid-associated weakness may affect a wider variety of muscles and be more severe.

Why does this happen?

While steroids have saved countless lives and are vital in many situations, they are also known to cause the breakdown or “atrophy” of muscle fibers. Fast-twitch or “type 2b” muscle fibers that help with short, powerful bursts of activity are particularly vulnerable. Slow-twitch “type 1” muscle fibers, needed for longer-lasting activities, can also be affected, but usually to a lesser extent. 

The problem most commonly affects the muscles of the shoulders and hips, which allow you to lift objects above your head, raise your legs, and walk in a stable manner. Together, the problems resulting from muscle weakness in these areas can make movement uncomfortable, increase your risk of falling, and make it harder to get back up again if you have fallen. Even tasks such as getting in and out of a chair or getting out of the bathtub may become more difficult. 

Dr Jeffrey M. Gelfand, a neurologist at the University of California, UCSF, specializes in caring for people with neuroinflammatory conditions. He routinely needs to prescribe steroids to rapidly reduce brain inflammation or other problems in the nervous system and is keenly aware of the need to closely monitor patients for signs of muscle weakness in the shoulders and hips.

Dr Gelfand explains that steroids cause shoulder and hip muscle weakness by increasing the rate of muscle fiber breakdown, getting in the way of the muscles making new proteins, and lowering the levels of blood potassium and phosphate, which are important in the body’s muscle signaling processes.

What to look out for

When you take steroids, it’s important to pay close attention to any changes in your ability to climb stairs or lift things. If you become concerned about this, make a note of your symptoms and speak with your doctor as soon as possible.

Top tips for staying strong

Sometimes, instances of steroid-induced myopathy are identified in the clinic even before the patient has realized that there may be a problem with muscle strength. Other times, however, patients themselves recognize that there is a problem before their doctor does. Being informed about the potential for developing muscle weakness because of steroid use can help to limit the problem.

Dr Gelfand recommends that you: 

  • Stay as active as possible. Even a gentle daily walk can help.
  • Talk to your doctor to find out what type of resistance and endurance exercises you might be able to include in your daily routine.
  • Try to eat an adequate amount of protein-rich foods. The protein contained in meat, eggs, nuts, and beans can help slow the rate of muscle decline. 

The good news is that steroid-induced myopathy is generally completely reversible. Improvement is usually noticeable within 3 to 4 weeks of beginning a steroid taper (i.e., to reduce your daily dose). Full recovery can take months to a year. 

To hear more from Dr Gelfand, watch our film on steroid-induced myopathy.

“Steroid-induced muscle weakness is generally completely reversible”

 

The bottom line

Steroids are great for helping patients manage inflammatory and autoimmune conditions. However, they can have quite a significant effect on certain muscles, making it harder to perform some everyday tasks. By taking steps to protect yourself, such as staying active and eating well, you can help to keep yourself strong.

Remember, always consult your doctor before making any changes to your medication or lifestyle to ensure the best care for your specific health needs.