In surveys of CBD users, pain management is always one of the top reasons given for using nonintoxicating cannabis products. So it makes sense that nearly all brands, especially those targeting athletes, now offer topical solutions meant to be applied directly to achy areas. Are these balms, salves, creams, lotions, roll-ons, patches, and sprays an intriguing advance in sports medicine? Or are they mostly an expensive but ineffective throwback to the Bengay locker-room aromas of decades ago?
The first step in answering these questions is to examine whether topical solutions of any sort do anything. Topical nonsteroidal anti-inflammatories (i.e., ibuprofen, diclofenac, and the like) are available as both prescription medications and over-the-counter products. Given the FDA’s approval, there’s evidence that this general class of products works. As when you take anti-inflammatories orally, the goal is to reduce pain and lower inflammation and swelling. By applying anti-inflammatories directly to the affected area, you’re theoretically increasing the product’s effectiveness.
There’s also support for the seemingly laughable practice of applying topicals to “loosen up.” A Canadian study published last year found that students’ hip range of motion increased more when they were rubbed with the (non-CBD) menthol-based gel Biofreeze than with a placebo gel. For this effect, and for topicals to work as an anti-inflammatory, they’re formulated so that the solution penetrates beyond the outer layer of skin (that’s “transdermal,” in medicalese). In the Canadian study, topicals were applied to only one leg, but the range of motion increased in both hips, suggesting a body-wide effect.
And when we ask if topicals really “do anything,” that depends on what you mean. These products usually impart scents (lavender and mint are common) and sensations (cooling menthol, warming camphor) that can distract you enough to change the woe-is-me narrative. This phenomenon is akin to positive self-talk shifting your attention during a race or a hard workout—you’re not really changing anything physiologically, but you’re not as constrained by your duress.
Placebo Isn’t a Four-Letter Word
Right about now, you’re probably thinking, It’s all just a placebo effect. That may be true, but it’s not as damning an indictment as you think.
Placebos are grounded in belief, not deception. There’s ample evidence that physiological changes can happen if the person receiving a treatment believes it will help. Take, for example, the effectiveness of rinsing and spitting with a sports drink. The practice shouldn’t work, because no fuel enters your bloodstream, yet it has consistently been shown to improve performance, most likely because your brain thinks sugar is on the way. Or consider the many athletes who have a performance breakthrough soon after joining a new team or getting a new coach: barring doping, those athletes are unlikely to be physically different than they were two weeks before, but it’s the belief in the new setup that underlies their improvement.
So if you think a topical solution will help with your throbbing Achilles tendon, it just might.
So What About CBD?
The placebo effect is likely behind some reports of CBD topicals’ efficacy. Given that they can cost twice as much as conventional topicals, it’s understandable that you’d be more inclined to believe they’ll work.
But there are indications of effectiveness independent of belief. A University of Kentucky study induced a simulation of arthritis in rats. Half of the rats then received topical CBD treatment at the site of their inflammation for four days. After treatment, the CBD-treated rats appeared to be in less pain than the other rats—they withdrew their paws when touched only about as often as before they were injured. The CBD rats also had significantly reduced inflammation, including joint swelling and immune-cell activity in the injured area. Granted, this was an animal study, which comes with the usual caveats. On the other hand, the placebo effect presumably doesn’t exist in rats.
The usual explanation for CBD topicals’ potential effectiveness is that, once the substances penetrate the outer layer of skin, they bind with cannabinoid receptors. These receptors can be thought of as locks on the surface of cells, causing cellular changes when they’re unlocked. In this metaphor, cannabinoids are the keys to the locks, and those keys can be either the body’s own endocannabinoids (which play a role in exercise euphoria) or an external source of cannabinoids, such as a CBD topical.
What exactly happens as a result of this unlocking remains a matter of discussion in medical circles. It’s logical to think that reduced pain can result from activating the same cannabinoid receptors that contribute to a runner’s high. There’s also a theoretical basis for CBD lowering inflammation by inhibiting the same enzymes targeted by popular nonnarcotic pain medications such as ibuprofen and naproxen.
For Now, Experiments of One
Anecdotally, CBD topicals seem to work best in managing flare-ups of the chronic low-grade problems most endurance athletes live with. Aggravated iliotibial band from running on slanted roads? Check. Shoulder strain from too much time riding an indoor trainer? Check. Torn ACL or ruptured Achilles? Not so check.
Clinical evidence to support these claims probably won’t exist in the near future. Most of the current research on CBD focuses on specific disease conditions, such as the number of epileptic seizures someone suffers per day or the degree of tremors from Parkinson’s. Studies on, say, whether a CBD balm eases the rusty-coil sensation in your left hamstring insertion aren’t a public-health priority. Industry-funded research on such usage is unlikely, for two main (related) reasons. A robust clinical trial can cost millions, which is beyond the budget of almost all CBD brands. Even so, if they had the resources to fund such a trial, a given brand probably lacks the incentive. And the CBD molecule is a natural substance considered to be in the public domain, so it can’t be patented. Any positive results from the study could therefore be used by all CBD brands in their marketing.
As with all things athletic, it’s best not to view CBD topicals as a magic bullet. Pain is a signal to be heeded, not masked. The goal is not to be the CBD-user equivalent of my friend Jim, who gobbles enough ibuprofen every day to keep his 37-year running streak alive. Sound training and recovery principles go a long way toward preventing aches and pains from developing in the first place. If, despite your best efforts, you have a complaining body part, maybe that’s the time to consider reaching for a topical.