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Get Back In The Game

Can cannabis help you recover from common sports injuries and perform better? Science offers hope.

It’s been ages since weekend warriors had any new DIY options for treating minor injuries, soothing muscle aches, and speeding recovery. Until recently, the choices were either popping OTC anti-inflammatories such as Advil and Aleve (risking bleeding ulcers and kidney damage), or asking your doctor to prescribe an opioid (risking addiction and death). But now there’s the cannabis option, and many athletes are embracing it.

Detailed human research is still evolving, and medical use of cannabis is complex enough that the most knowledgeable doctors have become specialists in cannabis care. But it’s not a widespread specialty, yet. So we’ve prepared this primer to help you understand how its various chemical compounds (called cannabinoids) work and whether you might benefit.

The Mechanism

Most folks think cannabinoids are foreign to the human body. But in 1992, scientists discovered we actually grow our own. They are called endocannabinoids, and they’re part of an endocannabinoid system (ECS). Unlike our motor and sensory systems, the ECS operates behind the scenes in a modulatory role, which is why it took ages to find.

“Think of little satellite dishes, like the one on your house, scattered throughout your body receiving signals,” explains Jordan Tishler, M.D., instructor of medicine, Harvard Medical School. “Those signals are the endocannabinoids. The function of the ECS is to keep our other systems in balance. That’s called homeostasis, and it’s a major job.”

It wasn’t long before researchers started trying to tweak this system by introducing cannabinoids from the cannabis plant. (There are at least 113 different types, including the most well known: THC and CBD.) One theory is that when you feel sick or sore, it may be because your ECS needs a boost. 

“Taking in cannabinoids could be thought of as supplementing or increasing the activity of your body’s existing system,” says Chris Carmichael, founder and CEO of Carmichael Training Systems in Colorado Springs. “Athletes apply greater stress to their bodies, leading to pain and inflammation greater than the ECS can handle. Adding a cannabinoid may help this overloaded system get neurotransmitters back under control.”

Dr. Tishler points out that this theory (the “endocannabinoid deficiency hypothesis”) is just that— a theory. “The interesting thing is we can now intervene in the body’s function with plant-derived chemicals that directly mimic our own internal stuff.” he says

Say, for example, you twist an ankle playing basketball. “That produces an inflammatory response at the ankle, as well as a neurologic response feeding pain signals to the brain,” he explains. “And then there’s all the complex stuff that happens in your head.” With cannabis, the potential is to treat and positively affect all of that.
With the caveat that our understanding of the ECS is still evolving, here’s a rundown of common ailments and how to potentially address them.

Athletes apply greater stress to their bodies, leading to pain and inflammation greater than the ECS can handle. Adding a cannabinoid may help this overloaded system get neurotransmitters back under control.”
—Chris Carmichael, founder and CEO of Carmichael Training Systems

The Treatments

Joint pain (short term): Sprained ankle, strained back, tennis elbow, cranky knee, sore shoulder: These are the types of minor injuries, with readily identifiable causes, that can be treated with cannabis. Dr. Tishler, who is the president of the Association of Cannabis Specialists, recommends inhaling whole cannabis flower with a quality vaporizer that’ll keep the temperature at a consistent 350⁰F in order to avoid carcinogens. “Inhalation is rapid onset and relatively short duration [3 to 4 hours] so it’s like taking an Advil but faster acting. It’s really good for acute or episodic things.”

Joint pain (long term): If you’re a long-distance runner with a problem knee that’ll eventually need surgery or an ex-jock with an arthritic hip that is heading toward replacement, Dr. Tishler recommends edibles. “Inhalation will give you a yo-yo effect—a spike of intoxication and pain relief, followed by a sloping off, after which you’ll need to take more. To treat chronic pain, you need something more consistent. Edibles are slow to work, which is why they’re not as good for acute pain, but once they start they work for 8 to 12 hours. Someone with constant, unremitting pain should look to the oral stuff as their primary approach.”

See Also How CBD Is Revolutionizing How Athletes Recover

What’s interesting about this chronic pain strategy is that it won’t actually get rid of the pain. Although cannabis has anti-inflammatory properties that help alleviate swelling and also mediate the body’s pain system, it does so in an almost philosophical way. “I tell my patients with chronic pain that cannabis isn’t going to make your pain go away. If I ask you, ‘Does your knee still hurt?’ you will answer, ‘Yeah, it still hurts.’ But when I ask, ‘Is it bothering you? You’ll say, ‘No.’ That’s the difference. Cannabis has its major effect on the suffering associated with pain.”

Headaches and concussion: A blow to the head causes varying degrees of inflammation, and recent research from McMaster University in Canada found that this plays a role in post-trauma symptoms such as headaches, dizziness, and difficulty thinking. Because of its anti-inflammatory properties, cannabis may help protect the brain if taken after a concussion. THC may also help flatten the mood swings that often accompany head trauma. 

Dr. Tishler says he successfully treats patients with tension and migraine headaches using inhalation rather than edibles because the pain is episodic. However, he notes that headaches post-exertion are often simply the result of dehydration. And when it comes to treating concussion, he points out that all the studies to date on head trauma and cannabis have been done with mice, so no definitive recommendation can be made for human athletes. Any blow to the head should be treated seriously and assessed by a doctor first.

General soreness (pre- or post-game):
To deal with minor aches and pains, many athletes take NSAIDs (non-steroidal anti-inflammatory drugs). But long-term use can cause gastrointestinal problems, kidney damage, even heart attacks and stroke. As a result, Dr. Tishler recommends using them in conjunction with cannabis. For example, before your game, take the usual Aleve or Advil, if necessary. But then, instead of popping more ibuprofen afterward, take a few puffs of cannabis in the manner suggested earlier. “The two will work synergistically, and you won’t need as much of either,” he explains. Of course, never use cannabis before an event or combine it with alcohol due to its intoxicant effects.

Anxiety (pre-race): Cannabis is not a performance enhancer. In fact, it negatively affects oxygen consumption, peak strength, peak speed, and other athletic components, according to Dr. Tishler. However, if your anxiety before a big game or event is such that it compromises performance, try this: “Take a very low dose of cannabis the night before,” he says. “Its intoxicant effects will wear off overnight, but its anxiety-fighting properties will persist through the next day. And it may also even provide you with better sleep.”

THCa: The New Wonder Cannabinoid?

There are thousands, if not millions, of different cannabinoids in the plant world, all of which may have different effects on our endocannabinoid system. One type that Dr. Tishler is currently excited about is THCa. 

“The cannabis plant actually manufactures THCa not THC,” he explains. “When we dry the plant and ignite or vaporize it, the heat converts the parent molecule [THCa] into THC. THCa is non-psychoactive, meaning it doesn’t cause intoxication, and it’s 10 to 20 times more potent as an anti-inflammatory than CBD. So if you need 1,000mg of CBD to get in the ballpark for anti-inflammatory effects, well now you need just 50mg of THCa, and it’s easier to come by because every cannabis plant makes it. It’s not rare like CBD.”

The trick is, you have to do a cold extraction to obtain THCa. “You put the plant material and your extraction material essentially in the freezer,” explains Dr. Tishler. “You do it all cold so you don’t cause any of the transition, which is called decarboxylation. What you end up with is a tincture or oil of THCa you can use either orally or in a gummy or however you want to manufacture it. I’ve been using it successfully with many of my patients.”