Cannabidiol (CBD) in Sports Medicine: Can It Help with Sports Injuries?
When treating active individuals, both acute and chronic sports injuries can significantly disrupt performance, progress, and quality of life.
Many patients prefer treatment options that don’t interfere with overall physical or mental capabilities. Cannabidiol (CBD) is a non-psychoactive component of the cannabis plant with anti-inflammatory properties, making it an ideal candidate for treating injuries. Notably, CBD is approved by the World Anti-Doping Agency, which controls banned substances in sports globally.1 Along with relieving joint pain and inflammation, CBD shows promise for treating concussions and other types of sports injuries.
The Endocannabinoid System’s (ECS) Role in Pain Modulation
The ECS is involved in pain regulation via cannabinoid receptors 1 and 2 (CB1 and CB2). Endocannabinoids are endogenous ligands that bind to these receptors to modulate inflammation and pain. CBD is structurally similar and can also influence receptors and endocannabinoid levels, as well as interact with numerous other pain signaling systems.2
CBD versus Other Pain Relievers
NSAIDs and opioid pain medications are commonly used in athletes but are not without side effects. NSAIDs can cause gastric injury, kidney damage, and minimize muscle gains.3, 4 Opioid analgesics can cause nausea, headaches, sleep disturbances, and withdrawal effects. Considering these side effects, athletes often seek alternative pain relief strategies.4
CBD has anti-inflammatory, analgesic, anxiolytic, and neuroprotective properties, which can help manage injury, anxiety, stress, and sleep issues.1, 4 CBD is even being studied in animal models for acute skeletal fractures, wound-healing properties, and tendon healing.5, 6 Side effects are typically mild to moderate, even at higher doses, and include diarrhea, nausea, headache, and somnolence.7
While there is limited human research specifically examining the use of CBD for athletic injuries, existing studies show promising results in the treatment of neurological and pain-related conditions. A systematic review on CBD for chronic pain management found that it may be effective in treating various pain conditions, and in some cases, patients were able to reduce their use of opioid medications.8 Additionally, a survey of 151 individuals with chronic pain reported that CBD provided relief for conditions such as back, neck, limb, and nerve pain, as well as fibromyalgia, migraines, and other pain-related issues. Many participants also noted a decreased reliance on other pain medications.9
CBD: Anti-Inflammatory and Analgesic Use in Sports
Professional rugby players were surveyed on CBD use, and 133/517 (26%) players either currently or previously used CBD. Rugby players endure muscle soreness as a combination of exercise- and impact-induced muscle damage. The pain can be debilitating, affecting daily function and may remain throughout the season. The players' reasons for using CBD included improving recovery/pain, sleep, anxiety, concussion, long-term injury, and chemotherapy, with 67% perceiving a benefit and none reporting adverse effects.4
A small pilot study on CBD use following eccentric exercise showed that inflammation, assessed by IL-6, was lowered by both low and higher dose CBD supplementation. The double-blind, repeated measures crossover design randomized participants to a placebo, low dose of 2 mg/kg, or high dose of 10 mg/kg of CBD. The study only included 4 people; therefore, larger studies are needed to confirm this effect.3
Six weeks of topical CBD (10 mg BID) was given to former elite athletes who had played football, basketball, or track and field and had chronic lower extremity muscle and joint pain. There was a significant improvement in self-reported pain levels and pain-related disability.10
Can CBD Help a Concussion?
Sports-related concussion is a common form of mild traumatic brain injury (mTBI). An estimated 3.8 million concussions occur in the U.S. annually from sports or recreation.11 Preclinical studies show that CBD influences the blood-brain barrier, brain-derived neurotrophic factor (BDNF), cognition, cerebrovasculature, neurogenesis, and cardiovascular function, all factors known to be altered by concussion. CBD’s neuroprotective properties may help with post-concussion syndrome (PCS), which can persist for over 6 months in 40% of mTBI patients.12
Numerous preclinical studies show the benefit of CBD in TBI, and human studies are currently underway, including studies on CBD with professional athletes.13, 14 A small case series showed that CBD can improve autonomic dysfunction in 4 females with PCS. PCS can cause dysfunction in heart rate variability as well as systolic blood pressure variability (SBPV). Over the 70-day study, systolic BPV improved with individualized CBD dosing. Other symptoms also improved, including headache, balance problems, confusion, emotional issues, drowsiness, dizziness, and fatigue.15
What Dose is Needed?
Reviews conclude that while CBD shows potential, dosing based on the condition may vary and needs to be determined.2, 8 The idea of individualized dosing in the PCS study is important in personalized medicine, with clinicians tailoring protocols to each patient. Animal TBI studies suggest that chronic CBD treatment may be more effective than acute intervention. In practice, this would require athletes at risk of TBI to use CBD prophylactically.2
Doses of 10 mg/kg daily or higher are suggested for exercise recovery benefits.1 Acute doses of up to 6000 mg CBD were safely tolerated in healthy individuals.7 Animal models show that low doses do not consistently alleviate pain, whereas higher doses have mixed results.2 Finding the “Goldilocks zone” seems to be the best approach.
CBD for Acute and Chronic Sports Injuries
CBD’s anti-inflammatory, neuroprotective, analgesic, and anxiolytic actions have the potential to benefit athletes. Although more clinical research is needed, preliminary studies are promising, especially as a safe alternative to current pain medications, with little to no adverse effects. An individualized dosing strategy may be beneficial.
References:
1. Rojas-Valverde D, Fallas-Campos A. Cannabidiol in sports: insights on how CBD could improve performance and recovery. Frontiers in pharmacology. 2023;14:1210202.
2. McCartney D, Benson MJ, Desbrow B, Irwin C, Suraev A, McGregor IS. Cannabidiol and Sports Performance: a Narrative Review of Relevant Evidence and Recommendations for Future Research. Sports medicine - open. 2020;6(1):27.
3. Stone WJ, Tolusso DV, Pancheco G, Brgoch S, Nguyen VT. A Pilot Study on Cannabidiol (CBD) and Eccentric Exercise: Impact on Inflammation, Performance, and Pain. International journal of exercise science. 2023;16(2):109-117.
4. Kasper AM, Sparks SA, Hooks M, et al. High Prevalence of Cannabidiol Use Within Male Professional Rugby Union and League Players: A Quest for Pain Relief and Enhanced Recovery. International journal of sport nutrition and exercise metabolism. 2020;30(5):315-322.
5. Parikh AC, Jeffery CS, Sandhu Z, Brownlee BP, Queimado L, Mims MM. The effect of cannabinoids on wound healing: A review. Health science reports. 2024;7(2):e1908.
6. Stauch C, Ammerman B, Aynardi M, et al. Biomechanical Effects of Δ9-Tetrahydrocannabinol (THC) and Cannabidiol (CBD), the Major Constituents of Cannabis, on Tendon to Tendon Healing in a Sprague Dawley Rat Achilles Tendon Surgical Repair Model. Orthop J Sports Med. 2020 Jul 31;8(7 suppl6):2325967120S00391.
7. Taylor L, Gidal B, Blakey G, Tayo B, Morrison G. A Phase I, Randomized, Double-Blind, Placebo-Controlled, Single Ascending Dose, Multiple Dose, and Food Effect Trial of the Safety, Tolerability and Pharmacokinetics of Highly Purified Cannabidiol in Healthy Subjects. CNS drugs. 2018;32(11):1053-1067.
8. Villanueva MRB, Joshaghani N, Villa N, et al. Efficacy, Safety, and Regulation of Cannabidiol on Chronic Pain: A Systematic Review. Cureus. 2022;14(7):e26913.
9. Schilling JM, Hughes CG, Wallace MS, Sexton M, Backonja M, Moeller-Bertram T. Cannabidiol as a Treatment for Chronic Pain: A Survey of Patients' Perspectives and Attitudes. Journal of pain research. 2021;14:1241-1250.
10. Hall N, James B, Bhuiyan MAN, Crane E, Falgout C, Murnane KS. Topical cannabidiol is well tolerated in individuals with a history of elite physical performance and chronic lower extremity pain. Journal of cannabis research. 2023;5(1):11.
11. Hallock H, Mantwill M, Vajkoczy P, et al. Sport-Related Concussion: A Cognitive Perspective. Neurology Clinical practice. 2023;13(2):e200123.
12. Singh J, Neary JP. Neuroprotection Following Concussion: The Potential Role for Cannabidiol. The Canadian journal of neurological sciences Le journal canadien des sciences neurologiques. 2020;47(3):289-300.
13. NIH. Cannabinoids and Traumatic Brain Injury: A Randomized, Placebo Controlled Trial. 2025; https://clinicaltrials.gov/study/NCT05632627.
14. Neary JP, Singh J, Alcorn J, et al. Pharmacological and physiological effects of cannabidiol: a dose escalation, placebo washout study protocol. BMC neurology. 2024;24(1):340.
15. Singh J, Bhagaloo L, Piskorski J, Neary JP. Effects of phytocannabinoids on heart rate variability and blood pressure variability in female post-concussion syndrome patients: case series. Canadian journal of physiology and pharmacology. 2022;100(2):192-196.
