A Smarter Way to Approach Joint Pain and Movement Limits
Have you ever had a client who exercises, stretches regularly, and does mobility work, but still has chronic tension or lack of mobility? I know I have. I have trained clients like this and been one myself.
Neurocentric fitness is not new, but it might give you a new perspective on training. After being somewhat gatekept in specialty settings like physical therapy clinics and athletic training facilities, more trainers are starting to utilize these brain-focused techniques with their clients.
Neurocentric fitness is an approach to training that prioritizes the nervous system before or alongside the muscles. We’re not talking about crossword puzzle apps or memory games. Neuro-based exercises still involve physical movement, just with a different purpose.
In this article, I’ll be giving you neurocentric fitness tools to improve joint recovery, manage pain, and improve mobility and efficiency. I’ll start with simple explanations of brain-based concepts so you can have confidence in what you’re teaching (and explain it to your questioning clients). Then I’ll walk you through practical drill ideas and safety considerations so you can start applying these principles today.
The Core of Neurocentric Fitness
In the realm of recovery and pain management, neurocentric fitness starts with the premise that the body’s nervous system controls or greatly influences movement quality, pain perception, and joint stability. That’s a lot to take in. We already know that injury, chronic conditions, and scar tissue all affect movement, and now I’m telling you that your brain affects it, too. It almost seems like there are too many moving parts, too many paths to chase to get someone feeling better.
You can see this knowledge in two ways: it can be one more burdensome thing to add to your client’s program, or it can be an opportunity to find a missing puzzle piece. I like to see it as the latter, and I hope you will too. Remember, we’re not medical providers, so we aren’t providing clinical-level treatment to patients. Our scope of practice is training movements and exercise integrations that support our clients for a holistic approach.
Let’s talk about three neurocentric concepts that will get your clients on the road to movement with less pain:
- Pain Perception is multifaceted. When the body senses pain, nerves transmit a signal to the part of the brain associated with initial pain perception. A second part of the brain that involves emotion also activates. Together, these help determine how pain is perceived. Research published in the journal Practical Pain Management has shown that pain perception is also influenced by non-physiological factors, including “personality, cognitions, beliefs, sociocultural variables, learning, and emotional reactivity.”
Training Application: Teach your clients exercises and techniques that can help them manage pain. This can include breathing techniques and the difference between pain and discomfort during exercise. - Central sensitization occurs when the nervous system’s sensitivity to pain is heightened. This can happen as a result of chronic health conditions, ongoing inflammation or injury, sleep deprivation, and nerve damage.
Training Application: Help your clients understand the importance of movement and recovery to decrease inflammation and stress related to chronic conditions. - The biopsychosocial model suggests that pain management (and a person’s entire health) is dependent on a combination of biological, psychological, and social factors. Some of these include genetics and physical health (biological factors), coping skills and self-esteem (psychological factors), and relationships and social life (social factors).
Training Application: Where possible, address each of these three components in your training sessions. Encourage positive self-talk, try small-group training, and celebrate your clients’ physical and mental wins.
With these three concepts in mind, let’s jump into systems you can start using today to help your clients manage their pain and improve joint health.
Pain Reduction Systems in Neurocentric Fitness
Within the realm of pain management, neurocentric fitness uses three systems or bodily functions. These include the vision, vestibular, and proprioceptive systems. Each one supports a different part of pain management, making a combination of the three the most effective for improved overall function.
Vision System
The vision system’s role is to guide balance, posture, and movement control.
- Vision Drills:
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- Smooth pursuit eye-tracking – Track a moving object with the eyes. It should be slow and controlled.
- Focal-point head turns – Keep the eyes focused on a stationary point, then turn the head slowly to the sides.
- Effects of training: These exercises lower protective muscular guarding and increase movement confidence. They also improve functional movement by improving balance and stability.
Vestibular System
The vestibular system (found in the inner ear) plays a role in orientation and balance.
- Vestibular Drills:
- Slow head nods – Nod the head up and down with control. It can be paired with focal-point eye tracking.
- Gentle rotational head movements – Move the head in various directions. Pair it with controlled breathing.
- Effects of training: These exercises, while seemingly simple, can decrease neck and back pain, help steady the posture, and train the body to remain balanced when the head or eyes move.
Proprioceptive System
The body’s proprioceptive system affects body awareness, joint mapping, and safety signals during movement.
- Proprioceptive Drills:
- Controlled joint circles – Rotate major joints through their range of motion. Drawing letters or shapes in the air with the extremities is also effective.
- Controlled short-range movements – Perform an activity on an unstable surface or add a small movement to an isometric exercise.
- Effects of training: Proprioceptive training can increase joint control and reduce joint guarding, which leads to better flexibility and smoother mobility.
Neurocentric Exercise Protocols for Common Joint and Pain Challenges
Using the systems we just discussed, let’s dive into some practical applications and ready-to-use protocols for the most common complaints we see as trainers.
Neck Pain and Limited Rotation
Neck pain is a top concern among school- and working-age Americans. Most people spend several hours a day in front of a screen, whether working or relaxing. This can lead to neck strain and chronic pain. Chronic stress can also create lasting tension in the neck, limiting the range of motion and causing pain. You can help counteract this by teaching corrective exercises to reduce pain and increase functional movement.
Exercises for Neck Mobility:
- Eye tracking: Follow a moving object or a pattern. Perform 2–4 slow reps in various directions.
- Chin tucks: Tuck the chin in (like you’re making a double chin) and hold for 2-3 seconds. Repeat 8–10 times.
- Head-turn mapping: Move the head with control side-to-side, up and down, and on diagonals. Repeat 2–3 times in each direction.
Shoulder Stiffness or Clicking
Shoulder stiffness, pain, or clicking is often the result of an injury or damage to the joint. It can also be caused by chronic conditions that cause degeneration of joints. You can improve shoulder mobility, reduce pain, and increase functional range of motion through mobility drills.
Exercises for Shoulder Mobility:
- Dynamic scapular mapping: Move the arm through flexion, extension, abduction, adduction, and internal and external rotation 2–3 times in each direction.
- Wall slides with breathing: Stand against a wall, elbows and the backs of hands against the wall. Slowly slide the arms up the wall, then back down. Perform 8–10 reps.
- Short-range band exercises: Perform band pull-apart, overhead pull-aparts, banded external rotation, or scapular retractions as needed for 10–12 reps.
Low Back Pain
Low back pain affects most people at some point in their lives. An estimated 90% of low back pain is non-specific, meaning that there is no defined reason for the pain. This is why neurocentric exercise can be so beneficial. It helps target pain that can’t be defined by disease or structural damage.
Exercises:
- Breathing resets: Start with diaphragmatic breathing, taking slow, controlled breaths in and out. Incorporate movements such as pelvic tilts or cat-cows that match breaths. Start with 6–8 slow breaths.
- Hip mobility CARs: In a controlled manner, take the hip through its full range of motion. Repeat 3–4 times on each side.
- Bird-dog variations: From a quadruped position, engage the core, and extend one leg and the opposite arm, holding for 2-3 seconds before coming back to quadruped. Repeat 6–8 times per side. For more stability, only raise one limb at a time.
Knee or Hip Discomfort
Knee pain is often associated with joint instability at the knee, hip, or ankle joint, and can be caused by injury, disease, weakness, or weight-related challenges. You can improve function and reduce pain by incorporating mobility exercises that foster the mind-muscle connection.
Exercises:
- Single leg and tandem stands: For single leg stands, stand on one leg for 10-15 seconds, focusing on good posture. For tandem stands, place one foot directly in front of the other and balance using both legs for 10-15 seconds without shifting too far onto one leg. Repeat both stands on each leg 2-3 times.
- Heel-to-shin slide: While lying down, slide one heel along the other shin, from knee to ankle. Repeat 3–4 times on each leg.
- Lateral walks: Take 10–15 steps to the side, then repeat going the opposite direction.
General Frequency and Progression Guidelines
You may already be doing many of these exercises with your clients. If you are, take a moment to reevaluate form and purpose for doing them. Encourage mindfulness with each movement.
These exercises can be done 2–4 times per week as part of your client’s warm-up or regular exercises. When movements feel smooth and are less guarded, the exercises can be progressed. Remember to always stay within your scope of practice and maintain current liability insurance in case of an accident. Many progressions or advanced neurocentric exercises fall within the scope of a physical therapist or other healthcare professional, so ensure your choice of exercises is both safe and appropriate for your client and your role as a trainer.
Pain Neuroscience Education in Fitness Settings
When it comes to training clients, especially those with chronic pain, education is key. Work with your clients and their healthcare provider to better understand pain, and whether they are protective signals or damage.
Support confident movement and physical activity without fear. The fear of pain can be a large barrier to exercise. Start slow and within comfortable limits, and progress as the client is ready. Stay within your scope of practice by only providing appropriate movement-based guidance.
How to Build a Neurocentric Exercise Program
When training a client using neurocentric exercises, you can incorporate them into a regular workout routine or create a neurocentric program. Most general population clients benefit from adding these exercises to their regular training, where some deconditioned individuals or special populations may need an entire program built around these exercises. If that is the case, it is recommended that you work with a client’s healthcare provider to ensure safety and stay within your scope of practice.
To build a neurocentric exercise program or add to an existing program, you can add exercises in the warm-up, main workout, and cool-down as follows.
Warm-Up (5 minutes)
Start with gentle activities that activate the three systems we discussed earlier: vision, vestibular, and proprioceptive. These will help your client focus while feeling balanced and stable as they get ready for more movement. It introduces movement as being pain-free, helping lower guarding and pain-related stress. Start with:
- Vision drills
- Vestibular rotation drills
- Controlled breathing.
Main Set (15–25 minutes)
In the early stages, keep movements low-stress and pain-free as much as possible. This can give your client’s brain the chance to develop positive attitudes and behaviors toward exercise. Jumping into activity that increases pain or inflammation can result in a loss of program adherence. As a client progresses, more strength-building and challenging exercises can be introduced in a way that feels safe for the client.
During the main body of the workout, focus on:
- Low-threat resistance training
- Functional movement patterns
- Graded exposure.
Cool-Down (5 minutes)
We’ve all heard not to skip the warm-up or cool-down, and neurocentric training is no exception. The cool-down is an ideal time to help a client relieve any stress, tension, or pain that they may have experienced during the workout. Try:
- Controlled breathing exercises
- Gentle mobility training
- Reassessment of feelings, pain, and motivation.
Track and Adjust
Just as muscles build and adjust to the stress placed on them, the brain does the same. Our brain and body adapt to the neurocentric exercises we do. Adjust your drills and exercises to the needs and abilities of your clients. Besides tracking their strength or reps, monitor their mobility, confidence, fatigue, and discomfort. Pain can be an incredible demotivator, but the lack of it can greatly encourage movement. Allow your clients to experience pain-free movement, and they’ll keep coming back.
Why Trainers Need Liability Insurance for Neurocentric Work
Neurocentric fitness is an ever-evolving field and, in many cases, dances on the border of the personal training scope of practice. Education and communication are key for trainers who want to provide this offering for their clients. It can give qualified trainers practical ways to support mobility, reduce discomfort, and improve movement confidence in new and more complete ways.
Insure Fitness Group’s annual liability insurance protects you when customers report discomfort or involve healthcare professionals. It can give you and your clients the confidence to move forward.
Ready to add these tools to your training skill set with proper professional protection?
Get an annual insurance estimate today.
