Glucocorticoids for herniated disc treatment and injury risk

Medical Q&A [Moderated]
1

Hey there!

This is a follow-up on my previous thread (which was moved to Pain & Rehab but not approved) regarding undiagnosed leg pain. I’ve since had a number of different doctor appointments which leave me with a few open questions that I’d appreciate to get some input on from you.

I’ll try summarize:

  1. Pain in back side of left upper leg that has started around 8 weeks ago (no trauma/injury) and since has gradually worsened (no numbness or other symptoms except the pain)
  2. MRI imaging of leg shows no abnormalities
  3. MRI imaging of spine shows disc herniation (L5/S1) and compression of S1 nerve root (left) that seems to match with the symptoms
  4. Neurological tests (ENoG) show no abnormalities
  5. Orthopedist suggested trying conservative therapy first → Dexamethasone for one week and starting physical therapy. Wait for improvement within two weeks, then consider further steps like surgery for herniation removal My questions:
  6. What do you think of disc herniation treatments using glucocorticoids?
  7. Glucocorticoids seem to have side effects that can include weakening of the musculoskeletal system. Does one week of Dexamethasone likely increase my risk of muscle or tendon injuries? Should I lower the load to lower intensities/RPE for a while (especially for bench and movements that are unaffected by the herniation) or is this rather a risk worth noting when being on these drugs for several weeks/months?
  8. Does the rehab of disc herniations differ if there was no direct movement/trauma causing the herniation? I wasn’t able to squat and deadlift for the past few weeks regardless of weight and therefore stopped doing so before there was a clear diagnosis of the injury. After reading and listening to a lot of your pain & rehab material, I meanwhile think it would probably be wise to slowly start squatting and deadlifting again. I would cut the range of motion to where it is pain free and slowly add weight on the bar on a weekly basis or so. Does this make sense or should I wait for the dexamethasone to do its job for 1-2 weeks, in case surgery is necessary afterwards?
  9. Is it possible or likely this herniation will have long term effects on competitive powerlifting? E.g. lifting related re-injuring of the already impaired disc during a max effort attempt?

Thanks a lot in advance. Your material out there has helped me a lot already and I’m really grateful for that.

2

Hey there,

Apologize for that previous thread slipping through the cracks.

1/2) In general, systemic/oral glucocorticoids (like dexamethasone, prednisone, etc.) do not have clear benefit for this kind of situation. If I were training while on glucocorticoids, then yes, I would be reducing intensities while taking them.

  1. The rehab does not inherently need to differ, but as with any other injury it should be designed and adjusted based on the individual’s baseline fitness, tolerance, limitations, and goals. If you can get moving in the desired movement patterns again, even if gradually or partially, that would be wise. I would not set any specific / rigid timeline on load increments, though.

  2. Unlikely to have long-term effects, although risk is never zero either. This is difficult to answer without having evaluated you myself - and I do think that in your situation it would likely be helpful to pursue a consultation with our rehab team (even if just a one-time appointment to talk though all of this and design a plan).

Glad you have found the material helpful.

3

Thank you for the fast and informative response!

I will consider a consultation with the rehab team within the next few days. Sure seems to be worth doing for something that affects both my long term health and passion, even more so because I think I’d be in good hands at BBM.

4

As far as I’ve understood BBM material, herniated discs seem generally not to be something worth worrying about long-term. Am I incorrect on this, or is it more specific to symptoms present that makes it different from NSLBP?

5

It depends on the associated signs & symptoms. Neurological complications increase the degree of concern significantly.

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6

Just to clarify, neurological symptoms being motor control or sensory perception issues specifically, rather than referred pain or sciatica?

7

Things like motor weakness, urinary / fecal incontinence or retention, saddle anesthesia, etc.

Sensory changes / paresthesia I don’t immediately worry about, although this is a more case-by-case consideration. Radicular pain alone similarly does not by itself dramatically change my initial management, although bilateral radicular pain would be more concerning.

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