Overview

Multiple Sclerosis (MS) is a condition that affects the central nervous system. It is thought to be an autoimmune disease because MS causes your immune system to mistakenly attack the protective layers (myelin sheath) that surround the brain and spinal cord. The brain and spinal cord send messages to the rest of the body so when their protective layers are damaged, the functions they control, such as vision, sensation and movement become impaired. This can lead to symptoms such as blurred vision, muscle spasms, and mobility issues. 

There is currently no cure for MS and people who experience symptoms struggle to find effective medications to improve their quality of life. Surveys show that many people with MS currently use cannabis products to manage symptoms and that it helps them with muscle spasms, stiffness, sleep problems, and pain.¹ Cannabis contains compounds called cannabinoids which interact with the body’s endocannabinoid system and can give sensations such as relaxation, pain relief, and feeling “high”.

When combined with physical therapy, cannabis could reduce the severity of symptoms. Physical therapy is an important part of MS treatment, helping to maintain mobility, improving muscle strength, and addressing balance issues. By reducing pain and muscle tension, cannabis might help patients to engage more fully in their physical therapy sessions, leading to better long-term outcomes and improved quality of life.

Understanding multiple sclerosis and its challenges in physical therapy

Multiple Sclerosis (MS) is an autoimmune disease affecting the brain and spinal cord, specifically targeting the protective layers that cover nerves. This disrupts the flow of messages (signals) between the brain and the rest of the body, leading to a range of symptoms such as:

• Muscle spasms, cramps and stiffness
• Feeling dizzy, lacking coordination
• Extreme fatigue (tiredness)
• Blurred vision
• Numbness and tingling in different areas of the body
• Problems with memory or concentration

These symptoms can come in waves, known as “flare-ups” or “relapses”, and can go away for periods of time (“remission”). They can not only cause discomfort, but can also get worse over time and lead to long-term disability if not properly managed.

Physical therapy is a vital part of managing MS and helps people address their challenges and symptoms head-on. Through a personalised routine consisting of exercises, stretches, and balance training, physical therapy can improve muscle strength, flexibility, and coordination.² It has been proven to reduce muscle stiffness, improve balance and mobility, helping people with MS to maintain their independence for longer.³ Through personalising treatment plans to suit each patient and their symptoms, physical therapy can improve quality of life and help people with MS manage their physical limitations more effectively.

How cannabis affects the body: the science behind symptom relief

In recent years, cannabis has gained a lot of attention as a potential therapy for managing symptoms for several conditions, including Multiple Sclerosis (MS). The therapeutic potential of cannabis comes from its active compounds, the two most commonly studied are tetrahyrdocannabinol (THC), which is responsible for the “high” sensations, and Cannabidiol (CBD), which has anticonvulsant properties, meaning it can suppress brain signal firing and control abnormal brain activity.⁴ These cannabinoids interact with the body’s endocannabinoid system (ECS), a network of receptors that regulate functions like pain perception, muscle movement, inflammation, and immune response. 

One of the most debilitating symptoms of MS is muscle spasms which cause muscles to become stiff and tight, and reduce your ability to move. Research shows that cannabis, specifically THC, could reduce muscle spasms by altering the brain signals responsible for muscle contraction. This helps patients improve their flexibility and mobility, improving their ability to perform daily activities.^5,6 Additionally, THC and CBD have both been shown to have anti-inflammatory properties and could be used to decrease inflammation throughout the nervous system, potentially alleviating symptoms and slowing down the long-term impacts of MS.⁷

Chronic pain is another common symptom of MS which affects around 50% of patients.⁸ Cannabis can directly interact with the body’s ECS to block pain signals.⁵ The cannabinoids in cannabis affect the way the brain registers pain signals, potentially making it an effective option for managing both neuropathic (nerve-related) and musculoskeletal pain in MS patients. Cannabis can also improve sleep quality, which is often disrupted by chronic pain, further increasing the general wellbeing of people living with MS.⁹

Cannabis and physical therapy

Cannabis has the potential to significantly enhance the effectiveness of physical therapy for people with MS by addressing some of the most common symptoms such as pain, muscle tension and reduced mobility. By including cannabis in their treatment plan, MS patients might find their physical therapy more productive and less physically strenuous.¹⁰

People with MS commonly experience chronic pain, which can make it difficult to fully engage with therapy exercises. The cannabinoids in cannabis, specifically THC and CBD, interact with the body’s ECS system to change the brain’s perception of pain and reduce its intensity. This can allow MS patients to perform more physically taxing and movement-intensive exercises without being hindered by discomfort. Pain relief from cannabis is particularly valuable to MS patients who experience neuropathic pain, which is resistant to many conventional treatment options.¹¹

Muscle stiffness can limit your ability to move freely and perform the exercises necessary for improving strength and mobility. Cannabis could help to relax muscles, reducing tension and spasticity.¹² Less muscle stiffness means that muscle-related injuries are less likely to occur during daily activities and physical therapy. 

As well as providing relief from the physical symptoms of MS, cannabis can also improve the emotional and mental aspects of physical therapy. MS patients often struggle with fatigue, anxiety and depression, all of which could negatively impact their focus and motivation during therapy.¹³ Studies show that THC can improve mood by stimulating the release of dopamine into the brain, a neurotransmitter that contributes to feelings of pleasure and reward.¹⁴ On the other hand, CBD can reduce anxiety and stabilise mood, which could keep you calm and focused throughout therapy.⁵

When used alongside a personalised and well-structured physical therapy program, cannabis could help people with MS achieve better mobility, increased flexibility and a more positive mindset, allowing them to manage their condition more effectively.^5,6,10,12,13

Methods of cannabis use for MS patients in physical therapy

If you decide to add cannabis to your physical therapy routine, it’s vital to make sure you choose the right method of consumption to maximise its benefits. Understanding how the different methods work, how to correctly dose and administer, can help MS patients optimise their physical therapy outcomes.

• Capsules and sprays: The only forms of cannabis currently prescribed in the UK and are readily prescribed in various other countries. Nabiximols (also known as Sativex) are a cannabis-based mouth spray containing THC and CBD. Research shows that Nabiximols can reduce the severity of symptoms such as spasticity.^6,10 Nabilone is a capsule containing the cannabinoid THC, commonly used to treat nausea in cancer patients but some doctors also prescribe it to MS patients experiencing neuropathic pain and muscle spasms.¹⁶ These methods of consuming CBD are naturally more discreet and convenient than others, such as smoking or vaporising.
• Oils and tinctures: Cannabis oils and tinctures are also popular options, which are usually taken under the tongue (sublingually) or mixed into food and drinks. When cannabis is absorbed through the mouth like this, cannabinoids enter the bloodstream quickly, providing faster relief from muscle stiffness, pain and sleep disturbances.¹⁷ The effects of oils and tinctures also tend to last longer than those of inhaled cannabis.¹⁸
• Inhalation: This is another fast-acting method of cannabis consumption. Vaporising heats the cannabis to a temperature that releases cannabinoids without combustion, making it a much healthier alternative to smoking. When inhaled, the cannabinoids quickly enter the bloodstream through the lungs, providing almost immediate relief from symptoms like pain relief, muscle stiffness, and anxiety.¹⁹ 

For cannabis to effectively complement physical therapy, it is vital to follow the appropriate dosing and timing guidelines given to you by a medical professional. Recommended dosage and timing can vary greatly between people depending on several factors such as body weight, severity of symptoms and medical history. 

Timing is also very important for maximising the benefits of cannabis during physical therapy. MS patients should aim to consume cannabis so that the effects peak during their physical therapy session, allowing for better muscle relaxation, pain relief and mental focus while performing exercises. 

Potential risks and considerations

Cannabis products, particularly those containing THC, can cause several side effects that you should be mindful of. These side effects include:

• Dizziness and lightheadedness
• Fatigue and sedation
• Cognitive impairment
• Anxiety or paranoia
• Dependence and increased tolerance

You should be especially cautious of overconsumption, as high doses of THC can amplify these side effects and lead to uncomfortable or even harmful experiences.

Before starting any cannabis-based therapy, it is essential to consult your healthcare provider as they will determine whether cannabis therapy is an appropriate option for you based on your symptoms, overall health, and any medications you are already taking. 

The legal status of cannabis can vary greatly between different countries so it is important to be aware of the laws governing cannabis use in your location. In many places, cannabis is legal for medical purposes but you might require a prescription or medical cannabis license issued by a healthcare provider. It is vital that you familiarise yourself with the specific laws regarding cannabis use to avoid any legal issues.

Summary

Combining cannabis with physical therapy can offer a promising approach to managing the symptoms of multiple sclerosis and helping to optimise the effects of physical therapy. By reducing muscle spasms, alleviating pain, and improving relaxation, cannabis can help MS patients improve their general well-being. During physical therapy, it can help people with MS achieve greater mobility, flexibility, and comfort - enabling them to engage more fully with their rehabilitation process. Additionally, cannabis can support mental well-being, stabilise mood, and reduce anxiety, contributing further to successful outcomes.