Golfers, Arthritis and Cannabis: What Do We Know?

Younger wunderkinds such as Rory McIlroy or Jason Day notwithstanding, golf players skew older, in large part because it’s a sport people can play for the rest of their lives. A recent review on golf’s health benefits recommended it not only for its contribution to mental and physical health, but for its “potential contribution to increased life expectancy.” Yet as players get older, they do begin to suffer physical conditions that compromise the sport’s benefits and corrupt their game. One of the biggest culprits is arthritis, which amongst other chronic non-cancer pain (CNCP) sources such as fibromyalgia, neuropathic pain and irritable bowel syndrome is estimated to affect 30% of the population globally. And you don’t even have to be a senior citizen to fall prey to it, either — longtime PGA/Masters champion Phil Mickelson came down with a crippling bout of psioratic arthritis when he was just 39. The question, however, is how you tamp down the pain when it hits?

Like many athletes, the cannabis option has become more seductive as legalization and medicalization begins to wind its way through even formerly red states with older populations and large courses. And interest is clearly growing. An observational study found that cannabis use increased between the years 2014 (6.3%) to 2019 (18.4%) among rheumatoid arthritis sufferers, with 62% in 2019 reporting effectiveness for symptom reduction. But what is known about cannabis and arthritis? Can it help with treating the symptoms of psoriatic or rheumatoid arthritis? So far, this is what’s been determined.

WHAT WE KNOW

In short: only so much. This year, a structured summary of published studies on the therapeutic effectiveness of cannabis, cannabis-derived products and synthetic cannabis could only find one randomized clinical trial. It paired the oromucosal 1:1 THC/CBD spray Sativex against a placebo among a majority female cohort of senior patients in the UK. This study found minimal reduction in disease activity and little to no difference in pain reduction, but was limited only to this preparation. Neither this nor any of the other studies looked at quality of life. Questions about whether specific strains or different cannabinoid ratios or dosages may have worked better for rheumatoid arthritis were left on the table. A 2021 case report of an 85 year-old woman with severe osteoarthritis on several medications, including heavy-duty opioids such as hydromorphone and fentanyl, reported on the results of her experience with CBD Oil Drops produced by CannTrust in Canada. Initially, she was able to decrease her daily use of the hydromorphone for a week, and it reduced her pain scores, and she was able to join in recreational activities in the long-term care home where she lived. She was also given THC oil briefly, but she waved it off after a week.

In the meantime, athletes of all ages are beginning to take matters into their own hands. Zach Scioli, of SF-based fitness studio DIAKADI found his own conversion story after suffering a slipped disc after a workout. “Being prescribed extremely strong prescription painkillers to treat pain, I realized their high addiction and toxicity potential,” he told Muscle & Fitness. “I opted to try CBD oil and high-grade THC extracts to manage pain and inflammation. Looking back, it was the best choice I could have made.” And it’s not just heavy painkillers golfers should watch for. Even non-steroidal anti-inflammatory drugs, often prescribed as a first-line treatment for arthritis, can contribute to ulcers and increase kidney failure if one is dehydrated. Noting this in Men’s Health, cannabis therapeutics specialist Jordan Tishler, M.D. concluded, “Cannabis, on the other hand, is absolutely safe to use after a workout.”

While it’s still early days, a study assessing clinical recommendations for patients living with CNPC found it could still be recommended as a third or fourth-line therapy intervention. In addition, an exhaustive analysis of arthritis studies found that the endocannabinoid system — a set of nerve receptors found throughout the body and brain —is implicated in inflammation. Because of this, “Both synthetic and plant-derived cannabinoids appear to be promising candidates for pain treatment and inhibiting arthritis development.” While certain questions still need to be answered about how cannabis interacts with other medications, the research shows promise

GETTING A GRIP ON ONE’S GAME

Arthritis-stricken golfers can consider all the options that can work for their condition, if only because certain solutions might fall out of favor from time to time. Take, for instance, the plethora of golf grips marketed for arthritic hands. A recent study which measured grip force exerted by both arthritic and non-arthritic golfers during their swings found that out of 12 golf grips only one registered less force exerted onto the grip by the hands of arthritic golfers, and found no difference between arthritic and non-arthritic golfers among four of the five fingers. In short, “despite how these grips are marketed, there are no “savings” in finger force or grip configuration when using the “arthritic” designed golf grips.”

With the PGA’s slow embrace of CBD, more information will be sure to come. In a future article, Hytiva® will share more information about how some up-and-coming cannabinoids may be able to further assist in reducing the aches and injuries which occasionally befall golfers on the fairway. In the meantime, work with your doctor on developing dosage and exploring what may work for you. Everybody’s endocannabinoid system is different and considering how many doctors and physicians play the sport, it’s possible that the fairway may be the next great laboratory for medical cannabis and arthritis innovation.