A Cure For Creaky Joints?

When my fibula struck the court, there was an audible “thunk” that reverberated across the gym like an axe hitting a tree trunk. Fighting for a rebound, I’d jumped high enough to grab the ball off the rim—and I’d come down hard enough to dislocate my ankle after grazing an opponent’s shoe. Two hundred pounds falling several feet onto the body’s most fragile and complex joint: The orthopedist said I was lucky I’d “only” ripped 95% of my ligaments. 

Decades later, I turn my head when ESPN replays injury clips. The sight of another player rolling his ankle summons visceral flashbacks of a pain so intense I nearly passed out en route to the hospital. 

But queasy memories are a small price compared to the lasting damage to my ankle. To this day, my left foot has been pain- and sprain-prone. Case in point: I’ve just returned from a 10-mile trail run, and the side of my ankle is throbbing.

Sound familiar? One in three American adults experience joint pain, more than 50 million of them alone suffering from arthritis. That’s not surprising when you consider that we’re living longer and getting heavier—and when you realize the human body contains a whopping 360 joints. It’s a miraculous machine, but that’s an awful lot of moving parts to protect.

Fortunately, cannabis is emerging as an effective alternative to yesterday’s pain medications, one that doesn’t come with harsh side effects and addiction risks. 

Anatomy of Joint Pain

Knuckles, wrists, elbows, shoulders, neck, spine, ribs, hips, knees, feet … and don’t forget the jaw. Anywhere bone meets bone, evolution has created intricate, articulating structures that facilitate motion—sometimes in two dimensions, sometimes in three—while providing stability and cushioning. 

Our joints share five primary components. Cartilage is a soft tissue that covers the surface of a bone at the point of contact and reduces friction. Synovial membranes oil the joint by secreting a lubricating fluid. Ligaments are elastic bands of connective tissue that support the joint and prevent hyperextension. They work alongside larger, stronger tendons to control movement. And bursas are fluid-filled sacs that sit between bones and ligaments, providing cushion in weight-bearing joints.

In simple terms, joint pain is typically caused by inflammation or swelling, or by direct bone-on-bone grinding and impact. Many people also develop inflammation or swelling due to injuries like mine, from tendonitis or bursitis, or from ailments like gout, lupus, and cancer. When it comes to arthritis specifically, most people suffer from osteoarthritis, which breaks down cartilage, or rheumatoid arthritis, an autoimmune disease that causes inflammation.

Osteoarthritis usually results from injury, overuse, or infection—with the initial damage often accelerated by obesity and lack of exercise. A Harvard University study showed that cases of osteoarthritis in the knee had doubled in America since 1950 and cited weight gain and inactivity as the primary culprits.

Treatment Options

Before trying any medication or therapy, conduct a thorough self-assessment. Is your joint swollen, red, tender, or warm? If so, see a doctor; these symptoms are indicative of infection. Likewise, see a doctor for consistent pain lasting more than three days, or for mechanical problems like clicking in your knee or an inability to raise or extend your arm; these may require surgery or rehabilitation. And giddy-up to the emergency room if the joint is deformed, suddenly swollen, completely immobile, or severely painful.

The rest of us should focus on reducing the inflammation that’s causing pain. Start with non-invasive, non-medicinal therapies, and give them weeks or months to work, not days. Studies published in Arthritis & Rheumatism and other journals have found that losing one pound results in four to six pounds of pressure removed from the knees and hips when walking. To lose those pounds, pair an improved diet rich in joint-lubricating omega-3 fatty acids with regular exercise. If joint pain makes sports difficult, try a low-impact sport like swimming or cycling.

Related: Pain, Pain Go Away

Like exercise, a simple stretching and massage routine will improve blood flow and range of motion, especially when combined with hot/cold therapy. Alternate a soak in your hot tub, which loosens tight tissue, with a short ice bath, which reduces inflammation. The World Health Organization now recommends acupuncture and a National Institutes of Health study showed that turmeric can reduce inflammation.

Scientists and physicians are also starting to recommend cannabis as a potential remedy. Kevin Boehnke, PhD and research investigator at the Chronic Pain and Fatigue Research Center of the University of Michigan Medical School, is one of them.

One of his studies, published last year in The Journal of Pain, surveyed 1,321 respondents who’d substituted cannabis for traditional medications in search of better pain management. Some tried CBD, some THC, and some both; most users were vaping, eating, or using tinctures and topicals rather than smoking. Very few reported getting high, or wanting to get high. As Boehnke tells me, “It’s a myth than you need to get high to get pain relief [from cannabis].”

One in three American adults experience joint pain, more than 50 million of them alone suffering from a type of arthritis.

The vast majority of respondents reported positive results in the form of reduced pain and milder side effects, enough that many (but not all) had forsaken their previous prescriptions. Most significantly, 72% of 690 opioid users experienced such good results that they had completely stopped using opioids. As Boehnke notes, this finding has significant ramifications amidst an opioid crisis that has killed more than 100,000 people over the last five years. “Marijuana definitely has negatives,” he notes, “like damage to the lungs when smoking and adverse effects in young brains. But no one has ever died of a cannabis overdose. If you compare the relative merits of opioids and cannabis for pain management, cannabis is a clear winner.”

Reflecting further on his study’s findings, Boehnke offers hope—and important caveats. “More than a dozen other studies have found the exact same thing as we did. Because of that, I feel quite confident that for some people who use cannabis for pain management, they can effectively and safely replace opioids with cannabis. But there’s a subset of people for whom this would not be an effective treatment. It depends a lot on an individual’s personal metabolism and condition.” 

Of course, this is also true of other chronic pain medications. Not every treatment works for every individual. “Cannabis is not a panacea,” Boehnke warns. “It’s a tool that may be helpful for some people and some conditions, and it may be helpful in some forms but not others. But the downsides are so limited that doctors ought to be educating patients and helping them find their own answer.”

I pose a hypothetical scenario: Let’s say a 50-something hoops junkie with an arthritic ankle wants to give cannabis a try. What does Boehnke recommend?
Reminding me that he’s a PhD, not an MD, he suggests starting with CBD. “It’s been studied less for pain than THC, but we know it’s been very well tolerated and appears to be quite safe, with anti-inflammatory benefits for arthritis and positive effects for anxiety.” Begin with a low dose of CBD that you increase every week over a month. If you’re not seeing improvement after a month, try adding a low dose of THC. “It adds pain relief,” says Boehnke, “and appears to work synergistically [with CBD and other cannabinoids] to extract the full benefit of the plant.”

Related: Get Back In the Game

Once your symptoms are relieved, stick to that daily amount. “There seems to be a sweet spot in dosing,” Boehnke tells me. “If you take more than needed, you don’t get any additional benefit and may actually reduce the benefit.”
Boehnke generally believes that tinctures work best for chronic pain. Smoking and vaporizing take effect very quickly, but don’t last long—only 2–4 hours. Edibles behave more like a time-release medication, with a more sustained benefit, but dosages can be hard to manage. Tinctures are easier to measure; they provide steady, long-lasting symptom relief (hold under the tongue for a full two minutes, Boehnke emphasizes); and they don’t pollute your lungs with combusted materials. 

There have been few studies conducted on topicals, and most products contain other active ingredients like menthol or arnica, so it’s hard to know how well the cannabis is working. Boehnke sees wisdom in using a salve in combination with a tincture if you’re treating joints that are close to the surface, like knuckles or wrists. 

Or ankles. I’m not a patient person, so I skip straight to a THC-enhanced salve. And it works—so well that I’m feeling frisky about tomorrow’s workout.