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Creatine and Your Spine: What the Evidence Shows

Creatine and your spine: wellbeing guide

By Mr Ahmed-Ramadan Sadek, Neurosurgeon · 9 min read

🎧 Listen to this guideAbout 7.5 minutes. Narrated in Mr Sadek’s voice using AI technology. General information only, not personal medical advice.

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Key points

  • Creatine is a natural substance made by the body and found in meat and fish. Muscles use it for short bursts of effort.
  • In older adults, creatine taken alongside strength training led to slightly bigger gains in muscle mass and strength than strength training alone in several pooled analyses. The gains are small, and the exercise does most of the work.
  • On its own, without exercise, creatine did not improve muscle or bone in a two-year trial in older women.
  • Large trials have not shown that creatine improves bone density.
  • We could find no trials of creatine for back pain or for recovery after spine surgery. Trials after knee surgery found no benefit.
  • In healthy adults, trials have not shown kidney harm, but creatine can raise a blood test used to check the kidneys. If you have kidney disease, are pregnant or take regular medicines, speak to your GP or pharmacist first.

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What is creatine?

Creatine is made in the body from amino acids, the building blocks of protein. It is also found in meat and fish. Most of it is stored in muscle, where it helps supply energy for short, hard efforts such as lifting or sprinting.[1]

It is one of the most researched sports supplements. An international sports nutrition society describes it as safe and effective in healthy people.[1] That position statement, and two later expert reviews, were written by researchers several of whom have received funding from, or advise, companies that make creatine.[1][2][3] That does not make them wrong, but it is worth knowing when you read claims about it online.

Why would creatine matter for the spine?

Strong muscles around the trunk, hips and legs support the spine and help with everyday tasks such as getting up from a chair, lifting and walking. Muscle mass and strength fall with age, a process called sarcopenia, and they fall faster during illness, bed rest or time off after an injury or operation.[4][5]

The question is whether creatine adds anything to what exercise already does. It is not a treatment for back pain or for any spinal condition.

Muscle strength and mass in older adults

This is where most of the evidence is. Several pooled analyses of randomised trials have looked at creatine or a dummy (placebo) taken alongside a strength training programme in adults in their late 50s to 70s:

  • A 2014 analysis of 357 older adults found that creatine plus strength training led to more gain in lean (fat-free) mass and in chest and leg press strength, and better performance on a 30-second chair stand test, than training alone.[6]
  • A 2017 analysis of 22 trials with 721 people found an average extra gain of about 1.4 kg of lean tissue, with small extra gains in upper and lower body strength.[7]
  • A 2025 analysis of 8 trials with 482 people found small extra gains in leg strength and lean mass, but not in upper body strength. The benefit was clearest in programmes lasting up to 32 weeks.[8]
  • Another 2025 analysis of 20 trials with 1,093 older adults found improvements in strength and body fat, but not in bone density.[9]
  • A 2024 analysis by a London critical care group pooled 33 trials in older adults and people with long-term illness. Creatine improved sit-to-stand performance, grip and upper body strength and lean mass, but the authors rated the quality of evidence as low or very low because of a high risk of bias.[5]

A 2026 analysis in women after the menopause found small gains in lean mass and leg strength only when creatine was combined with strength training. Trials without strength training showed no measurable effect.[10] This fits a two-year trial in 200 older women with thinning bones, where creatine on its own, without a training programme, did not increase muscle mass or improve muscle function.[11]

In plain terms: if you are older and doing regular strength exercise, creatine may add a small extra gain in muscle and strength. It does not replace the exercise.

Recovery after injury, immobilisation or surgery

Results here are mixed and the trials are small:

  • In 22 young healthy volunteers whose leg was put in a cast for two weeks, those taking creatine during the following 10 weeks of rehabilitation regained thigh muscle size and power faster than those taking a placebo.[12]
  • In a trial of 60 people having anterior cruciate ligament (ACL) knee reconstruction, creatine made no difference to strength recovery over the first 12 weeks, or to function at six months.[13]
  • In a trial of 37 people having a knee replacement, creatine taken before and after surgery did not improve muscle strength, body composition or recovery.[14]

A 2021 review of creatine in medical rehabilitation called some findings “encouraging” but said the results were not consistent, with too few small studies to draw firm conclusions.[4]

Bone density

Creatine has been suggested as a way to protect bone, but the trials so far are disappointing:

  • A 2018 analysis of 5 trials found no extra effect of creatine plus strength training on bone density of the whole body, hip or lumbar spine compared with training alone.[15]
  • A two-year trial in 237 women after the menopause, all doing strength training and walking, found no effect on bone density at the hip or lumbar spine. There were small improvements in some measures of hip bone shape linked with bending strength.[16]
  • The two-year trial in 200 older women mentioned above found no effect on bone density, bone markers, falls or fractures.[11]
  • The 2025 and 2026 pooled analyses also found no clear effect on bone density.[9][10]

Creatine should not be used in place of proven ways to protect bone. Our guide on diet and spinal health covers calcium and vitamin D, and our supplements guide covers the evidence for vitamin D and fracture.

Back pain and spine surgery

We searched PubMed in October 2026 and could not find any randomised trials of creatine for low back pain, neck pain or recovery after spine surgery. There is no evidence that it eases back pain, helps discs heal or improves the result of spinal surgery.

If you are recovering from spine surgery, the things with real evidence are gradually building up walking and activity, following your physiotherapy plan, eating well and, if you smoke, stopping. Our guide on pain after spine surgery explains what usually helps. If you have had a fusion, see our smoking and spinal health guide for why stopping smoking matters so much.

Is creatine safe?

Kidneys

The main worry people have is the kidneys. Creatine is broken down into creatinine, the substance measured in the standard kidney blood test. Two recent pooled analyses of trials found:

  • a small rise in blood creatinine with creatine, but no change in the estimated filtration rate (a measure of how well the kidneys clean the blood).[17][18]
  • that this rise is most likely due to creatine being broken down, not kidney damage.[17]

The 2026 analysis said longer trials, over more than a year, are still needed to be sure about kidney safety.[18] These trials were mainly in people without kidney disease.

Practical point: if you take creatine, tell your GP or the person arranging any blood test. Otherwise a higher creatinine result could be mistaken for a kidney problem.

Hydration and cramps

Online claims that creatine causes dehydration or muscle cramps are common. Expert reviews of the trial evidence have not found that it does.[2][19] An expert review found that the most common side effect is holding some extra water in the first several days, which can show as a small rise in body weight.[2] Drink normally and follow NHS advice on fluids, particularly in hot weather and during exercise.

Medicines and other conditions

We do not list specific interactions here. As a general rule, speak to your GP or pharmacist before taking creatine if you:

  • have kidney disease, or have been told your kidney function is reduced
  • have liver disease or diabetes
  • take any regular prescribed medicines, particularly medicines that can affect the kidneys
  • are pregnant, breastfeeding or under 18
  • are due to have surgery (tell your surgical and anaesthetic team about all supplements)

Never stop a prescribed medicine to take a supplement.

How much to take

We do not give amounts in our guides. If you decide to try creatine, follow the product label and NHS advice, and speak to your GP or pharmacist, particularly if any of the points above apply to you.

Product quality

In the UK, supplements are sold as foods, not medicines. They are not tested or licensed in the way medicines are, and the seller is responsible for making sure they are safe and correctly labelled.[20]

  • A 2026 review of supplement contamination found the risk is highest in multi-ingredient products, “pre-workout” products, muscle-building and weight-loss products, and those sold as “testosterone boosters”. It recommended products with independent (third-party) testing.[21]
  • A review of US regulator warnings found that some products sold for muscle building contained hidden steroid-like ingredients.[22]

If you choose creatine, a single-ingredient product from a reputable UK supplier, with independent batch testing, is safer than a blend. Be wary of products that promise to “rebuild discs”, “fix back pain” or “reverse ageing”.

What is still unknown

  • Whether creatine helps people with back pain or other spinal conditions. There are no trials.
  • Whether it helps recovery after spine surgery. Trials after knee surgery were negative.
  • Long-term kidney safety beyond a year, and safety in people with kidney disease.
  • Whether the small gains in muscle seen in trials make a real difference to falls, independence or fractures.
  • Whether it helps without regular strength exercise. So far, it appears not.

When to get help

This follows the NHS advice on back pain.[23]

See a GP if you have back pain and:

  • it does not improve after treating it at home for a few weeks
  • it is stopping you doing your day-to-day activities
  • you are worried about the pain or struggling to cope
  • you have lost weight without trying to

Also see a GP if you are losing muscle strength quickly, or you have side effects you think may be from a supplement.

Ask for an urgent GP appointment or get help from 111 if you have back pain and:

  • you feel hot, cold, shivery or generally unwell
  • it is severe pain that starts suddenly, or it is getting worse quickly

Call 999 or go to A&E if you have back pain and:

  • pain, tingling, weakness or numbness in both legs
  • a loss of feeling around your genitals or anus
  • changes in your bladder or bowels, such as difficulty peeing, or peeing or pooing yourself
  • changes in how your penis or vagina feels during sex, not being able to get or keep an erection, or not being able to orgasm
  • chest pain
  • it started after a serious accident, such as a car accident

Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance.[23] Problems with the bladder, bowels or feeling around the genitals can be signs of cauda equina syndrome.

Frequently asked questions

Will creatine help my back pain?

There is no evidence that it does. No trials have tested it for back pain. Staying active and a guided exercise programme have much better evidence.

I am over 60. Should I take creatine to keep my muscles strong?

Strength exercise is the most important part. Trials suggest creatine may add a small extra gain when taken alongside strength training, but not on its own. If you are thinking about it, speak to your GP or pharmacist, especially if you take regular medicines.

Is creatine a steroid?

No. It is a natural substance found in muscle, meat and fish, and it works differently from anabolic steroids, which are drugs.[2] The concern is that some muscle-building blends have been found to contain hidden steroid-like ingredients, which is one reason to avoid multi-ingredient products.[22]

Does creatine damage the kidneys?

Trials in healthy adults have not shown kidney damage, but it raises the creatinine level in kidney blood tests.[17][18] If you have kidney disease, do not take it without medical advice. Always tell your doctor you take it before a blood test.

Should I take creatine before or after my spine operation?

There is no evidence that it helps recovery after spine surgery, and trials after knee surgery found no benefit.[13][14] Tell your surgical and anaesthetic team about any supplement you take, and follow their advice.

Can creatine strengthen my bones or prevent osteoporosis?

The trials so far say no. Large two-year trials found no effect on bone density.[11][16] Talk to your GP about proven ways to protect your bones.

Is creatine safe for women?

Trials in women after the menopause found no more side effects than placebo, and kidney blood measures were unchanged.[10] Pregnant and breastfeeding women should speak to their GP or midwife before taking any supplement.

How do I choose a product?

Choose a single-ingredient product from a reputable supplier with independent batch testing. Follow the label, and avoid blends that also contain stimulants or “boosters”.[21]

References

  1. Kreider RB, Kalman DS, Antonio J, et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr. 2017;14:18. Link
  2. Antonio J, Candow DG, Forbes SC, et al. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show? J Int Soc Sports Nutr. 2021;18(1):13. Link
  3. Antonio J, Brown AF, Candow DG, et al. Part II. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show? J Int Soc Sports Nutr. 2025;22(1):2441760. Link
  4. Harmon KK, Stout JR, Fukuda DH, et al. The application of creatine supplementation in medical rehabilitation. Nutrients. 2021;13(6):1825. Link
  5. Davies TW, Watson N, Pilkington JJ, et al. Creatine supplementation for optimization of physical function in the patient at risk of functional disability: a systematic review and meta-analysis. JPEN J Parenter Enteral Nutr. 2024;48(4):389-405. Link
  6. Devries MC, Phillips SM. Creatine supplementation during resistance training in older adults: a meta-analysis. Med Sci Sports Exerc. 2014;46(6):1194-1203. Link
  7. Chilibeck PD, Kaviani M, Candow DG, Zello GA. Effect of creatine supplementation during resistance training on lean tissue mass and muscular strength in older adults: a meta-analysis. Open Access J Sports Med. 2017;8:213-226. Link
  8. Liu S, Huang N, Wu W, et al. The impact of creatine supplementation associated with resistance training on muscular strength and lean tissue mass in the aged: a systematic review and meta-analysis. Eur Rev Aging Phys Act. 2025;22(1):26. Link
  9. Sharifian G, Aseminia P, Heidary D, Esformes JI. Impact of creatine supplementation and exercise training in older adults: a systematic review and meta-analysis. Eur Rev Aging Phys Act. 2025;22(1):17. Link
  10. Naddafha S, Antonio J, Kreider RB, Stout JR. Creatine monohydrate for lean mass, strength, and bone density in postmenopausal women: a systematic review and meta-analysis. J Int Soc Sports Nutr. 2026;23(1):2668435. Link
  11. Sales LP, Pinto AJ, Rodrigues SF, et al. Creatine supplementation (3 g/d) and bone health in older women: a 2-year, randomized, placebo-controlled trial. J Gerontol A Biol Sci Med Sci. 2020;75(5):931-938. Link
  12. Hespel P, Op’t Eijnde B, Van Leemputte M, et al. Oral creatine supplementation facilitates the rehabilitation of disuse atrophy and alters the expression of muscle myogenic factors in humans. J Physiol. 2001;536(Pt 2):625-633. Link
  13. Tyler TF, Nicholas SJ, Hershman EB, et al. The effect of creatine supplementation on strength recovery after anterior cruciate ligament (ACL) reconstruction: a randomized, placebo-controlled, double-blind trial. Am J Sports Med. 2004;32(2):383-388. Link
  14. Roy BD, de Beer J, Harvey D, Tarnopolsky MA. Creatine monohydrate supplementation does not improve functional recovery after total knee arthroplasty. Arch Phys Med Rehabil. 2005;86(7):1293-1298. Link
  15. Forbes SC, Chilibeck PD, Candow DG. Creatine supplementation during resistance training does not lead to greater bone mineral density in older humans: a brief meta-analysis. Front Nutr. 2018;5:27. Link
  16. Chilibeck PD, Candow DG, Gordon JJ, et al. A 2-yr randomized controlled trial on creatine supplementation during exercise for postmenopausal bone health. Med Sci Sports Exerc. 2023;55(10):1750-1760. Link
  17. Naeini EK, Eskandari M, Mortazavi M, et al. Effect of creatine supplementation on kidney function: a systematic review and meta-analysis. BMC Nephrol. 2025;26(1):622. Link
  18. Tsiaras A, Loufopoulos G, Theodoridis X, et al. The effect of creatine supplementation on kidney function: a systematic review and meta-analysis of randomized controlled trials. J Ren Nutr. 2026 (online ahead of print). Link
  19. Dalbo VJ, Roberts MD, Stout JR, Kerksick CM. Putting to rest the myth of creatine supplementation leading to muscle cramps and dehydration. Br J Sports Med. 2008;42(7):567-573. Link
  20. Food Standards Agency. Food supplements: guidance for businesses. GOV.UK. Link
  21. Mancin L, Close GL, Jeukendrup A, et al. Reducing the risk of unintentional doping from supplements: a practical guide for athletes and support teams. Transl Sports Med. 2026;2026:5919439. Link
  22. Tucker J, Fischer T, Upjohn L, et al. Unapproved pharmaceutical ingredients included in dietary supplements associated with US Food and Drug Administration warnings. JAMA Netw Open. 2018;1(6):e183337. Link
  23. NHS. Back pain. NHS website. Page last reviewed 5 March 2026. Link

This article is general information and is not a substitute for advice about your own situation. Please speak to your GP or specialist before making any change to your treatment.

Last checked: October 2026