What is Neurocentric Training?

Hady Daboul is the co-founder and Chief Scientific Officer at Heyvie, which is working towards making neurocentric training, a brain-rewiring technique known so far only to elite athletes and a handful of therapists, accessible to everyone for a more resilient and pain-free life. Read on to learn what neurocentric training is all about!

Marta: Hady, today we will talk about neurocentric training. Maybe I’ll start by asking how did you find out about neurocentric training? Cause I assume this is not something they taught you at a medical school, right?

Hady: So that goes a while back. I was in med school and I was a little bit frustrated because if you finished med school and you’re a doctor at a hospital and someone’s coming in and they have, for example, back pain, the thing you can do as a doctor is tell them “ You can go see your physiotherapist, maybe he can help you. Or you can take these painkillers.” But that’s the most direct thing you’re doing as a doctor and this was frustrating for me. So maybe I was just open to alternatives. Also, I was a bit lucky because my judo trainer at that time was a physical therapist and she was using neurocentric training with her patients. And at some point I got injured. I did Brazilian jujitsu and I injured my right biceps tendon, and that problems stuck with me for like two or three, four weeks. My father is a surgeon and he always says “if you’re injured, just take six weeks off and then see if it’s better”. But at some point I was like, this is not getting better. And Romana (Romana Kučerová), that’s her name, told me to come in so she could have a look. The problem went away so quick that I was like, what are you doing? I don’t understand this. And that’s kinda how it started. So she taught me a lot in the beginning and then I went to all the courses that Z-Health (Neurocentric education institute founded by Dr. Eric Cobb) was providing in Europe and now in America.

Marta: And do you know where she got to know neurocentric training?

Hady: I believe she was trained by Lars Lienhard. He made it kind of famous in Germany because he’s working a lot with elite athletes. He’s working in tennis and soccer. He went with the German national team to Rio to coach them.

Marta: It feels like this is such a secret in a way, right? Like there are all these elite athletes practicing it but it’s completely inaccessible to the masses. Why do you think that’s the case?

Hady: First of all, it’s a very hard education because you need to know a lot about the brain from the beginning. I’ve been in this for seven years right now and I’m still learning every day. I have a medical background. So if you’re a physiotherapist or someone without the medical neuroanatomical background, it’s really hard to grasp the concept at first and you need to put in a lot of effort. Also, the education is not cheap. There are not many trainers and the people who are trainers, they are just working with whoever comes through the door so it doesn’t get much attention. But we are trying to change that.

Marta: You know, when you learned about this, was it a kind of an “aha moment” where you felt like this makes total sense for you as a doctor and someone with a background in neurology? Or were you a bit at skeptical in the beginning?

Hady: I was very frustrated because it works so well and I was studying medicine in Bonn, where we had a big emphasis on neuroanatomy because we had a really good professor. So we had more neuroanatomy than any other German medical faculty. And I thought, why not just put in this extra 10 minutes of effort to show people how to apply whatever is taught in the (neuro)anatomy class instead of just teaching names of nerves, names of tracks, names of organs and how they function. Instead, teach how they are involved in movement and what kind of use we can take out of it? I was frustrated because I could have learned this 3, 4, 5 years earlier with much less effort.

Marta: I think we’re touching now on the science of the training itself. This is the million dollar question, right? So what is neurocentric training?

Hady: Basically what we do is, we try to look at different brain parts and see which brain part might profit from extra activation. So whatever that person is missing, we try to give it to them and we try to find out what’s missing by looking at the brain. And we do this by simple movement assessments. So if someone is coming to us we tell them for example to stand on their left leg and then their right leg. Maybe they fall over to the one or the other side, depending on which leg they stand on. This is one of the movement tests for us and it’s really important to know which brain part is involved in stabilising one leg. Essentially every movement you do is applied neuroanatomy and neurology. We just try to find it to make sense out of it so that the right person gets what’s right for their brain at that point

Marta: I think it makes a lot of sense because when I think about myself, for example, going to a fitness class or having to do an exercise that involves my right side or the left side I definitely see the difference usually. I am comfortable more with one side or the other. This is something you’re looking for?

Hady: That’s exactly how we think about it. A lot of people are right-handed: they write with their right hand, they throw with their right hand, they catch a ball with their right hand. And this of course leaves some kind of mark on the brain and how the brain evolves. And it’s not only this writing and throwing and catching. It’s everything you do. It is how you move, how you think, how neurons in your brain are connected with each other. Some things are easy for you because you’ve been doing them in a habitual way for a long period of time. You are not very inclined to use the best movement pattern, the most physiologic movement pattern that requires objectively the least effort because the other one seems more natural to you. And we try to just tell your brain: “maybe you can move as well like this”.

Marta: You’re rewiring the brain, right?

Hady: We are trying to let the brain know that it can use whatever is out there instead of not using it. There are capacities not used because of an injury for example. And we try to remind the brain “you can use it, it’s fine for you”.

Marta: This is an interesting question. How do you know that someone performs a task in a kind of suboptimal way, that the brain could find a better way for them to do it?

Hady: I think everything we do could be done in a better and more efficient way, or we would all be pro athletes in every kind of sport. We strongly believe we can make everyone better by looking at their brains, instead of saying “we think you move bad” we ask “let’s see why you move bad”.

Marta: And you do this rewiring by making people do short exercise that you call drills?

Hady: Our brains really love novelty. So whenever we give them something new they will remember it more easily because it’s new and they need to pay a lot of attention to what’s happening. So we try to find first what’s new for them so that they really pay attention to what they are doing at that moment. And we also try to find what kind of area do we want to target? Do we need an eye movement? Do we need something for the balance system? Do we need some sensational stimulus to your hand or whatever? And by providing this stimulus that essentially targets the excited part of the brain that could benefit from the innovation we initiate some kind of rewiring.

Marta: Could you give an example of what a drill could look like?

Hady: For example, just tilting your head to the left side and really focusing on the good movement is one of the exercises. Some people need activation for their left balance system and some for the right. We try to find out through the initial movement assessments what side might be the best for the people. And then we give them either the head turn to the right or to the left. So it is really easy exercise and we try to make people do it three to five times a day,

Marta: And they’re not long, right? So you can do it for example, at your desk, whenever.

Hady: That’s a big plus. We try to make them as easy as possible and accessible as possible so that people have tools to use whenever they need them. So when their knee starts to hurt again, they know they can do it (the exercise) anywhere. And maybe that’s enough for them to get home without pain in the knee. Even just the thought of having a tool like this available to you when you are in some kind of danger or something hurts, is maybe enough to not have the pain.

Marta: It sounds kind of like magic, right? Because people take medication for pain or go to physiotherapists with injuries. Are you saying that neurocentric training could replace that?

Hady: I think there is a time and point for every intervention. If you broke your leg and you are in pain obviously see the doctor. We don’t want anyone to have a pain memory. But for all the chronic pain, I think we need other strategies to address them because it shouldn’t really be treated by just taking painkillers for people’s entire lives.

Marta: Could you give an example or examples of types of chronic pain that neurocentric training could help with?

Hady: So a lot of times people have an operation for their knee for example but they don’t really feel better afterwards. Everything is fine and seems fine. If you do an MRI and x-ray you don’t see any structural damage. So what do we do then is first of all we look at the scars. Because every scar is a damage to the receptors on the skin. So we’re interested if you actually feel the scar as well as healthy skin? Oftentimes you’ll see some kind of reduction in sensation. What does that mean? If your brain doesn’t know where the knee is exactly in space, it will hesitate to move it. If you don’t know where it this, you don’t want to move it because you risk injury and an injury for your brain is very threatening. Let’s say a hundred, 200, 300, 400 years ago if you damaged your neck, you could not get to the lake to get water. If there would be a wild animal, you would be dead. So that’s where we come from. So the brain really protects your leg by putting out pain. There does not need to be any physical damage, but still the pain is there. So what we do, we try to reeducate the sensation on the skin, we try to find stimulus that’s good for that scar so that it gets a healthy skin feeling back so that your brain feel safe enough to move it in different positions.

Marta: That’s very fascinating. But I think when we talked initially one of the problems that you were trying to solve with neurocentric training was, for example, migraine, right? How does migraine fit into this example that you’ve given with the knee? How does the brain interpret it?

Hady: If you look, for example at different professions, you see changes in the brain. An architect has a different brain structure than a doctor because they use different parts of the brain. They train it like a muscle. And with migraine it’s the same. So basically we look at what’s maybe weak in migraine. What is the weak link? For your muscles in your arms and legs the nerves come out of your spinal cord, for your face these nerves come from your brainstem. So sensation in your face, how you move your jaw, chewing food, smelling, everything comes from your brainstem and your brain. In migraine one of these nerves seems to be impaired very much. So in a migraine the blood vessels in your brain dilate, they become bigger, and they stay like this. And the nerve that’s responsible for this also does sensation in your face and also goes to your jaw musculature.What we see in some studies for example, is that neck muscle endurance is significantly lower in chronic migraine patients then in healthy controls. Some brain change can lead to this. We just try to go to the structures that seem to be the weakest link, for example the trigeminal nerve, that controls the sensation of the face. We are very much interested in can you actually feel on the right side of your face as you can feel on the left side of your face. We’ve seen that a lot of people detected a difference for themselves as they tested it. And we are very curious to see what happens if that feeling comes back — and the feeling can come back again and it can get to a healthy level. What happens if we train your neck musculature on the right side or your left side? We just want to see what happens if we give it back some physiological action and safety so to also make it less hypersensitive to stress, which is often in migraines. So that the neck should feel safe enough to support whatever’s happening or your trigeminal nerve needs to feel safe enough that when stress is happening, the outlet is not the migraine. You don’t need to shut down your system.

Marta: So essentially you can decompose every pain in that way and apply neurocentric training to it?

Hady: Neurocentric training is just how we look at things. It’s putting the brain first and then looking at what is the disease, what does my body need to do in order to make it better?

Marta: But we started off by talking about elite athletes using it because it’s not just for pain management, it’s also to kind of improve your performance, to make your body move and behave in an optimal way.

Hady: For me personally, it’s not really different having some kind of disease or training someone who has ambitions of being a pro athlete or is a pro athlete because we all have brains and they function roughly the same. So the demands are also the same and then it’s just the question of where is the weakest link for that athlete? Is it his eyes and he cannot maintain focus on the target that comes to his eyes at a certain speed. So we can train that. Or maybe it’s their balance system on the left side that’s a little bit impaired. It’s always the same thought: what demands does the sport have and what does the brain think of that movement and where is the access point for us.

Marta: I guess it’s not just about doing sports right but also mobility in everyday life.

Hady: You can think about it this way: most people when expected to turn, would turn to one side. For example, they would always turn to the right side even if it’s a longer way. This then has implications for stability because your balance system stabilizes the spine and the muscles by a reflex so that you can maintain upright and load your spine or load your body so that you don’t fall over. But if leaning to the left side is a little bit weird for you then you just lean to your right more all your life. If you carry your bag, you carry it on the right side, whatever. So if we build up then the balance system on the left side, your spine gets stabilized a little bit better. Maybe it has carry over effect to good movement, it’s practical.

Marta: I think it’s a great proposition because we’re getting older but it would be great if we could live longer but also healthier and more independent. Just live our lives better and move better. This is a journey. It’s not like you can rewire your brain once by doing some exercise and then not do anything else? You have to do it on a regular basis?

Hady: Yes. I’ve had clients who had pain and then we fixed it and you don’t see them anymore of course. But if you really are into longevity and you want to live a healthy life for years to come, I believe that you have to move. And you have to move in a way that your brain craves because that is what is best for you. If you already move, it’s really good for you, but then on top, moving how your brain needs it, is just like a little better or gives you a little bit more health.

If want to experience neurocentric training for yourself, go checkout what Heyvie is doing. And if you’re building a health tech startup I would like to hear from you! Drop me an email at marta@calmstorm.vc