Dr. Kevin Most: Back pain and CBD Oil


Dr. Kevin Most

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Last week we saw a historic Masters, Tiger woods victory was simply amazing. Many in the medical field felt this was almost impossible following his back surgery. The week also raised questions about why were Tiger and Phil both chewing gum thru the tournament and did Phil ingest CBD oil during his rounds at Augusta.

It is rare that a sporting event brings up a medical discussion that actually had little to do with the event, however each of the three topics sure caught the attention of the media this past week. We can touch on the three of them, I am not sure if any will help your golf game but one never knows.

First lets discuss Tiger, since 1994 thru the spring of 2017, Tiger had 4 knee surgeries and 4 back surgeries. For the common man one would be happy to be up and walking following what he has gone thru. We have discussed knee surgery in the past with prominent athlete’s injuring their ACL. This is one of the ligaments that holds the femur (thigh bone) to your tibia (the bone you kick into coffee tables). Tiger had ACL surgery in 2008, this was his 4th knee surgery and for many this injury and repair would certainly impact if not restrict the ability to play golf daily and more importantly play golf walking, not riding in a cart. In 2010 Tiger started having back issues and in 2014 he underwent his first of 4 back surgeries.

Let’s do a little primer on our back.  Everyone in the world will have back pain at some time in their lives, for many it is a minor inconvenience but for many it can be debilitating. The back is a complex group of bones that gives us our structure and also delivers and protects our spinal cord and nerves. The back is made up of 33 separate bones, we break them up into sections. The cervical area has 7 bones and makes up our neck essentially, the thoracic or chest area has 12 bones, the lumbar or low back has 5 bones, the sacral area around our hip area has 5 bones and then the lower area has 4 bones which are fused together and make up our tail bone. These bones are separated by a spinal disc,  think of this as a cushion between each bone in the stack. The disc is a strong elastic pivot for each joint, this allows stability as well allowing a wide range of movement in all directions. Think of the positions you can put your head and neck in, think of bending forward, bending backwards, bending sideways, twisting, all of these motions are possible because of the bones, discs and ligament support.

When individuals have back problems it is often a disc problem. The disc will lose its strength and pliability and will shift or move. This shift can  put pressure on nerves exiting the spinal cord and can cause neck pain, arm pain, back pain, leg pain, numbness and weakness. You may hear people say they have a pinched nerve, slipped disc, herniated disc or bulging disc. These often cause discomfort as many of  the nerves that supply the body come out at various levels of the spinal cord.

The problems individuals have can often be located based totally on their symptoms as the nerve patterns for most individuals is identical. For example

Tiger had the problem where his disc was impinging on a nerve that was causing him discomfort. The surgery is done using a scope and very fine tools, they do not cut muscles, they push them a side and then shave off any bone spurs and then dissect the portion of the disc that is putting pressure on the nerve. Once the pressure is off the nerve the pain resolves and the weakness and numbness often resolve as well. This surgery is done as an outpatient and the patient will be up and moving right after surgery and discharged without a stay overnight.

Not all back pain or disc issues need surgery. Medication and rest are often the first line therapy. Physical therapy will often be used in place of surgery as exercise, stretching and core strengthening may alleviate the problem. People often put off seeing the doctor because of the fear of surgery.

Tiger’s most recent surgery 2 years ago was a lot more complex than the micro disc surgery. His last surgery was actually a fusion surgery. For this case the surgeon actually places metal hardware that connect 2 or more of the bones together to give support and stabilize the level. This often results in decreased motion and flexibility. It is this surgery that is the most complex and surprising that Tiger could come back to his playability level as quickly and as well as he has. Tiger had his fusion surgery in the area of the low back which is where the main strain comes in with the golf swing. This surgery can be done at almost any level of the spine and is not uncommon.

We talked about Tiger’s back surgery and his recovery, we should also touch base on Phil’s medical history with his issue with arthritis. We have discussed arthritis in the past to put it in very simple terms there are many causes of arthritis but they really fall into 2 main buckets. One is arthritis due to age and over use, as we age we wear down the protective tissue between bones and eventually end up with that protection being gone and the bone pushes against the other bones and causes pain and inflammation, in the other cases the body for some reason decides to attack or inflame what is a normal joint. This is seen in psoriatic arthritis, the type of arthritis that Phil has. This arthritis can be debilitating and can leave individuals in severe pain and with limited mobility. Phil woke up one day and had this pain and stiffness in his joints. He was diagnosed and treated and it appears that his treatment is quite effective as at 48 years of age he can still drive a golf ball over 300 yards and moves around a golf course pain free. You have probably seen commercials for a medication that Phil takes to control his arthritis

So why discuss this, sure Phil played well and contended at The Masters, however the media story here is the question that Phil was using CBD oil during his round as he was noted to be ingesting some liquid out of a dropper during the round. Many who use CBD oil say that is sure what it looked like. CBD oil is one of the hot crazes going on now in health care. Now to be clear, CBD is not considered a performance enhancing drug by the PGA Tour, so even if he was using CBD oil, he was not breaking any rules. Nor  does it contain any THC which is the active portion of the marijuana plant

For many CBD reminds us of the “snake oil” treatments of the past. Those treatments had many claims yet no truly tested fully vetted studies to back those claims. Unfortunately, CBD oil sits in that position now as well.    There are hundreds of products on the market from oils to lotions to brownies to lattes, the list goes on as everyone is jumping on this hot item. Currently there is only one approved product from the FDA, Epidiolex. This can be used to treat a specific form of seizures.  We do not have good controlled studies to show us what else it will be beneficial or effective for, what the correct dose is and what concerns we should have. The FDA is concerned with the proliferation of the products and the claims they make.

That being said, estimates are that 1 in 4 American’s have used CBD oil as they are looking for alternative ways to treat many conditions

So, what actually is CBD oil? CBD oil comes from the oily resin of the cannabis plant, the oil appears to protect the plant, and the amount of CBD oil varies in each strain of cannabis plants. The oil is extracted from the plants and is then refined and formulated into many consumable products including edibles, topical, beverages and gels. The oil is then concentrated to a texture and purity based on how it will be used. The most important fact is that these products  do not contain the chemical THC which is the chemical that causes the “high” seen with marijuana use. It is not regulated by the FDA, however it is approved for use in 37 states for medicinal use, this includes Illinois. CBD oil can come from the Hemp plant as well as the marijuana plant. Hemp based CBD is sold over the counter. Search Amazon for CBD  oil products and you will see they have over 4,000 products for sale. Now Amazon is being very careful and only selling oil from Hemp plants and not from marijuana plants as the state laws vary on CBD oil from marijuana plants. Some states allow for CBD infused food and drinks, while others still ban its use. Retailers are taking varying views as well, some are selling topical creams infused with CBD oil some are selling supplements. The confusion comes from the fact that the hemp plant is legal while the marijuana plant is not under federal law.

There are many conditions that some claim CBD oil will help and the list is extensive.  However one must understand that these are claims that for the most part have not been proven in scientific studies

  1.      Pain both acute and chronic
  2.      Nausea
  3.      Anxiety
  4.      Cancer prevention
  5.      Arthritis
  6.      Treat seizures
  7.      Improve sleep
  8.      Treat migraines
  9.      Skin care
  10.   Sexual enhancement
  11.   Alzheimer’s disease
  12.   Parkinson’s disease
  13.   Multiple sclerosis
  14.   Huntington’s disease
  15.   Depression
  16.   Inflammatory diseases
  17.   Inflammatory bowel and Crohn’s disease
  18.   Cardiovascular diseases
  19.   Diabetic complications

This list continues to grow as unfortunately unfound claims of the benefits continue to rise without true studies on humans to prove its effectiveness. There is very little if any true studies that show it works, on the other hand there are not studies that show it does not work. Some studies have been done on mice but have not been reproduced on humans in a controlled study. This lack of data

You may have noticed that both Tiger and Phil were chewing gum at the Masters last week. Phil had shared earlier in the year that he is chewing gum to stimulate the frontal cortex portion of his brain. Now many who know Phil do not find that unusual. He is often the first to know about or try something new. He is always looking at his diet and what he can eat to make his body healthier and also looking for any advantage to stay young and compete with individuals half his age. Stimulation of the frontal cortex is thought to decrease stress and increase alertness. It also is thought to improve the ability to process information. Now the science is not real strong, although studies have shown this to be true.

Tiger on the other hand said he is chewing gum to prevent him from feeling hungry. Now look at the list of PGA tour players who chew gum and perhaps it is something that many regular players may consider. Payne Stewart was known to chew gum regularly, Jordan Spieth has used gum in the past as well and was chewing gum in 2017 when he won the British Open for his 3rd major.

There is speculation that they were both chewing CBD infused gum. Phil’s comment that the brand he was chewing was not available yet, led to the speculation. If Phil was looking for the mechanical motion of chewing to stimulate his brain, the brand would not matter one would think. If it has an ingredient that is not found in normal chewing gum this is what led to the thought that it may be CBD gum.

If Tiger and Phil promote a new CBD gum, one would expect it to fly off the shelves  as soon as they announced it, I guess we all have to stay tuned.

Whether Phil has the science correct or whether the others got the benefit without knowing the science, perhaps it is something we should consider for golf or anytime we want to relax or increase our awareness.

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