Steroid medication – friend or foe?

What is a steroid — and why is it so divisive?

First, let’s clear up a common misunderstanding. What we are talking about here is a corticosteroid: a synthetic, medicinal version of your own hormone called cortisol, produced in the adrenal cortex. It powerfully reduces inflammation and suppresses the immune system. It has nothing to do with the anabolic steroids used to build muscle and notorious for misuse — the two are related in name only.

When is it a friend? When it may even save a life

This is important to say, because some people reject necessary treatment after reading horror stories online — and put themselves at risk as a result. There are situations in which a steroid is not an option, but a necessary, potentially life-saving tool.

In a severe allergic reaction (anaphylaxis) — for example after a wasp sting or peanut allergy — a steroid may be part of rapidly administered medical treatment and can help stabilise the condition. In autoimmune diseases — lupus, vasculitis and severe rheumatoid arthritis — a flare-up can damage vital organs such as the kidneys, lungs and blood vessels; in these cases, a steroid buys the time needed to establish long-term treatment. It may also play a key role in severe worsening of asthma and COPD. In these situations, the balance is clear: the benefit of the steroid often far outweighs its risk.

There is also a middle ground: short, targeted courses. A steroid treatment lasting a few days or weeks and supervised by a doctor does not cause lasting problems in most people. The real setting for side effects is continuous use over months or years.

How does it work, and what forms can you take?

When does it become a foe? The price of long-term use

According to research, the overwhelming majority of people who take steroids regularly for a longer period — up to 90% in some surveys — develop some kind of side effect. Not all are serious, but it is worth knowing about them because most are initially unnoticed:

Joint or musculoskeletal problem? Don’t rely on steroids alone

Now we come to the most important part of the article — the part that people living with musculoskeletal problems need to read right through. Steroid injections are still widely given for knee osteoarthritis, shoulder pain, tennis elbow and spinal problems — and they do work in the short term: the pain eases within days. That is precisely the trap.

Research consistently shows that with joint and tendon problems, the effect of steroids reverses over time: the first injection helps a lot, the next one helps less and for a shorter time, while regular repetition not only fails to improve the long-term outcome but may worsen it — at the expense of cartilage and tendon tissue.^2,4 A steroid switches off the pain, but it does not treat the cause of the problem — weak muscles, an overloaded tendon or worn cartilage. What is more, during the pain-free weeks many people continue to load the joint in the same way, so the underlying problem quietly worsens.

What do I suggest instead? A two-pronged strategy — and keep the steroid for what it is: occasional firefighting.

The first pillar is strengthening the muscles and tendons. Your joint’s main protector is the strong muscle around it: it takes over part of the load, stabilises the joint and nourishes the cartilage — cartilage is nourished by movement. A strengthening programme prepared by a physiotherapist and regular, gentle exercise (walking, cycling, swimming, water exercise) do not merely treat the symptoms; they address the cause. Research shows that in knee osteoarthritis, consistent physiotherapy produced better results after one year than a steroid injection³ — it works more slowly, but its effects last longer.

The second pillar is complementary physiotherapy using natural forms of energy. These methods work not with chemical substances but with physical stimuli — light, sound, electrical impulses and magnetic fields — so they do not burden the stomach, bones or blood sugar. Therapeutic ultrasound and soft laser may support local blood circulation and cellular regeneration in the treated area; magnetotherapy (PEMF) may support tissue repair; TENS can help dampen pain signals; microcurrent may support energy production in damaged tissues; and EMS can help rebuild weak muscles — serving precisely the first pillar. The aim is not to “replace” steroids overnight, but to gradually reduce the need for them: if pain can be kept under control with physiotherapy and exercise, you need to call in the fire brigade less often. 

What does the research say?

Practical advice for people taking steroids

The lowest dose, for the shortest possible time. This is the golden rule of steroid treatment — and you have the right to ask your doctor whether your dose follows it and when it may be time to try reducing it.

Prefer local forms where appropriate. If your problem is local — skin, one joint or the airways — local treatment (cream, injection or inhaler) generally causes fewer whole-body side effects than tablets. This is also a medical decision — but you are allowed to ask.

Attend check-ups. During long-term use, regular monitoring of blood pressure, blood sugar, the eyes and bone density is not excessive caution, but part of the treatment. Most side effects can be managed well when detected early.

Keep moving — especially because of the steroid. Long-term use may cause muscle weakness and bone loss; regular strengthening and weight-bearing exercise work against both. For someone taking steroids, exercise is not optional but vital.