Neuromuscular activation disorders are frequently observed after trauma, surgery, or chronic pain. They manifest as difficulty in effectively recruiting certain muscle groups, resulting in weakness, movement desynchronization, and inappropriate co-contractions [1-3]. These disturbances can slow functional recovery, perpetuate pain, and reinforce fear of movement [4-6]. Neuromuscular disorders can affect all the articulations of the body but the knee remains the most studied joint regarding this concern, with growing evidence of the necessity to treat this issue [7,8].

A range of therapeutic solutions are available to practitioners to help their patients improve symptoms, but these methods can be invasive and expensive [9-11]. They also might have side effects (injections, medications, etc).

Following the current trend toward the digitalization of health care [12-14], we have developed a guided visualization method for neuromuscular reactivation, combining mindfulness and motor imagery (Yuzit° SAS [15]). This approach aims to restore coherence between intention, perception, and muscle activation by mobilizing the neurocognitive mechanisms of cortical control and cerebral neuroplasticity [16]. In a recent study, it was shown to have efficacy in relieving pain in patients with obesity [14]. Mindfulness at the beginning of the session prepares the attentional state, reduces pain-related hypervigilance, and improves introspection [17]. It creates a mental context conducive to plasticity [18]. Guided motor imagery then targets muscle perception rather than the joint: the patient visualizes the contraction and direction of movement without actually performing it, according to the guiding principle that “muscles move joints, not the other way around.” [19]

To ensure the reproducibility and accessibility of this method, it has been adapted for digital use via the Yuzit app. This platform standardizes audiovisual guidance, collects self-assessments (visual analogue scale [VAS], single assessment numeric evaluation [SANE]), and guarantees data confidentiality and security. This digital adaptation allows for structured delivery, independent practice, and seamless integration into conventional rehabilitation programs.

The objective of this study was to provide a comprehensive description of a neuromuscular reactivation method combining mindfulness and guided motor imagery, along with its digital implementation via the Yuzit app. In addition, exploratory observational data from early users were analyzed to assess feasibility and the type of patient-reported outcomes that can be collected in real-world conditions. We hypothesized that use of the Yuzit app would be associated with a reduction in pain intensity and high levels of patient satisfaction.

We assessed the first 30 patients who used the app for musculoskeletal pain. They all completed the treatment. The mean age was 50 (SD 15.4) years, the average BMI was 24.8 (SD 4.5) kg/m², and more females were included in the study than males (n=19, 63% female). The patients started the program between October 3, 2025, and October 26, 2025. The final assessments were carried out between October 13, 2025, and December 14, 2025. Patients completed the treatment after 26.1 (SD 21) days on average. The results showed an average decrease of 1.62 points in the VAS score from 5.62 (SD 1.97) to 4.00 (SD 2.15) (ie, a 29% decrease; P<.05) and an increase of 13.3 points in the SANE score from 51.8 (SD 17.2) to 65.1 (SD 18.9) (ie, a 26% increase; P=.02). These patients complained of pain in different body areas (hip, knee, ankle, shoulder, elbow, hand/wrist, lower back, and neck). The overall satisfaction was high and very high for 83% (n=25) of the patients. Their mean satisfaction score was 4.1/5.

Preliminary observations from the first 30 users of the app suggested a reduction in pain intensity and an improvement in perceived function after completion of the program. Pain scores decreased by an average of 1.62 points on the VAS, while SANE scores increased by 13.3 points. In addition, overall user satisfaction was high, with 83% (n=25) of participants reporting high or very high satisfaction with the intervention. These findings should be interpreted cautiously, as they were derived from an observational cohort without a control group, but they nevertheless suggest that this neurocognitive approach may represent a promising complementary strategy in musculoskeletal rehabilitation. The originality of the proposed protocol lies primarily in the explicit focus on muscle perception during motor imagery and in its standardized digital delivery. The authors have previously published a score to assess muscle perception (the Biarritz Activation Score-Knee [BAS-K]) and use it routinely [21]. While mindfulness and motor imagery have both been studied separately in rehabilitation contexts, their sequential integration within a structured and reproducible digital program represents a novel attempt to facilitate neuromuscular reactivation through cortical mechanisms. Motor imagery has been widely investigated as a strategy to activate cortical motor networks without physical movement [22]. Neuroimaging studies have shown that imagined movements activate neural circuits similar to those involved in actual movement execution, including the premotor cortex, supplementary motor area, and primary motor cortex [23]. Such activation is believed to contribute to neuroplastic changes that may facilitate motor learning and recovery. Previous works have therefore proposed motor imagery as a useful adjunct to rehabilitation, particularly in situations where physical movement is limited or painful [24,25]. In the context of musculoskeletal disorders, impaired neuromuscular activation is frequently observed following trauma, surgery, or prolonged pain states [5]. Arthrogenic muscle inhibition, for example, has been extensively described in knee injuries and can persist despite adequate structural healing [26]. These central inhibitory mechanisms may prevent effective muscle recruitment and delay functional recovery [27]. Interventions targeting cortical control and sensorimotor integration may complement conventional mechanical or strength-based rehabilitation strategies [28].

The protocol incorporates a mindfulness phase prior to imagery practice. Mindfulness interventions have been shown to modulate attention, reduce pain-related hypervigilance, and improve interoceptive awareness [29,30]. These mechanisms may create a cognitive state more favorable to motor imagery practice by enhancing concentration and reducing competing sensory inputs. Digital health platforms have also increasingly been explored as tools for delivering rehabilitation interventions [8]. Mobile apps may improve accessibility, support self-management, and enable structured home-based training. However, many currently available digital rehabilitation tools focus primarily on exercise guidance or symptom monitoring [21,31]. The Yuzit app differs in that it delivers a standardized neurocognitive intervention specifically targeting neuromuscular activation through guided imagery and attentional training.