Injury-Related Pain and CBD for Pain Relief

Eric Finger recently sat down with Carey Rouse of Rouse Fit in Austin to discuss physical therapy, pain relief, and CBD products. Watch the video on YouTube or check out the brief summary transcript below.

Eric Finger:
Hey, guys. Eric here again with Move Empower Concierge PT. Starting the New Year off Jan 2023 with an interview. A colleague friend here in Austin, Texas, got Carey Rouse. He’s a personal trainer and founder of Rouse Fit here in Austin. So excited to have him here today.

Carey Rouse:
I have been in Austin for quite some time, been here since 92, but I have been doing personal trainings for the past 20 years, since 2002 and been involved in athletics my entire life. And I’ve recently founded Rouse Fit, which is a fitness and training and CBD company for health and fitness. And the primary focus is recovery and better sleep for the folks involved. We really focus on our clients and our customers who are 40 plus and are still active athletes or fitness enthusiasts. And so the products we we create are specifically for them and we try to serve them with services for personal training and the products for wellness.

Eric Finger:
One thing we probably both deal with, with both our clients and like physical therapy and then with your training clients and such is: pain. You know, when should we, you know, hit the pause button? When can we work through it? You know, when I’m dealing with my patients, they seek me out because they’re typically in pain. I think the first thing that I have to look at is, you know, what type  and how long has this pain sticking around? Is it, you know, for instance, an ankle sprain or or something that happened within the last week that’s very painful, swollen, maybe still hot to the touch. That’s that’s one type of pain that we’re going to kind of box it in the other boxes that maybe that pain that’s been around for five months or even five years, that’s more than the chronic. So when I first find out where those guys are at because if it’s in that box, which is more of that new injury that’s still hot and swollen, we’re definitely going to probably hit the pause button on exercise or anything that really aggravates it. So we can encourage the the body to let itself heal and such vice versa. On that other end, on the chronic end, what we’re finding out with like will say, Achilles tendon of these, these are, you know, injuries that typically can bog a person down for months and such and that what we’re finding out interesting from the research is that we actually want to load those those folks up. We actually want to load that tendon because that helps increase and kind of kickstart the healing process, if you will. So I think that’s the big thing. First is when I’m talking with someone, it’s like, where are we at here in this injury? Is this is this new or is this something that’s been around? Because that’s really going to help guide me as a physical therapist to know where we start with these folks.

Carey Rouse:
So when you say new, though, I’m thinking through like, what does that mean? Is that is that a month old or is a week old? Is it a day old? What kind of time frame are you or are you thinking of in time?

Eric Finger:
We’ve got kind of acute subacute and then chronic. So that acute stage is really going to be from kind of 0 to 72 hours. From there, let’s go back to that sprained ankle example. That’s going to be definitely more what we call RICE. You’re going to rest. We’re going to ice it, use compression and then elevate it. I’m sure you’ve noticed that maybe an anti-inflammatory reaction is happening as well. So really, we’re not going to be trying to grind through it, trying to walk with that swollen ankle. We really want to kind of nurture that injury in that first stage, in that subacute stage, that’s where we might add a little more activity, some weight bearing and such if we’re still using that ankle sprain example versus that chronic pain — chronic would be something that’s been hanging around maybe for three months or longer kind of thing. And that’s where we’re going to actually potentially start activity first and get off, you know, lounging on the couch with an ice pack or something like that.

Carey Rouse:

And I’ve heard different theories on the role of inflammation. And it can be confusing, I think, because people are like, well, inflammation is important because a part of the healing process. But at the same time, you always hear about, well, we got to do this to reduce inflammation. So what what are your thoughts on that to maybe help clarify for people when it’s good and when it’s not?

Eric Finger:

Inflammation is critical for healing. Our body is a master at, you know, kind of kickstarting that healing process from the get go. I’m going to go back to that ankle injury again, that sprained ankle with swelling and such — the fluid that’s being attracted there is there on purpose to help kind of start breaking down and working on the repair of that injury. I think where that can get us in trouble is if that swelling with that ankle injury again is hanging around three weeks, four weeks, five weeks and such, that’s going to impair your movement, that’s going to impair the the muscles from functioning normally. So I want that swelling there up front. But as it starts hanging out for longer and longer, that’s when it can become not as useful, maybe more of a detractor from, you know, someone getting back to their active lifestyle and such.

Carey Rouse:

This the RICE method you were talking about is really in the first 72 hours or is in the subacute as well.

Eric Finger:
I tend to use that RICE for that first maybe 72 hours and such. After that we could switch to if there’s some stiffness there, we could add some heat or you could actually do a contrast. You go ice and heat. We’re going to contract. And then when we heat things, it’s going to open up those blood vessels that we’re going to kind of create almost like this little plant to help get some of the fluid out. I think in that subacute stage, you know, when we’re in that 5, to 5 days out to maybe to two weeks out, we’re going to want to start adding movement so you don’t want to just to be doing passive stuff. When I say passive, meaning lounging on the couch with an ice pack or something like that in that subacute stage. That’s where we want to do some specific motions with an injury, be it going back to the ankle, be it walking correctly, you know, getting out, doing some light, strengthening exercises and such, that’s pretty critical. And that’s kind of where I guess my bias as a physical therapist is where we can really help folks out to make sure kind of guide them, like, okay, you’re here, great. Now we’re in this stage. We’ve got to start moving on. I think that’s where therapy comes in. There are two points I wanted to bring up. One is during the during the acute phase, we’re still using, you know, elevation, compression, ice and things like that. And that for 72 hours now, those those modalities feel like they’re things that help reduce inflammation. But inflammation is important, especially during the first 72 hours. So is it you’re not trying to stop the inflammation from happening with those modalities. It’s more controlling. It may be so that when you do get past the 72 hour point, you can begin to do movement because with too much inflammation is too difficult. Also, the ice is going to help with pain as well. So just in the pain, the more and more pain you have, the more and more restriction you might cause yourself, which can kind of cause that swelling to kind of stagnate down in the region of the injury, too. So, yes, we want that process to we want that normal inflammatory process to happen, yet we want to maybe control it so it doesn’t get maybe out of hand and such.

Carey Rouse:
The other thing I wanted to mention is I have gone through a rotator cuff surgery before and I have never gone through something like that with any kind of injury. You worry about hurting it more and you hold off on your movement, which is probably the wrong thing to do, especially when you’re a few days into it. I followed my doctor’s advice and we had specific stretches and things like that, and every day was painful. Every single day was a painful day pushing through it. But I had almost full range of motion, you know, maybe six weeks after that surgery. So it was a really fast healing process. But that was because of the movement.

Eric Finger:

So when you’re when you’re dealing with a an injury like the rotator cuff, be it, you know, as surgery, surgery’s a little different, but, you know, or a strain, if you will, the rotator cuff timing is going to be a little different but definitely a movement. Yeah as you said, the movement, the stretching you did was key to you getting your range of motion back and being able to restore the function of those of the rotator cuff muscles to make sure that shoulder, you know, is able to do what you needed to do activity wise from throwing a ball to picking up a jug of milk. 

Carey Rouse:

I’ve had a specific type of injury myself where I have bone on bone in both my knees from just the cartilage wearing out. And that started at a pretty young age for me, almost like 24 years old. I had a scope on one of my knees. They took out some of the cartilage, which unfortunately just made it worse. So now any type of running or jumping movement, it’s I mean, it doesn’t take but 30, 40 minutes of that. And my knee starts swelling up and it stays swollen for five or six days. And at this point, I have just decided that I need to do something else besides running and jumping, you know? And so I’ve picked up cycling, which doesn’t interfere, doesn’t cause that bone on bone. For people that are in that situation where that particular movement it produces an inflammation and that is quite painful. It just fills my knee with fluid each time other than ice. And maybe no movement is good, but I feel like movement in that situation, there’s no way to avoid aggravating it.

Eric Finger:
So your example, it sounds like kind of moderate to severe knee arthritis, right? So I think we can use that swelling to find out, you know, in your case it sounds like if you were to go out and jog for a half mile or something like that that your knee would maybe swell up the next day. I think my first thought to those for those folks are my my you know, instructions would be don’t give up on it. We’re learning more and more about knee arthritis. I think you need to have a strategy and kind of just step back and and learn about what other exercises you can do to kind of build up the shock absorbers of the of the knee, which are going to be the kind of the bigger muscles of the leg, thigh muscle with the quads, the calf muscles and such, and build a tolerance to that joint start grating. This is a long process. This is months versus overnight. But I think if you can find the exercises like you’re doing, you’re doing the cycling in such low, low impact exercises that are definitely an entry point I think of of trying to kind of condition those those leg muscles and then also strength training — I’m a big proponent of you’ve got to start making sure that the quadriceps and the whole lower chain from the glutes all the way down to the the calf muscles, making sure they have the strength to be adequate shock absorbers when you’re walking in the mall or taking your dog for a walk to maybe something a little more high impact and such.

Carey Rouse:

Something I’ve been doing in this relates to the movement theme is low impact, slower movement, squats and then full range squats, specifically to try to help my knees by building the muscles that need to be built up and also forcing my body into a more full movement. I do to the squat all the way to the floor beyond parallel, and then back up. And I started with bodyweight and I’m just slowly adding more and more weight by holding a dumbbell and I feel like my legs are getting stronger and pushing my legs into that extreme extension is is is actually helping with the range of motion for my knees. That’s one way I’m trying to do it. And I hope that other people hearing this understand that I really still totally believe that movement is the key to to get through some of this stuff. But it’s going to be a wise movement. I’m not going out and doing plyometrics on boxes or anything like that.

Eric Finger:

You started out, I guess for the listener who might be having problems with knee arthritis and building strength, you probably didn’t start with those deep squats from day one. You worked up to that for sure.

Carey Rouse:

Yeah. I mean, for me, I spent hours and hours and hours building up my leg muscles on a bicycle and that’s a totally different movement, but it’s still working.

Eric Finger:

So tell me from your perspective, you spoke early about with CBD products you have. Tell us about, you know, the CBD product. I guess my big question is there are a lot of products out there. How does the stuff I can get at the grocery store compare to I guess some of your products, is there a difference?

Carey Rouse:

Yeah. So there’s a lot of different ways that you can formulate CBD and CBD is just one cannabinoid and there are a couple hundred of them. CBD is the most well known one, it’s the most well-studied, it’s the one that’s in the highest quantity by far of any cannabinoid that’s out there. And we have cannabinoids in a lot of different foods and things that we already eat. It just so happens that, you know, the marijuana plant is the one that is has gotten the most notoriety because it’s got such a large amount of cannabinoids in it with CBD being the highest. And we’ve probably also heard of THC, which is more of the hallucinogenic one. And so there’s different ways to put it together. So there’s CBD isolate, which is only the CBD cannabinoid in a certain product. It could be oil, it could be something else. And then the next item that you may hear is called broad spectrum. And what that means is that CBD plus several other trace amounts of other cannabinoids, except not THC. So it could you could have all the cannabinoids, but not THC, and that would be broad spectrum. And then full spectrum is just all of them, including THC. Those are the different designations for how the cannabinoids are put together. And then, of course, you can’t have more that more than 0.3% THC in any product or that would be illegal. And then even any amount of THC, depending on the locality that you’re in, could be illegal. But hemp based CBD at the federal level is is legal. And so those products can meet CBD isolated, broad spectrum or full spectrum. So that’s one way to understand the differences of what you’re getting. There are some theories that having the trace amounts of the other cannabinoids with CBD allow CBD to work better, but there really isn’t enough studies yet to prove that. So there’s some in place right now and it’s just going to take some time to get the results back from that. But there have been several studies completed for pure CBD in its effect on immune system, on just general wellness and your ability to sleep and fighting pain. Now the way that these things work is they don’t work by themselves. CBD itself doesn’t make the pain go away. All these cannabinoids work with your endocannabinoid system, it’s in your body. And that system, when working properly, essentially just allows your body to work in the way it’s supposed to work. It allows your body to fight pain in the way that it normally fights pain or fight and improve immunity the way that it normally does. And we find that our body is usually deficient in CBD or there’s something off. And that’s why recently, with the introduction of CBD supplementation, we’re finding that we’re allowing that endocannabinoid system to work better and then we feel better. So the most the most common one I think is really we hear about pain or just relief that you can get from using CBD products. I myself got introduced to it through lifting and I like to push when I lift and I had a tennis elbow type pain for months, it just would not go away. I kept on lifting with it. I kept on moving with it and was introduced to a CBD cream that I put on my elbow and there’s a little bit of an immediate relief, but after two weeks it was gone and it was something I could not get rid of for months. I’ve done the same thing with an arthritis pain I had in my fingers when I was lifting. And you still have to grip when you lift. And I wasn’t going to stop lifting. And I just again, I kept on re aggravating it. I started putting the cream on and within two weeks nothing. No pain. So I’ve been sold on the stuff for a while. One other aspect you asked, which is really important that people don’t realize, and that is the concentration of the CBD and it’s typically the units are milligrams of CBD per milliliter of solution that it’s in. So if we’re talking about a CBD oil or tincture, that would be, you know, there’s one milliliter in there. So, how many CBD milligrams are in that milliliter and that’s usually 100 milliliters in the container. So the thing you’ve got to do when you go shopping for these things is do the math because they won’t do it for you in most cases. So take the total amount of CBD milligrams per the bottle divided by the milliliters in the bottle. So good rule of thumb is 50 milligrams per milliliter is a good amount for the creams. That’s a good amount for the creams and then for the oils you probably should be shooting for 100 milligrams per milliliter or greater for the oils. So look at those measures. When I talked to my scientist at my manufacturer, the minimum amount for the creams where they found the most effective results was at 50 milligrams per milliliter. There’s another form, a common form of CBD that’s taken that’s out there and they’re usually in the form of CBD gummies and those are generally going to have a lower amount of CBD in them. Those are generally just for sleep or general wellness. And I can tell you that if you put too much CBD in gummy, it’s not going to taste good. So they usually limit those to 25 milligrams or less for CBD gummy. It is important to kind of do the math to kind of find out the amount of the CBD in there and you know, be it a cream or a gummy and such.

Eric Finger:

It’s also interesting that like you said, tinctures is that like drops so there’s drops, there’s gummies, there’s creams. It seems like there’s a lot of different ways to take it.

Carey Rouse:

The three most common are the creams that you rub and it’s more for a localized muscle and joint pain. Like you’re not going to absorb that all throughout your body, but it’s definitely going to help the area that you’re rubbing on. CBD oil or tincture is dropped. You put underneath your tongue, you hold it there between one and 3 minutes and it absorbs directly into your body and gets CBD into your whole system that way. And then the CBD gummies are just an easy way to take some CBD generally, it’s usually used for helping people sleep.

Eric Finger:

I think that’s important for our listeners to know. This is why this is good information for me, because there’s a lot out there and I’m like, Oh, how does this stuff work here? So great to hear it. And then how do you offer your clients, you know, these products, you’ve shown them, you know, hey, you know, for the aches here, use this and such. How often can you use these these creams? Is this daily use? Is this, you know, a few times a week or, you know, kind of help us out?

Carey Rouse:

I would say the cream is depending on the size of the area. You’re only going to need about one milliliter of cream. Actually resolve the issue unless it’s a large area. But I would apply it 3 to 4 times a day, depending on the severity of the pain and definitely before a workout, definitely after the workout and maybe morning and evening. Something to keep in mind. A lot of these creams have menthol or lidocaine in them, so just make sure you wash your hands afterwards. You don’t get anything in your eyes. The oils, it’s just one milliliter underneath your tongue per day. And the gummies is just one or two before you go to bed.

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