Global Postural Reeducation (GPR) — Souchard Method

Introduction to GPR

Global Postural Reeducation (GPR), created by French physiotherapist Philippe Emmanuel Souchard in the 1980s, constitutes a physiotherapy method that revolutionizes the traditional conception of musculoskeletal rehabilitation by proposing a global approach based on active stretching of muscle chains and breathing integration. Born from Souchard's dissatisfaction with conventional analytical approaches that treat local symptoms without considering global postural imbalances, GPR proposes a coherent conceptual and practical framework.

GPR's theoretical foundation rests on three major clinical observations. First, static muscles (tonic, postural) have a natural tendency toward shortening and stiffness, unlike dynamic muscles (phasic) that tend toward weakness and lengthening. Second, muscles function not in isolation but are organized in muscle chains — overlapping muscle groups functioning synergistically. Third, any muscular shortening in a chain reverberates throughout the entire chain through cascading compensation, explaining why local pain may have a distant cause.

Since its creation, GPR has spread internationally with accredited training centers in over twenty countries. Clinical research has progressed considerably, with RCTs demonstrating efficacy in chronic low back pain, cervicalgia, adolescent idiopathic scoliosis, lumbar disc herniation, ankylosing spondylitis, and temporomandibular disorders.

Muscle Chain Theory

GPR identifies eight main muscle chains organized in two functional systems: anteroposterior coordination and lateral coordination. Each chain forms a myo-fascial continuity from head to feet. Shortening in one muscle creates tension propagating along the entire chain, modifying posture and potentially generating distant pain.

The great posterior master chain extends from skull base to foot soles, through paravertebrals, hamstrings, and triceps surae. Its shortening increases spinal curvatures. The great anterior master chain includes the diaphragm, psoas-iliacus, adductors, quadriceps, and tibialis anterior; its shortening causes lumbar lordosis accentuation through pelvic anteversion.

The respiratory system holds central place in Souchard's theory. The diaphragm's state of permanent contraction and tendency to shorten under stress directly influences spinal posture. GPR pays particular attention to diaphragmatic lengthening and optimal respiratory mechanics restoration. Complementary chains include the antero-internal shoulder chain, antero-internal hip chain, lateral trunk chain, and anterior arm chain.

The Eight Treatment Postures

GPR treatment uses eight progressive global stretching postures, each targeting specific muscle chains. Maintained for 15-25 minutes each, these postures enable simultaneous lengthening of all muscles in the targeted chain, avoiding compensations occurring during local analytical stretches. The physiotherapist manually guides the patient, correcting postural and respiratory compensations in real time.

Coxo-femoral opening postures (posterior chain lengthening) include supine with arm elevation (posture 1) and supine with arms alongside (posture 2). Coxo-femoral closing postures include seated with legs extended (posture 3) and standing forward bend (posture 4). Standing postures include against-wall standing (posture 5) and free standing (posture 6). Lateral decubitus posture (posture 7) targets lateral trunk chains, and cross-legged seated posture (posture 8) targets internal lower limb chains.

Each posture follows a precise protocol: patient installation, progressive segmental alignment correction (feet, knees, pelvis, spine, shoulders, head), diaphragmatic breathing integration with expiratory lengthening, progressive micro-corrections, and final posture maintenance. Intensity is modulated according to patient tolerance, progression always slow and pain-threshold respecting.

Indications and Clinical Evidence

Chronic low back pain is the most studied GPR indication. An RCT in Clinical Rehabilitation of 148 chronic low back pain patients showed GPR (individual 1-hour sessions, twice weekly for 12 weeks) significantly superior to conventional analytical exercises for pain reduction and function improvement. Another RCT in Spine demonstrated GPR superiority over spinal stabilization exercises.

Adolescent idiopathic scoliosis is a major GPR indication. An RCT showed GPR significantly improved Cobb angle, vertebral rotation, and postural symmetry in adolescents with 15-40 degree scoliosis. Lumbar disc herniation benefits from global posterior chain lengthening decompressing intervertebral discs. Cervicalgia and tension headaches benefit from GPR's global approach treating cervical posterior chain shortenings in continuity with thoracic and lumbar chains.

Ankylosing spondylitis benefits from global anterior chain and diaphragm stretching postures combined with thoracic expansion and respiratory rehabilitation. An RCT showed GPR significantly improved spinal mobility, respiratory capacity, and quality of life compared to conventional exercises.

Course of a GPR Session

GPR sessions are always individual, lasting approximately one hour. The initial assessment includes detailed standing postural analysis, segmental and global spinal mobility examination, analytical and global muscle chain testing, respiratory mechanics evaluation, and pain assessment.

Postural examination evaluates head position, shoulder alignment, sagittal spinal curvatures, pelvic alignment, knee alignment, and foot position. Standardized photographs document initial state and progress. Treatment posture selection is determined by the initial assessment, identifying primarily retracted muscle chains. Sessions typically include two complementary postures.

During each posture, the physiotherapist guides through verbal cues and continuous manual corrections following distal-proximal or proximal-distal sequences, systematically integrating respiratory components. The patient maintains prolonged active expiration during correction phases. Compensations are identified and corrected in real time: foot rotation, knee flexum, or lumbar hyperlordosis appearing during stretching indicate specific chain segment retraction.

Variants and Associated Approaches

Active global stretching (SGA), developed by Souchard, adapts GPR principles to autonomous exercises patients can perform at home. SGA uses simplified postures held 2-5 minutes with controlled breathing. GPR-manual therapy integration combines global postural approach with local articular techniques. GPR-stabilization exercise integration adds deep stabilizer strengthening within the GPR-corrected postural framework.

Aquatic GPR uses water properties (buoyancy, resistance, thermal effect) to facilitate global stretching postures. Pediatric GPR application is particularly relevant for adolescent idiopathic scoliosis. Sports GPR adapts principles to athletes' specific needs, identifying discipline-specific muscle chain imbalances.

Contraindications and Precautions

GPR has few absolute contraindications. Acute spinal inflammatory pathologies contraindicate postures until the inflammatory phase is controlled. Recent vertebral fractures (less than three months) require consolidation before postural loading. Primary or secondary vertebral bone tumors require spinal stability assessment.

Cervical spine vascular pathologies (vertebrobasilar insufficiency, cervical arterial dissection) contraindicate maximum-amplitude cervical movements. Constitutional hyperlaxity (Ehlers-Danlos, Marfan syndrome) requires posture adaptation focusing on stabilization rather than maximum stretching.

General precautions include absolute respect for pain threshold, slow measured progression, individual adaptation, and neurovegative response monitoring. Pregnancy is not a contraindication but requires specific adaptations: avoiding prolonged supine after first trimester, prohibiting abdominal stretches, and emphasizing diaphragmatic relaxation and posterior chain lengthening.