Reconceptualizing Fall Risk Across the Lifespan: A Developmental Biotensegrity Framework Integrating Embodied Trauma

Falls are among the leading causes of injury, disability, and mortality worldwide, yet prevailing fall-prevention strategies continue to conceptualize fall risk primarily as a late-life problem driven by age-related decline, muscle weakness, and balance impairment. Despite decades of intervention, outcomes remain modest, suggesting that current models mischaracterize the underlying mechanisms of human stability. This white paper proposes a reconceptualization of fall risk as a lifespan phenomenon rooted in early developmental motor adaptations rather than an inevitable consequence of aging. Integrating the structural paradigm of biotensegrity with insights from developmental trauma science, this paper introduces a conceptual framework that explains how early experiences of instability, overwhelm, and insufficient support during motor development may become encoded as persistent postural and gait patterns that shape fall risk decades later. Central to this framework is the backward postural bias—a subtle but chronic posterior alignment of the thorax–pelvis axis interpreted here as a non-conscious defensive adaptation. Rather than representing degeneration, this bias is proposed to originate as a protective strategy during early childhood, adopted to reduce forward gravitational momentum when the developing nervous system perceives forward movement as unsafe. To account for the developmental origins of this adaptation, the paper introduces the DOVE ACEs framework (Developmental Overwhelm, Vulnerability, and Exclusion), which expands existing trauma models by distinguishing embodied, non-episodic developmental adversity from narrative, episodic trauma typically captured by traditional Adverse Childhood Experiences (ACEs). DOVE ACEs are conceptualized as somatic imprints encoded in autonomic tone, postural reflexes, and movement strategies rather than explicit memory. This framework provides a mechanism by which early relational and motor environments shape long-term biomechanical organization without requiring conscious recall of adverse events. The paper traces a biomechanical cascade linking backward postural bias to braking-dominant gait, elevated ground-reaction forces, progressive joint degeneration, heightened fear of falling, and the characteristic backward falls observed disproportionately in older adults. Within a biotensegrity model, these outcomes are understood not as isolated joint failures but as systemic consequences of altered global tension, disrupted elastic recoil, and impaired gravitational trust. This analysis reframes late-life falls as the predictable endpoint of a lifelong defensive locomotor strategy rather than a sudden failure of strength or balance. Building on this integrated model, the paper outlines a trauma-informed biomechanics approach to assessment and intervention. It argues for a shift in clinical focus from isolated strengthening toward developmental repair—defined as recalibrating the nervous system’s relationship with gravity and restoring adaptive whole-body coordination. Proposed assessment domains include center-of-mass alignment, gait braking impulses, autonomic regulation, movement variability, and early motor history. Intervention principles emphasize restoring fall-forward gravitational trust, reducing chronic posterior bracing, and enhancing dynamic stability through practices such as mindful walking and perturbation-based training. By generating testable hypotheses and offering a unifying explanatory framework, this white paper aims to bridge biomechanics, trauma science, gerontology, and public health. It provides a foundation for future empirical research and suggests that meaningful fall prevention may require intervention not only in old age, but across the lifespan—potentially beginning decades before the first injurious fall occurs.