TRE & Neurogenic Movement in Healing Trauma & Pain with Richmond Heath

Welcome back to the Pain Science Education Podcast

This episode of the Pain Science Education Podcast delves into the interconnectedness between chronic pain and trauma, particularly focusing on the use of neurogenic movement to release trauma and alleviate chronic pain. Dr. Tatta introduces Richmond Heath, a physiotherapist from Australia with expertise in treating chronic pain and trauma through tension and trauma-releasing exercises (TRE). The discussion begins by highlighting the overlap between chronic pain and trauma, emphasizing that both are active processes generated by the brain and body. Physiotherapist Richmond Heath explains how trauma responses can manifest as immobility and tension in the body, leading to chronic pain over time. The conversation shifts to the concept of neurogenic movement, where the nervous system generates movement spontaneously without conscious control. This natural recovery response is explored as a tool for releasing tension and trauma stored in the body.

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TRE & Neurogenic Movement in Healing Trauma & Pain with Richmond Heath

Welcome to the Pain Science Education Podcast, where we discuss ways to treat and reverse persistent pain. I’m your host, Dr. Joe Tatta, a licensed physical therapist and founder of the Integrative Pain Science Institute, where we train practitioners on whole person pain care. This podcast also serves as a public health campaign to support those living with chronic pain. This podcast is for informational purposes only, and it’s not intended to be a substitute for professional medical advice. Hey there, friends. Welcome to this week’s episode of the Pain Science Education Podcast. This week, we’re discussing how to treat comorbid chronic pain and trauma or PTSD, a often growing and important topic in the chronic pain world. When we look at the research in chronic pain, we see that anywhere between 10 to upwards of 75% of people with chronic pain also have comorbid trauma or PTSD. In fact, some researchers and clinicians believe that chronic pain in and of itself is a form of post-traumatic stress disorder or trauma, and certainly living with chronic pain that is poorly treated or undertreated does lead to trauma. This week we’ll discuss the interrelated connections between trauma and chronic pain. We’ll talk about how the brain informs the body and how the body informs the brain. Specifically on today’s episode, we’ll discuss how neurogenic movement can be used to help release trauma and cure chronic pain. My guest this week is Richmond Heath. He is a physiotherapist from Australia who has 30 years of treating chronic pain and trauma through a method called TRE or tension and trauma releasing exercises. This approach uses a neurogenic movement to help the body release stored trauma and of course to alleviate and cure chronic pain. On this week’s episode, we’ll discuss the neuroscientific basis or the interconnectedness between chronic pain and trauma. We’ll discuss the research behind neurogenic movement and how you can take some steps in applying this in your clinical practice or at home. If you’re someone looking for symptomatic relief. Okay. Without further ado, let’s begin and let’s meet Richmond Heath. Hey there Richmond. Thanks for joining me this week on the podcast. It’s great to have you here.

Yeah, thanks Joe. It’s been a while to get organized, but we finally made it.

Yeah, I’m excited to talk about all the things. Pain, trauma, neurogenic movement, using movement to heal stress-related conditions, let’s just call them that, right? I think a good place to probably start, because we’re going to be talking about lots of different conditions, but oftentimes These conditions have symptoms that overlap and can seem very similar. A good place to probably begin is, can you talk to us a little bit about the interconnectedness or similarities between something like chronic pain, which we often speak about on this podcast, and PTSD or what we know as trauma?

Yeah. So, I mean, the first thing is the context is in our Western medical model, we tend to split these two things apart. Pain is something that, you know, physical therapists, physios or whatever deal with. And trauma is something that mental health people deal with. So that creates this real disparity between the research and the knowledge base. But one way I like to talk about it, Joe, is that trauma is a verb now and pain, for me, pain is a verb as well. And what I mean by that is that What we call trauma or unresolved trauma, you know, we often define it in the mental health world by the external experience, you know, PTSD, you need to have a life or death threat. Whereas when we look at trauma from the physiology of the body, trauma is any time when the body or all the body globally or parts of the body are actively creating an immobility response. So in the trauma world, it gets called a freeze response or a fold response, but you could damage your shoulder and the receptors in the shoulder are picking up this danger and therefore they’re creating pain and immobility. So when we understand pain, while it’s multifactorial, is basically an output of the system, something the system is generating, then we start to see, right, both pain and trauma are these active processes which the body are habitually activating, often way after their initial responses were required. So, you know, that’s where we move into the element of chronic pain. And so I like to also use the example, you know, if you’ve got a trauma history where you’ve been bitten by a black dog as a young child and you’ve got unresolved trauma around dogs, well, someone can bring you in a fluffy white puppy and your body will generate a flight response. We’ll say I’ve got anxiety, but basically the body’s generating that flight response in the moment. And with pain, it’s very much similar, that even if the injury happened weeks, months, years ago, and movement now is associated with danger. And so there’s these active processes that are happening in the moment. Pain, I like to explain, for me, pain’s not a noun. It’s not something that’s in there and stuck in the system. It’s something the body is actively generating in the moment. So when we understand that they’re, you know, in a way, very, very similar processes. And for me, when I look at the body, pain is generally, certainly in terms of chronic pain and immobility response. So over years of exploring this and working with it, you know, I would basically say, look, pain is a trauma response, but we often don’t look at it from that angle because of that split between the mind and body.

Yeah, it’s a wonderful way to open up the interview here today. I mean, do you think, you know, so obviously you and I are both physical therapists or physiotherapists. Do you think we’re kind of missing something in traditional physical therapy? Because when we hear the word trauma, we think, as you mentioned, you’re in a car accident, you’ve been bit by the dog, and it’s almost like this full body response, right? But then we start to look at conditions like CRPS. which is almost like this mysterious condition, like what’s happening. Um, and if you talk to those patients or those people who are experiencing that, they will tell you on some level that, you know, I do feel kind of disconnected from this part of my body, or I feel detached from this part of my body. Do you think we’re missing something in physical therapy or physiotherapy? And we haven’t really fully grasped that this could happen in a part of the body and not just be an entire body experience.

Yeah, I absolutely do. And, you know, this was my experiences when I first got introduced to neurogenic movement and TRE. I really had to go out of the physio profession and look in the trauma world to start to make these connections and make an understanding. And a major turning point for me, Joe, was reading the book, The Body Bears the Burden, written by Dr. Robert Scaia. So the reason why is he was an orthopedic surgeon who ended up spending his life specializing in whiplash. Now, when I was at uni, whiplash was all about inflammation and all that sort of stuff, whereas he was taking a trauma-informed approach to whiplash and starting to talk about things like implicit memory or procedural responses in the body. So exactly what you’re saying is because trauma has been seen as something as okay, it’s physical life and death trauma with a car accident or it’s psycho-emotional, you know, abuse, that sort of trauma. We have totally as a profession, you know, we’re only just now starting to investigate the crossover. And so this is where for me is if we stop defining trauma based on external causes, and we literally just look at what are the states of health and openness or trauma in the nervous system or to the body, or I like to use a movement-based model of trauma, then we start to see the connections where I think the vast majority of conditions we treat as physiotherapists basically have trauma patterns, either globally or segmentally, either underlying them or certainly impacting them.

So I’d like to maybe unpack some of those things that you’re talking about. And I guess we should probably, as you mentioned, you’re looking at this through a movement system, if you will, which is very different because when people look at trauma, they’re primarily looking at it from a psychological perspective. So what are the, I guess, differences and similarities potentially between looking at trauma from a movement perspective versus looking at trauma from a psychological perspective?

Yeah, they’re absolutely sort of massive, but I also think really fundamental because ultimately our stress and trauma response is first and foremost about movement, either the generation of movement in the fight or flight sympathetic arousal, or the containment or the inhibition of movement in a dorsal vagal parasympathetic model. So this is where polyvagal theory and having these three states of the autonomic nervous system, which of course you can’t separate that from the somatic movement system, is so critical and we don’t, in the physio world, a lot of us don’t know about polyvagal theria, it’s not part of our model, but the body responds at a neuromuscular level before we even have the psycho-emotional response. So if we just start from that foundation, if a car backfires or a bomb goes off, our bodies respond instantly before we’re even having the experience of the emotion. when we recognise that all of our stress or trauma responses, or I like to use the term defensive responses or self-protective responses, so we don’t think about it in terms of life and death, psycho-emotional trauma, we’re just going, right, a protective or defensive response in the physiology of the body, they’re first and foremost about generating movement or containing it. So when we look at it from the physiology of the body, it doesn’t matter whether, you know, I’m worried about an abusive partner or whether I’m worried about my child being bullied at school, or I’m worried about running out of money, or I’m worried about a car that’s coming towards me in an accident, at a physiological level, the body is still always responding the same way in terms of at a neuromuscular level. The muscles either can brace, they can generate movement, they can brace, or they can collapse and inhibit. And this is, as I say, when we start to look at this from a movement model, we stop globalizing trauma in psychoemotional terms, and we might go, right, you’ve had a micro tear to your supraspinatus tendon. That part of the body, that segment can be generating its own little immobility, disconnection response. And you did touch upon those people with, you know, chronic regional pain, where a big factor that’s often overlooked is that part of our trauma immobility response is to disconnect from the body. I mean, that’s the protective mechanism. In an evolutionary sense, if I’m about to get eaten to death by the proverbial saber-toothed tiger, I don’t want to feel it. So in those states, initially in fight or flight, we get a hump full of adrenaline that generates movement. Whereas when we’re moving into the, you know, the trauma states where there’s nothing we can do to prevent or overcome a stressor by the globally or segmentally, you know, then we start to get flooded with the, you know, opioids and the endorphins and that. So we disconnect from the body. And so that disconnection, which is intricately linked with immobility responses, because when things don’t move, we lose that sensory mode of feedback. And that’s part of the trauma response or the defensive protective response.

Yeah, I think it’s so important to bring that sensory motor aspect into the care of pain and or trauma, because right now it’s really kind of caught up in the cognitive emotional piece. And that’s important, right? When I when I look at pain, I think there’s a sensory motor and a cognitive emotional piece to the entire entire sequelae, whether it’s acute pain, and or chronic pain. It’s interesting because when I think back to early training, I’ve been a PT probably as long as you’ve been. We were talking about this early on, almost 30 years. I think early on, we looked at this like, there’s people who have high tone and low tone, so to speak. But we were never really able to figure out why is it that someone has, you know, high tone or hypertonicity or low tone. But this starts to kind of build a nice framework and understanding, not only for the practitioner, but also for obviously the person who has these symptoms. I’d imagine that, you know, approaching a movement based model for stress, pain and trauma is very important for the physiotherapy profession.

Yeah, absolutely. I think it’s a real new frontier for us to move into. And exactly what you were saying there, where when we look at the neuromuscular system, and the body, if it wants to inhibit or stop movement, it can either go into a hypotonic in the trauma world that we call the freeze response, where the body literally goes into rigidity, and then further up the defensive response, it would go into a hypotonic or a collapse or a fold or a flop response, it gets called in the in the trauma world where literally people start to fall unconscious and the body collapses. But we can also translate that to a segmental level where you can have a chronically activated bracing piriformis muscle, or you could have a completely shut down disconnected psoas muscle. So if we, again, this is simplifying it, but when we look at it, we can translate these bigger global patterns back down to a segmental level. When I went to uni, why is piriformis tight? Oh, it’s because of your posture or it’s because it’s… But why is it still activating? Why is it activating and why is it so tight? Why is it activating in that moment? And also like to frame, you know, well, why does that muscle relax if you give me a general anesthetic? So this is the point where these are active patterns. They’re not just because the muscle’s tight. It’s like, why is the muscle tight? There’s a neuromuscular, you know, cause that’s underlying it. And that’s being generated, again, for want of a better word, by the nervous system. And that is exactly where this starts to fit in. So rather than thinking, wow, trauma, that’s something that other professions need to deal with. In the trauma world, the body is now becoming the focus. This is why it’s so relevant to physiotherapists. There’s all the books, the body bears the score, the body keeps the burden, the body remembers. But at this stage, a lot of the research in the trauma world, and again, because the people who are in that field are not body or movement based experts, There’s well, you know, it’s very well researched about what we call the, you know, the defense cascade, the steps the body physiologically moves through and that polyvagal curve to go into defense all subconsciously and subcortically, all primarily based around movement or the containment of movement. And yet we don’t then look at how the body potentially has the ability to come back out of those defensive responses subcortically. So while I completely agree with you that the cognitive element is critical if I’m really hyper-anxious and thinking it’s going to increase my pain responses in generation, But the point of difference with what we’ll talk about in a moment, neurogenic movement, is that we are limited by our cognitive capacity to change our body and to change pain. Otherwise, we just tell everyone to let go of their pain. And so that’s where there’s this other element that I see massive potential for physiotherapy and other clinical practices to integrate because it gives us access to unwind or calm the system in a subcortical or subconscious level in the same way that these pain responses and trauma responses are being generated.

Yeah. And you mentioned before implicit memory. And for those of you who don’t know, implicit memories are mostly subcortical, which, as you mentioned, it’s a subcortical way to approach this. Why is is because we kind of, you know, in neuroscience, psychology, even pain, there’s this kind of preference, if you will, on the cortex, right? So the prefrontal cortex being like you’ve heard these these metaphors, like the CEO of the brain, so to speak. But I really appreciate you bringing in kind of these lower cortical areas like the brainstem. Why is that or these subcortical areas? Why is that important for practitioners to understand and grasp?

Again, because there’s a limit to what we can consciously control. So it’s really simple. When your next client comes in, just tell them to consciously let go of the tension that they don’t even know exists in their spinal muscles. When someone’s frightened, just say, hey, calm down. This fluffy white puppy is not dangerous, calm down. So it’s really obvious that we have a limitation to what we can cognitively control in the body. If you spend your whole life meditating and becoming a yogi, you may be able to control your heart rate and pain responses and all that sort of stuff, but it’s going to take 30 or 40 years. And again, it’s still going to have its limitations. And this is where the trauma field is so useful to understand. And the reason people come to us as clinicians is because they can’t cognitively choose to change their condition. Otherwise, they would never see. So we’re starting from a fundamental foundational level that what we are working with is symptoms, but also conditions, again, from my opinion, things that are being actively generated by the body subcortically, and the really obvious one, pain, but also chronic tension. So again, we don’t often even feel the tension that we’ve got in our body because part of that immobility response is that we’re not aware of it. So I really think, and this was the journey I went on when I was reading Robert Scalia’s book, The Body Bears the Burden, And one of the reasons I love that book is he lists a whole range of sort of neuromusculoskeletal conditions. And he explains it, well, this is how that implicit memory is working. This is the implicit memory of the piriformis is chronically activated. It’s an implicit or a procedural response in the moment. So when we take that bigger trauma-informed view, not about life and death trauma, but about that way that the body responds, in creating or inhibiting movement, then anyone who’s working in the musculoskeletal field will start to say, wow, underlying the vast majority of processes and conditions that we’re working with are these procedural memories. And that’s why working with neurogenic movement as a procedural response or a subcortically generated movement is such a significant point of difference to doing cognitively directed movement. But the same with relaxation. So if I lie down, I say, look, just relax your shoulders. There’s a limit to how much we can physiologically relax. But the body, because it’s creating and generating that tension subcortically, also has the capacity to subcortically release that or rebalance or reorganize that tension as well.

Yeah, it’s a good point. Logic has its limitations, right? Yeah. Absolutely. Tell us what neurogenic movement is.

So look, neurogenic movement, or the term neurogenic is kind of a common man’s use for the term because we don’t have an official sort of definition for it. And we use the term neurogenic just to mean that the nervous system, and it’s not quite accurate, but it works well enough, that the nervous system is generating the movement rather than me doing it cognitively. So simple examples might be, if you’ve ever seen or you’ve been public speaking, you’ve seen someone’s hands shaking. Now the hands shaking there are not being, that movement’s not being generated because of muscle fatigue, but the nervous system is generating the movement without any muscular load. Very different perhaps from say, if you’ve got someone doing a plank or doing a maximum, you know, maximum contraction. where that postural fatigue or the muscles starting to shake because we’re volitionally trying to create movement. And so neurogenic is just this term of saying that the body has the capacity to generate the movement spontaneously without having any element of me doing it volitionally. I sometimes use the term autogenic just to sort of outline that it’s not necessarily only the nervous system that’s generating them, but it’s being involved. So, you know, common examples, like I say, somebody’s hands shaking when we’re public speaking, we might see that. Now, we would say, oh, that’s anxiety, isn’t it? But that shaking is not helping the body to fight or flee. It’s a recovery response or a downregulation response. Another example might be if you come across someone after a car accident or listeners might have had shock or a car accident, we start to shake and tremble now in our Western culture. we’ve all been told that’s a symptom of shock. So if someone’s shaking on the side of the road, you’re going to get a blanket, you think they’re cold, you’re going to try and calm that down. But again, that shaking and tremoring, that movement is not part of fight or flight or the froze response. It’s how the body is down-regulating and coming back out of shock. So people often think, well, my hands are shaking, it’s because of the adrenaline. The adrenaline doesn’t make your hands shake. The adrenaline is there to mobilize the system and generate movement. However, when we’re in recovery mode, the body does then start to shake and tremble to use up that adrenaline and down regulate it. So in a nutshell, the way most of this experience or think of or are aware of neurogenic movement is it’s this recovery response. It’s the second half of the stress or the trauma curve. It’s nothing to do with stress and trauma. It’s a recovery response. And anyone who’s ever owns dogs and have seen dogs shaking in a thunderstorm, The question I always ask people is, rather than saying, why is the dog shaking? Oh, because it’s anxious, is to actually ask a better question, which is, what is that shaking and trembling actually trying to achieve for that body? And when we start to consider that, because that’s what we haven’t done in Western world, because they’ve just been pathologized and stigmatized as, oh, that’s PTSD, that’s a panic attack. um you know that’s a symptom of anxiety or in our physio profession if you’re shaking during pilates or doing rehab we’ve all just been told that’s a sign of weakness fatigue and lack of control it’s time to stop the exercise or override it so this is where there’s such a you know there’s this whole field of spontaneous autogenic neurogenic movement that as a profession we’ve never been told about we’ve never researched it and yet clinically when we work with this you see these incredible you know, inconsistent or repeatable clinical results. So the question is, well, how do we make sense of this neurogenic? movement phenomenon. So that’s kind of where most people relate to it in this recovery phase. But at the same time, Joe, you can also consider it from this angle that if you’ve got any tension in your body right now, for our listeners, if you’ve got tight trapezius or even in your digestive system, on some level, that’s not a conscious movement. So it’s all a neurogenic movement in terms of this bracing. And then there’s other ways that we experience it where, for example, in utero, Our bodies are consistently twitching and moving and tremoring in utero, which again, most of us don’t get taught about. And it’s a primary way that the nerves growing from the central nervous system reach their target receptors in the periphery. And those spontaneous movements in utero are a primary way that the body develops the body schema and parts of the body relate and integrate with each other. So there’s this foundational spontaneous movement response that in the physio body-based world, we’ve overlooked as weakness, fatigue, lack of control, which partly it is because it’s a lack of volitional control. And in the psychological world, we’ve seen it as symptoms of PTSD and shock and anxiety, despite neither of those fields actually studying it or investigating it. And when one of the first research articles was done on TRE in this movement, it was defined as non-classified therapeutic tremors, because there was no term for it in the literature because we just completely overlooked it.

That’s great. So we can have neurogenic movements that are adaptive and are linked to kind of recovery or resilience, or we can have neurogenic movement that is in some way maladaptive and linked to burgeoning symptom and pathology, so to speak.

Yeah, that’s right. And so all of these defensive responses in the body, including pain, are healthy and normal responses in the acute setting. And the problem becomes when they don’t switch off or they don’t turn off. And this is the classic thing where For example, with post-traumatic stress, people are going, yep, I know that that red car that hit me, I know that’s not happening anymore. But every time I think about a red car or I see a red car, my body reacts as if that red car is about to hit me. So this is the same sort of thing with pain where the initial defensive responses may be really adaptive and healthy, but when they don’t complete or switch off or turn off, that’s when they’re starting to be chronically activated. And then that starts to lead to the sort of secondary conditions that we that people turn up with. So you might have a completely frozen lower back for a couple of weeks and that’s fine, but then it’s not until down the track, or more often say your diaphragm and your thoracic spine, and then it’s often not until weeks, months, years down the track that people start seeing us for what they’re thinking is their primary condition, which is, I’ve got pain in my lower back or my cervical spine. without even realizing that a lot of that is then a flow on effect from years and years of chronic immobility and bracing in the thoracic spine or somewhere else in the body. So these adaptive responses start to become maladaptive or not useful in the long term. And again, when we realize that these responses are something that is being done actively, they’re verbs, the piriformis is still actively bracing in that moment. then one of the key aspects of treatment or self-care is going to be how do we help the system, whether that’s the central nervous system globally or whether the segmental system, how do we help that system switch off or relax or let go of that procedural response? So it says, you know what, it’s safe, it’s over, we don’t have to have this contraction or this defensive self-protective pattern in the neuromuscular system.

Yeah. So at this point, we’ve done a lot of, I think, pain education or psychoeducation around kind of the topic that we’re talking about, right? If someone’s listening, or if there’s a practitioner listening, so obviously both practitioners and people with pain follow this, how do they start to do this on like a simple, easy kind of beginner level?

So look, there are people around the world, and just to explain, my background is working in something called TRE, which was originally developed called Tension and Trauma Release Exercises, that was the original naming. And the benefit of that is that’s a sort of neuroscientific model for this phenomenon, but this shaking phenomenon is common to all humans, and there’s lots of cultures all around the world that have been using it for thousands and thousands of years. So the TRE model is just one lens to look at it. And, you know, part of the reason I like it is kind of a polyvagal informed, you know, neuroscientific model that we can make sense of it. So there are TRE providers all around the world, I think in more than 80 countries. But if you’re someone listening and you want to investigate this thing, you know, I would recommend you do my free online course that during COVID when I couldn’t work, I created a online course that has three sessions. So you can go in there and get a little bit of the theory and have guided sessions. There’s a screening tool in there. So if you’ve got a major history of major trauma, if you’ve got major medical or physical or mental health conditions, then you’ll be directed to go and learn with a provider where you can learn in a sort of controlled therapeutic environment, at least initially. But the vast majority of people, Joe, are able to learn how to access this tremor mechanism, for want of a better word, and learn how to self-regulate it so they can use it. Because on one level, this is not a modality or a technique because what we’re doing is accessing a natural recovery response that’s inside every single one of us. So it’s a little bit like, if you know the benefit of crying or laughing to release the diaphragm, it’d be like saying, well, go and do this technique, it’s called crying. You’re like, oh, okay, right. So there may be different ways to access crying or do it. So this is the same thing with a spontaneous movement rather than thinking, hey, this is some new technique or some new thing. It’s been described as the oldest medicine in the world because mammals and humans have evolved with this natural movement response. It’s just that in our Western culture, we’ve stigmatized it and locked it down. Whereas if you’re in a different culture, you know, they might be identifying people who have the ability to allow their body to shake and tremor. So long answer, but short answer is, you know, there’s a free, my free online course, which is at Um, people can go away and yeah, guided three sessions and actually learn the, learn it and start using it for themselves.

Yeah. And I imagine some people and practitioners as well probably stumble on this in some way and realize, Oh, actually, you know, I don’t know. I had my patient in a modified bridge position and I noticed they were shaking, but they said they were fine. They were safe. And when the exercise was done, they felt like this sense of release or a calm come over them. Do people come in and they say, Oh, I’m actually doing some of this already, but I need kind of further, you know, I want to go deeper, so to speak.

Yeah, so it’s really common because it’s a natural phenomenon. Lots of people will say, oh, hang on, I know this response. This happens all the time when I’m in yoga or I’m in Pilates. I always thought that was just weakness. Or they say, yeah, you know, when I’m public speaking, my hands are shaking. So part of the joy for me in the work that I and my colleagues do is that we’re not really teaching people anything new, we’re just giving them a reframe about something that many of them experience. So, you know, there could be practitioners where you’re treating someone on the table and their body starts to shake and tremble, or, you know, doing rehab exercises, you might see little quivers in the, you know, VMO or something when people are doing knee work, or like you say, Pilates is a really, really common one. And, you know, for me, this is where when I first got introduced to it, I’d been teaching Pilates pretty much full time for about four or five years. And then all of a sudden, this became hugely exciting because when someone was on the reformer or on the trap table and their body started to shake or tremor, now I knew that their body was starting to reorganize tension patterns that were subcortical and below what we could ever work with cognitively. So it doesn’t replace anything that we’re doing, but it gives us a true bottom-up entry point to reorganize the neuromuscular system in a way that we can’t do cognitively, And so when you combine that sort of top-down volitional movement with this spontaneous movement, you tend to get enhanced benefits and results. And then because people can learn to use it themselves, that’s what I’m really passionate about, is that once you know how to invoke or connect with this response, well, you’ve got it there for the rest of your life. And every time you use it, your nervous system will just downregulate a little bit, your neuromuscular system will start to unwind itself in that classic sort of onion layers way.

Yeah, it’s interesting to think about and consider because there’s a number of large-scale systematic reviews on exercise and trauma and we’re starting to trend toward potentially higher intensity levels of exercise or potentially more therapeutic or people gain more of a benefit both physically and psychoemotionally. I’m wondering if you think that, you know, beyond the physical, that maybe what’s happening is that someone’s exercising at these higher intensity levels. Is there maybe tapping into some type of neurogenic movement? And that’s not like the exercise being enhancing someone’s physical capacity per se. So there’s a therapeutic effect of a higher intensity exercise on the nervous system and neurogenic movement specifically.

Yeah. Well, I don’t know enough about that particular research, but what I would say is that if you’ve got muscles that are chronically tight and activated at a baseline level, that we can’t just consciously choose to relax them. And that’s kind of a bit of a paradox. We can generally still choose to activate them even more. So, you know, if you’ve got that chronically tight piriformis that won’t let go, you know, just like any kind of hold relax technique or high intensity, the more you activate it and generate and, you know, use up the energy there, the more it’s more likely to let go and relax afterwards. So that’s a really common thing. And the same thing is true of the nervous system is, There’s another book called Shaking Medicine by a guy, Bradford Keeney, that looks at the use of spontaneous movement in a whole range of different cultures. And he makes a great point in there where he says, in the Western world, what we’ve done is we’ve brought over the relaxation response in the last 20 or 30 years from the Eastern world. So it’s all about mindfulness and calming down the system. But he makes the point that in terms of getting to calmness, you know, we need to have the full cycle, which is the arousal response first. So, you know, when people are drumming and dancing and activating the system so that then it bounces back and calms down afterwards. So I think it’s probably a, I think there’s probably a factor there. The original research PhD done by the Thierry founder, Dr. David Berselli, what he did was compared the people doing a whole set of exercises, like sort of basic stretching and muscle activation and wall sits, so reasonable intensity. And he compared people who had anxiety just doing the exercises with people who had anxiety who did the exercises and then allowed the spontaneous tremoring to occur afterwards. And of course, what he showed was doing the exercises had a significant effect on reducing anxiety, but people who were then adding in the neurogenic or spontaneous movement on top of that had an even far greater reduction in their levels of anxiety. So yeah, I definitely think that doing the intense exercise will be having a certain effect. but it’s certainly in the clinical setting and anecdotally with millions of people who are using this around the world, there seems to be a far greater effect in terms of down-regulating the system, whether it’s neuromuscular tension or whether it’s pain. And that’s an action research reality that we’re all seeing. And I see it in the clinic. I’ve taught more than 5,000 people. You can assess these instant impacts. And we’re kind of, rather than a lot of the physio world where we do the science and then we roll out the teaching, this is a little bit the other way, literally, because it’s a bottom-up process. It’s not top-down and cognitive, even on an individual movement level. But there is this phenomenon that exists and we need to be then, well, how do we make sense of it? Because it’s undeniable when we see it and the clinical effects it has.

Where do you see this fitting in with the psychologically informed practice movement in physiotherapy and other professions as well?

Yeah, so think it absolutely fits in there. But again, wouldn’t like to frame it saying, look, this is all about psychologically informed because it takes it back into psychology. You know, think it really fits in in three key areas in the physio world. And the first one is understanding that these trauma immobility protective, defensive responses are, as say, underlying or impacting just about every neuromuscular condition that we see. So just think this in future years, 20 or 30 years, this will just be mandatory. We will understand and know and there’ll be research and we’ll say, look, this makes sense. This is the model. So it definitely fits in there. also think there’s huge role for the physiotherapy profession to play in trauma recovery and prevention. because one of the beauties of learning about this spontaneous movement before the next bushfire or the next emergency is not only then if it spontaneously starts to arise, can you use it, you won’t suppress it and inhibit it and prevent the recovery response, but because it’s body based. And one of the beauties of working with this approach is we bypass the cognition and the story and the emotion. So, you know, that is right in the wheelhouse of physiotherapists because we’re experts in the body and movement. So see huge element there. Sports performance and recovery is an area where it’s really exploding. There’s elite athletes all around the world, but in Australia, you know, Olympians, AFL footballers, elite soldiers that are using this to enhance their their recovery. And then the other big one really, Joe, think is in the wellness space, where traditionally, as physios, we’re treating pathology and there’s still huge need for that. But the idea of training people how to use their movement system and their body system to actually build neurophysiological resilience in their system, to pre-train their capacity to recover, whether that’s from, sprained my ankle, And then when tremored, my ankle started to vibrate and shakes or whether had global stress or trauma and bushfire and my body started to shake, say it’s huge area of massive potential impact for people. And especially when we consider how empowering this process is. So it’s not dependent on you have to come and see me. can educate you. can teach you how to use the tremor mechanism. And then you’ve got that for the rest of your life as self-care resource. 

Yeah, and obviously resourcing individuals with simple and effective tools is one of the things that we focus on here on the Pain Science Education Podcast. think that lot of these tools are relatively simple and easy for people to use. They just have to obviously, we have to obviously advocate and make them more accessible for people. Richmond’s great speaking with you today. Let our viewers and listeners know how they can learn more about you and follow your work. 

Yeah, great. So the website to find me is just And to access that free online course is just And for your listeners, you know, it’s great resource. And if you’re clinician, you know, please share that with your clients as you deem appropriate. 

Great. want to thank everyone for tuning in today and listening to the Pain Science Education Podcast to learn more about TRE and neurogenic movement and how it relates to healing chronic pain and trauma. Please make sure to share this episode with your friends and family on Facebook, LinkedIn, Twitter, X, wherever anyone is talking about the treatment of chronic pain and trauma. I’m Dr. Joe Tata. Thanks for joining me and we’ll see you next week. Thank you for listening to the Pain Science Education Podcast. To subscribe to the podcast and learn more, visit That’s Sign up to receive weekly updates and learn about our continuing education courses. If you enjoyed this episode, leave us review on your favorite podcast platform and share this episode with your friends. Please join us next week as we share more science-backed solutions for treating and reversing chronic and persistent pain. 

Important Links




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About Ryan McGrath

Richmond Heath is an Australian Physiotherapist who has been driving innovation in the health sector for more than 30 years. Since introducing TRE to Australia & New Zealand in 2010 he has specialised in the trauma-informed use of neurogenic movement to help people reduce stress & anxiety, recover from trauma & optimise their mental health & physical wellbeing. With a passion for innovation & education & a background in mental health & youth suicide prevention, Richmond is pioneering a movement-based model of stress & trauma that highlights the critical role Physiotherapists have in healing trauma & the use of neurogenic movement to address the neuromuscular patterns underlying most chronic conditions including chronic pain. Having trained more than 5000 people & 100 practitioners in the use of neurogenic movement during Covid 19 Richmond also created the world’s first online TRE course that has had more than 10,000 enrolments to date.





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