Neural Re-Education: The Science of Re-learning Pain-Free Movement

Neural Re-Education (NRE) is an educational tool that was developed to be used in pain management and movement therapy. NRE as a protocol was explored in-depth and published in Dr Coetzee’s book WHY MOVEMENT IS MEDICINE (2020). NRE is rooted in pain and neuroscience education, aiming to help patients better understand and manage their pain and movement dysfunctions.

What is the NRE Protocol?

The Neural Re-Education (NRE) Protocol is a clinically applied method that helps people relearn pain-free movement by using the brain's natural ability to change: neuroplasticity. It’s based on the idea that the brain can learn pain - but also unlearn it, through the right movement, input, and environment.

NRE is the assisted relearning of pain free movement. NRE is our version of patient education.

As an educational framework and protocol, NRE can assist patients to regain control over their physical health. The core principle of NRE involves three essential steps (Remove, Re-move, Move. See below.)

Why Do We Use It?

Chronic pain is not always due to structural damage. Often, the brain has adapted to expect pain - a process called maladaptive plasticity. This means pain continues even when tissues are healed. The NRE protocol aims to reverse this by teaching the brain and body that movement is safe again.

NRE is not just about pain-free movement. It is a universal protocol for assisted neural re-learning - whether it’s how your spine moves, how your posture feels, or even how you speak or respond to stress.

NRE has its roots in the science of neuroplasticity: the brain’s ability to rewire based on experience. From overcoming my own stutter, to helping patients reclaim control of their movement, the same principle applies - we are not stuck with the brain we have. We can re-educate it.

Safely, progressively, and intentionally.

The NRE Process: Remove, Re-move, Move

“REMOVE”

• Identify and remove root causes of pain (posture, habits, stress)
• Use education to reduce threat and increase safety
• Calm the nervous system and prepare the brain for learning

“RE-MOVE”

• Reintroduce safe, novel movement using manual therapy and mobility drills
• Use surprise and variation to create positive prediction error
• Engage joint, muscle, and brain maps that have become underused or protective

“MOVE”

• Reinforce healthy movement with strength and control exercises
• Rebuild movement confidence and adaptability
• Shift from recovery to long-term performance

LENDS: The Lifestyle Engine Behind NRE

LENDS stands for Love, Exercise, Newness, Diet, Sleep. These five pillars support your brain’s ability to rewire.

The most important of these? Newness. Novel movement and enriched environments stimulate the exact systems NRE is designed to activate.

Love = Emotional safety calms the brain

Exercise = Movement drives plasticity

Newness = Novelty is essential for re-mapping movement

Diet = Fuels neurochemical balance

Sleep = Consolidates neural change

How Does NRE Work in Practice?

Learning to move better and with less pain is key to managing chronic pain effectively. Understanding pain as a concept is essential. Understanding pain as both a sensory and emotional experience - one that is not always proportional to tissue damage - is crucial in pain management.

By applying NRE principles, we can help patients break the cycle of their chronic pain through education. This holistic approach not only helps you overcome movement dysfunctions and chronic pain but also equips you with the tools to maintain an active, healthy lifestyle.

What does NRE look like in Clinic?

1. Thorough movement and neurological assessment.

2. Guided manual therapy or spinal manipulation to create clear sensory input.

3. Movement coaching that introduces safe, pain-free novelty.

4. Reinforcement through strength, mobility, or balance work.

5. Discussion around mindset, lifestyle, and how to keep progressing.

Pain Management & Movement Longevity

Our approach to Pain Management & Movement Longevity focuses on reducing pain and enhancing your ability to move efficiently and comfortably throughout your life. We combine various evidence-based therapies and techniques to address both acute and chronic pain, helping you maintain mobility and quality of life as you age. Education about these concepts is essential.

Chiropractors are trained in a variety of techniques, allowing them to create individualised plans that target your specific needs. This comprehensive approach assists not only pain relief but also long-term movement sustainability.

The Goal

Not just to eliminate pain - but to teach the nervous system that movement is safe again. The NRE Protocol helps you unlearn pain, relearn strength, and move forward with resilience.

"We aren’t just treating the body. We’re re-educating the brain."

This is the science of why movement is medicine.

This is NRE.

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.

Moseley GL, Butler DS. Fifteen years of explaining pain: The past, present, and future. The Journal of Pain. 2021.

Louw A, et al. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Musculoskeletal Science and Practice. 2016.

Stochkendahl MJ, et al. Manual therapy with or without physical exercise in the treatment of musculoskeletal conditions: A systematic review. Manual Therapy. 2020.

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.

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.

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.

Busse, J. W., et al. (2017). "Guideline for opioid therapy and chronic noncancer pain," CMAJ.

Merzenich MM, Van Vleet TM, Nahum M. Brain plasticity-based therapeutics. Front Hum Neurosci. 2014 Jun 27;8:385. doi: 10.3389/fnhum.2014.00385. PMID: 25018719; PMCID: PMC4072971.

Goh JO, Park DC. Neuroplasticity and cognitive aging: the scaffolding theory of aging and cognition. Restor Neurol Neurosci. 2009;27(5):391-403. doi: 10.3233/RNN-2009-0493. PMID: 19847066; PMCID: PMC3355626.

Shaffer J. Neuroplasticity and Clinical Practice: Building Brain Power for Health. Front Psychol. 2016 Jul 26;7:1118. doi: 10.3389/fpsyg.2016.01118. PMID: 27507957; PMCID: PMC4960264.

Voss P, Thomas ME, Cisneros-Franco JM, de Villers-Sidani É. Dynamic Brains and the Changing Rules of Neuroplasticity: Implications for Learning and Recovery. Front Psychol. 2017 Oct 4;8:1657. doi: 10.3389/fpsyg.2017.01657. PMID: 29085312; PMCID: PMC5649212.

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.

© Dr. Cuan Wayne Coetzee and @movemeduk. All rights reserved. Unauthorised use, reproduction, or distribution of the NRE concept or associated materials is prohibited.