Postural stability and locomotor autonomy are highly dependent on the efficient function of deep core musculature, particularly the transverse abdominis and lumbar multifidus. These deep stabilizing muscles play a central role in anticipatory postural adjustments, intersegmental coordination, and spinal load distribution. However, they are often under-activated or inhibited in individuals suffering from chronic back pain, neurological disorders, or age-related deconditioning. This article provides a comprehensive scientific overview of the rationale, mechanisms, and clinical evidence supporting deep muscle reeducation for improving postural control, preventing falls, and enhancing gait performance across populations ranging from older adults to elite athletes. It also explores innovative strategies such as reflex integration, passive-active decompression therapies, and neuro-modulation.
Introduction
The maintenance of upright posture and fluid locomotion requires a finely tuned neuromuscular system. Deep muscles—especially the transverse abdominis (TrA), multifidus, diaphragm, and pelvic floor—form the anatomical and functional foundation of this system. Unlike superficial movers, these muscles act as stabilizers and are activated reflexively to anticipate movement and stabilize the spine and pelvis. Their dysfunction has been implicated in a wide range of musculoskeletal and neurological conditions, including chronic low back pain, postural instability, gait abnormalities, and fall risk in the elderly.
Epidemiological data show that one in three adults over age 65 experiences at least one fall annually, and impaired postural control is a leading contributor to functional decline and loss of autonomy (WHO, 2015). In France, 450,000 people are hospitalized each year for fall-related injuries, and falls are the leading cause of injury-related deaths in people over 75 (Santé Publique France, 2020). In this context, targeting the deep stabilizing system emerges as a cornerstone of both prevention and rehabilitation strategies.
Recent advances in neurophysiology and biomechanics emphasize the need to retrain these muscles, particularly through reflex-based strategies that mimic fundamental motor patterns such as gait. The integration of passive and active mobilization, particularly in an anti-gravity position, has been shown to re-activate dormant neuromuscular circuits involved in posture and gait control. This article reviews the current evidence, with special focus on the DPA Med®—a device designed to restore deep muscle function through lemniscate pelvic motion, mobilization in decompression, and neuro-myofascial reflex stimulation.
Emerging evidence suggests that working in a supine, anti-gravity position facilitates neuromuscular reorganization. Lemniscate motion of the pelvis mimics gait cycles and stimulates archaic reflexes critical to locomotor patterning (Gramsbergen et al., 1999). Once these reflexive circuits are re-activated, they carry over to upright activities, enhancing postural automaticity and dynamic balance.
The DPA Med® facilitates this integration by offering combined passive, active, and decompressive motion that reproduces the neurodevelopmental sequences of gait. Through simple instructions to "resist" the motion of the device, users engage their deep muscles (especially the multifidus and TrA) reflexively, without requiring conscious motor control or prior body schema awareness. This leads to faster neuromotor acquisition and improved carryover to vertical postures and complex tasks.
Furthermore, passive mobilization aids in neuro-myofascial release, promoting mobility in osteoarticular chains. The reduction in fascial tension enhances joint range of motion, allowing more effective engagement during active phases of locomotion and sports. These adaptations are particularly valuable in patients with mobility restrictions, where restoring joint play and fascial gliding is essential.
Supine anti-gravity work removes gravitational constraints, encouraging more symmetrical engagement of spinal stabilizers. The unloading of postural chains offers a unique advantage in early rehabilitation or in individuals suffering from significant postural imbalance or neurological impairment.
Invasive neuromodulation techniques such as percutaneous electrical nerve stimulation (PENS) or intramuscular stimulation have shown promising results in reactivating deep stabilizing muscles. These interventions can target inhibited motor units and enhance cortical excitability, facilitating voluntary recruitment of TrA and multifidus. When integrated into a broader reeducation protocol, including motion-based devices like the DPA Med®, they help accelerate neuroplastic adaptations and restore functional movement patterns.
For instance, combining low-frequency transcutaneous stimulation with mobilization in decompression could further potentiate reflex pathways and enhance proprioceptive reintegration. Studies such as Lavelle et al. (2007) and Boudreau et al. (2010) support this multimodal approach for chronic pain and motor rehabilitation.
Author: Christophe BENSOUSSAN with the support of AI
Author: Christophe BENSOUSSAN with the support of AI - Image credits ©ChatGPT