Standing Without Falling

Triangles of Balance

“Even the thought of standing for extended periods makes my back ache,” writes decades-long runner and yoga practitioner Judi Ketteler in The New York Times. “Why do I find it so much less painful to run for an hour than stand for an hour?”

Prolonged standing and balancing relies on a complicated web of actions and reactions throughout the body, only recently the focus of medical research and possibly the greatest obstacle for creators of humanoid robots.

For humans, the additional challenge of fatigue—during prolonged standing in museums or at events—creates short- and long-term risks, usually because people who have trouble standing lock their knees.. Blood pooling in the lower legs when knees lock can cause fainting; and repeated knee-locking can imprint incorrect joint and muscle patterns on the brain, further weakening the ability to stand correctly. According to Smithsonian magazine, balance worsens with age, making falls “the number one cause of death from injury in the elderly.”

“Abs, glutes and lats”—or abdominal, gluteus and latissimus muscles—create a triangle of balance needed for standing and moving, according to adherents of strengthening practices such as Pilates. Repeated locking of the knees can worsen weakness in these muscle groups, resulting in the incorrect tilting of the pelvis that leads to pelvic imbalances. Strengthening core muscles can lead to long-term improvement in the ability to stand for long periods without needing to rest.

Meanwhile, in-the-moment strategies to avoid locking the knees include standing with slightly bent knees along with staggering the stance; and rocking from heel to toe, even periodically lifting first the heel and then the toes. To help stretch and strengthen postural muscles in the upper back and shoulders, and to open the chest to enable deeper breaths, extend both arms behind the back and interlace the hands if possible.

Some movement specialists, however, are focusing on a different triangle of balance that involves sensory perception (rather than joints and muscles) and that many consider the body’s sixth sense. Vision, one part of this system, includes both close vision, focused on distinct tasks, and peripheral vision, which takes in the surrounding space along with motion and speed. The latter can diminish with age as people over-focus on immediate circumstances, such as the sidewalk and curbs.

In addition, sensory signals inform the brain about about the body’s orientation in space by registering pressure changes in the organs and throughout the body. In 2021, Scripps neuroscientist Ardem Patapoutian won a Nobel Prize for his discovery of the protein called Piezo, which works via interoception to signal the brain about both internal sensations and reactions to the outside world.

Proprioception aids in detecting the body’s position and movement in space based on sensory signals from receptors located in muscles, tendons, ligaments, joints, and connective tissues, including tiny peripheral nerves in the hands and feet. Common difficulties with proprioception come from peripheral neuropathy—associated with diseases such as diabetes that reduce sensation in the feet and impair signaling to the brain.

And the sensory signals of kinesthesia refer to a broader sense of the ease, effort, quality, and rhythm of movement, and may be more accessible to conscious effort when standing and walking. “We cultivate kinesthesia by being aware of how we are performing movements—how our weight is shifting, how smooth is our transition from sitting to standing,” explains Rebecca Carli-Mills, who collaborated with Aline Newton to write Reimagining the Body: Somatic Practice, Embodiment, and the Science of Movement. “Our bodies are unstable by design, [which] makes walking inherently economical [but] it’s standing still that takes muscular effort to prevent a fall.”

Improved proprioception can come from balance activities, such as on a Bosu ball, or simply standing and walking with the eyes closed—especially when placing one foot directly in front of the other. And the movement routines of Tai Chi offer “a new way to manage instability,” according to Reimagining the Body, using the transformation of bodily positions and extensions to bolster awareness.

The vestibular system, the third pillar in the sensory triangle of balance, relies on tiny hairs in the inner ear to sense spatial orientation and gravity. Three semicircular canals in the inner ear detect motion in three dimensions: forward and backward, horizontal, and vertical. So-called “vestibular motion sickness” arises when the inner ears sense motion but signals to the brain from the eyes and muscles indicate stillness—or vice versa. Although disturbances in the vestibular system, such as vertigo, affect some 20% of people at least once, the medical community has paid little attention.

“I’d argue that there is no area of medicine where there’s a bigger discrepancy between the numbers of people who suffer [from vestibular loss] and the number of providers who are trying to take care of those patients,” UCSF Balance and Falls Center director Jeffrey Sharon told Smithsonian magazine. Researchers at the Johns Hopkins Vestibular NeuroEngineering Lab have recently created inner ear implants that can bypass damaged cells to provide better information to the brain.

Meanwhile, for robotics researchers, a major challenge is to create neural networks—based on decades of footage showing people moving around—that enable robots to successfully stand or walk on two legs without falling. “What you don’t see in most videos [of humanoid robots] is people standing near the robots,” warns Rodney Brooks, robotics pioneer and co-creator of the Roomba robot vacuum. Brooks talks about the risk of injury to people “if [or] when they lose their balance” and predicts that future robots working alongside people will have multiple arms and be on wheels.

But for humans, “it’s never too late to build muscle strength and improve balance,” Buff Bones creator Rebekah Rotstein told AARP magazine. Rotstein’s advice includes walking with free weights in each hand for 30 to 60 seconds at a time; sit-to-stands, rising from a chair without using hands, at least 10 times a day; and practicing “the flamingo,” standing on one foot, when brushing teeth, talking on the phone, or standing in line. Carli-Mills admires Rotstein’s plan because it coordinates the entire sensory triangle, which “in turn fires the muscle fibers.”

Prolonged standing is mostly challenging for me because of peripheral neuropathy, for which my 2026 plan includes taking high doses of B12—with some success shown in a multi-study review by researchers in England and elsewhere—and a course in Tai Chi.

At parties and receptions, I rely on friends willing to sit with me from time to time, while my walking stick works well for museums and outdoor activities. After hearing about a relative’s “shooting cane”—it unfolds to create a seat, originally designed for hunters and photographers—I have looked for something along those lines, but much more discreet.