How Your Brain Can Change (and Where to Start)
How Your Brain Can Change (and Where to Start)
As a chiropractor, one of the most powerful messages I share with my patients is this: your brain can change. In fact, it’s constantly rewiring itself based on what we do, think, and how we move. And here’s the exciting part — by understanding how this change happens, we can begin to move better, reduce pain, and ultimately, move for longer. This is where Neural Re-Education (NRE) comes in.
Once you understand that pain is an experience in the brain, then you should want to change your brain to change the experience of chronic pain or its reoccurrence.
What is Neural Re-Education (NRE)?
Neural Re-Education (NRE) is our educational tool that we use in clinic and it refers to the assisted re-learning of pain-free movement. I’ve been developing this protocol since 2013, and while it’s not something I’ve invented, merely adapted, it combines physical therapies, education, and exercise into an evidence-based approach that can help you manage pain and improve movement.
The beauty of NRE is that it taps into neuroplasticity — the brain’s remarkable ability to reorganise itself by forming new neural connections throughout life. Neuroplasticity is the foundation for how we can change pain pathways and re-learn movement patterns. Research has shown that the brain can ‘forget’ certain movement patterns when they become associated with pain, and it’s our job to re-teach the body that it’s okay to move again. Re-Educate better movement.
The NRE Protocol: Remove, Re-Move, Move
Let’s break down the three core components of the NRE protocol:
1. Remove: Patient Education
Education is the first step in this process. Remove refers to understanding the root cause of your pain or the risk factors behind it. Often, once patients understand what’s contributing to their pain, they feel empowered to make changes. In fact, research has shown that education alone can significantly improve chronic pain management outcomes . That’s why I spend so much time explaining the "why" behind your condition during a consultation. After all, the word ‘doctor’ literally means ‘teacher’, and that’s a role I believe we’re called to fulfil as healthcare practitioners.
2. Re-Move: Physical Therapy
Next comes the physical therapy component of NRE — Re-Move. This involves re-moving or mobilising joints that aren’t moving correctly and releasing muscles that are tight or contain myofascial trigger points. By doing so, we can ‘wake up’ the neural pathways for these structures, allowing them to start signalling to the brain again. When joints stop moving and muscles tense up, your brain can effectively shut down the associated neural pathways — it’s almost like the brain forgets how to move those areas without pain. Physical therapy reactivates those pathways, beginning the re-learning process.
3. Move: Exercise
The final step is Move — this is where we progress forward. Once we’ve re-educated the brain to allow pain-free movement, exercise becomes critical for maintaining these new pathways. Zone 2 exercise (moderate-intensity aerobic exercise), strength training, proprioception (balance training), and flexibility exercises all strengthen the new neural connections. In other words, exercise is how we reinforce what we’ve re-learned, ensuring that the brain keeps these new movement patterns alive and well. And beyond physical benefits, exercise also contributes to mental and emotional wellbeing .
The Five Principles of NRE and Health: LENDS
Now that we’ve covered the "what" and "how" of NRE, let’s talk about the principles underpinning this approach. I summarise these into five categories, using the acronym LENDS:
L: Love — emotional connection and positive relationships
E: Exercise — regular movement to strengthen neural pathways
N: Newness & Discomfort — challenging the brain and body with new, uncomfortable stimuli to promote growth
D: Diet — proper nutrition to fuel both body and brain
S: Sleep — adequate rest to allow for healing and recovery
These five principles not only support physical health but also provide the foundation for mental and emotional wellbeing. Remember, neuroplasticity thrives in environments of change — new experiences, new movements, and new ways of thinking.
Where to Start: Making Neural Re-Education Part of Your Life
If you’re dealing with pain or struggling with movement, the good news is that you can start changing your brain today. By integrating the NRE protocol into your routine, you’ll not only address the root causes of your pain but also create lasting improvements in your ability to move and function.
Start with education: Learn about your condition and the risk factors contributing to your pain. Understanding what’s happening in your body is the first step towards improvement.
Incorporate physical therapy: Whether it’s mobilisation exercises or targeted stretches, re-move those areas that have become restricted.
Commit to movement: Build regular exercise into your life, focusing on strengthening, balance, and flexibility. Remember, movement is medicine!
Conclusion: Changing Your Brain, Changing Your Life
In summary, your brain can change. The principles of NRE show us that by removing pain-inducing factors, re-moving dysfunctional movement patterns, and committing to regular exercise, we can not only reduce pain but also promote long-term movement longevity. It’s a process backed by research, and it’s one that works.
So, if you’re ready to move better and live better, now’s the time to start changing your brain — and I’m here to help guide you every step of the way.
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References:
GBD 2019 Diseases and Injuries Collaborators. (2020). "Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019," The Lancet. https://pubmed.ncbi.nlm.nih.gov/33069326/
Moseley GL, Butler DS. Fifteen years of explaining pain: The past, present, and future. The Journal of Pain. 2021. https://pubmed.ncbi.nlm.nih.gov/26051220/
Louw A, et al. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Musculoskeletal Science and Practice. 2016. https://pubmed.ncbi.nlm.nih.gov/27351541/
Stochkendahl MJ, et al. Manual therapy with or without physical exercise in the treatment of musculoskeletal conditions: A systematic review. Manual Therapy. 2020. https://pubmed.ncbi.nlm.nih.gov/20538501/
Chou, R., et al. (2017). "Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline," Annals of Internal Medicine. https://pubmed.ncbi.nlm.nih.gov/28192793/
Geneen, L. J., et al. (2017). "Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews," Cochrane Database of Systematic Reviews. https://pubmed.ncbi.nlm.nih.gov/28436583/
Abbott, J. H., et al. (2016). "Exercise therapy, manual therapy, or both, for osteoarthritis of the hip or knee: a systematic review and meta-analysis of randomized controlled trials," Osteoarthritis and Cartilage. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2644684/
Busse, J. W., et al. (2017). "Guideline for opioid therapy and chronic noncancer pain," CMAJ.
Disclaimer:
Neural Re-Education (NRE) is a proprietary term and treatment protocol developed by Dr. Cuan Wayne Coetzee. While NRE is grounded in established principles of pain neuroscience education and movement therapy, the specific methodology, combination, and application of these concepts within the NRE framework are unique to Dr. Coetzee's practice and intellectual property.
This approach has been developed through extensive clinical experience, rigorous analysis of current research, and observed patient outcomes. It continues to evolve in tandem with advancements in pain science, chiropractic care, and movement studies. NRE, as described in Dr. Coetzee's practice, publications, and educational materials, represents his personal interpretation and application of broader scientific principles. It is not a standardised medical protocol, nor is it currently trademarked or patented. The information provided about NRE is for educational purposes only and does not constitute medical advice. Individuals seeking treatment should consult with a qualified healthcare professional. Results may vary, and the efficacy of NRE may differ based on individual circumstances.
© 2024 Dr. Cuan Wayne Coetzee. All rights reserved. Unauthorised use, reproduction, or distribution of the NRE concept or associated materials is prohibited.
