How we stand upright

From Dr Pierre-Marie Gagey

Translated from French with permission.


How do we stand upright?


Has ever someone taught you how we stand upright? Nobody teaches that! Try to remember, at school, what have you been told about keeping the upright position? You do not remember of anything… Do not worry, it is not a slip of memory, you can be sure that nobody has never told you anything.

When you were 1 year old, one let you manage alone to stand up, of course!

Since then, no one has ever explained you anything about this posture. Do you know there are many things to learn about that field? “We stand upright all alone!” Everybody knows that. Hard luck… it is a nonsense! Standing upright is a process that involves an important set of control, it is extremely complex; so complex that your doctor does not have time to explain you, neither your rheumatologist, physiotherapist or chiropractic…

So you will have to instruct yourself!

This article stands here to help you, suggesting you explanations, experiences, exercises…

A lot of work… which address only those of you who have understood that it is worth making effort to stand upright until the end; for the other ones, we can just advise them to check their insurance pay all the expenses related to the consequences of repeated falls and dependence.

So for the one who is willing, let us go…


As long as you will not play, like a child, with all the mechanisms that make you stand upright, you will not understand.

You need to play, to exercise, you need an apparatus (a toy), that will be your own, you will have it close to you to play with at any time. It is not a toy you will share with others in a club or elsewhere, you must absolutely have it close to you, continuously, you must not need to walk, even 5 minutes, to go to get it.


Look at that apparatus:

You see, it is a kind of plate, like a disc, measuring 46 cm diameter, resting on a small wedge, slightly curved. You can buy this apparatus, or make it make by someone or even make it yourself. It is not protected by any patent.


Exercise 1: Primary position 


Once you have got your plate, put it down on a hard floor, ride on it, with your feet well centered, try to find your balance with fewer efforts preventing the edge of the plate touching the floor. “Play” on it a few minutes, without purpose or constraints, simply to feel what is happening.

You do not need much explanation to understand that this toy brings some challenge to the system which makes you stand upright.


Now, practice the exercise this way:

Put the plate in front of a window, stand on it with bare feet or with shoes, well centered, slightly apart to suit you. Stand your body and head naturally up straight, arms along the body, in order you can see things close to you (the window, curtain, others) and things far away. And standing this posture, reckon how many seconds you need to stabilize the plate, horizontal, almost motionless, during less than 1 second.

Try many times, until you feel that the less you intentionally intervene, the best it works.


Well controlling this primary position is not easy: you must achieve automatic control of your upright position when you are on the plate; it stabilizes by itself, without thinking of it… or almost!

When you achieve automatic control of the primary position, the plate continues of course to have some motions, but they are not sharp and have short amplitude, you fell it is all quiet and harmonious.


The goal of this first exercise of primary position is just succeeding to feel that: it is the proof you have automatic control of the primary position.

Go on training like that a few days. Do not go too fast, total control is necessary before starting others exercises, otherwise you will not feel them correctly. Even though you are curious to know more, be patient.


Exercise 2: Closed eyes


Did you succeed the primary position exercise?

You must be sure to have full automatic control of the primary position, the motions of the plate must be calm and harmonious.

Then in the primary position, close your eyes. That’s all!


Now you can feel and understand that sight has an important part in automatic upright control.

Yet you can think that the blind stand upright the same… It is true, and that points out how standing upright is far more complicated than we think of. The system controlling automatically our upright position uses a lot of information… if one is missing, it is not too bad, it can manage with what is left! The blind stand upright, without instability, like anybody, though they don’t see, yet sight is important to stand upright… The blind manage with other information.


Now think about your feet:

Did you think about them when you played the primary position?

You surely thought the difficulties to stand upright came from the curved wedge under the plate that makes it unstable… of course!

The reason is that your feet don’t feel same information when you are on the ground and when you are on the plate. Do you agree?

It is well sure: you can feel that when you are on the ground and lean forward, the pressure goes up under your feet, forward on the toes side and you feel it at once. The same when you lean to the right side, the pressure goes up under the right foot and you feel it at once, and so on. But when you are on the plate, do you think your feet feel the same variation of pressure while the surface of the plate is leaning with them at the same time? Of course not!

For instance, if you lean forward and on the right side, the pressure should go up under your right toes since the weight of your body goes this side, but as the plate gives way under him, the toes do not feel increasing pressure, at least as long as the plate do not touch the floor by its edge; it is only from this moment that pressure can go up under your toes, with an important delay.

That is what you can feel in your feet but not the actual evidence that the feet are useful to stand upright.


“Prohibited game” 


So if we would want to show the evidence, we should play at a “prohibited game”!


Strictly prohibited because it will make you to fall for sure. So you cannot do it unless a strong man stands close to you to catch you up: Stand on the plate, controlling the balance, then close your eyes, then turn your head quickly right and left. That’s all! If nobody is here to catch you up, you will fall for sure and may badly injure yourself.


So it is not an exercise to be practiced, just to bring evidence. 


What happens in that case? When you shake your head, you are moving tiny sense organs in your inner ear called otoliths. These organs are very important to stand upright: they give the upright position of your head. When you close your eyes, you see no more the vertical of the place, but these organs are there and give you the vertical. But if you shake them, they are disturbed and can no more give you the vertical.


So without eyes and inner ear, you cannot stand upright!


Then what about the feet?

You can do the same experience, closed eyes and shaking head, but this time with feet on the floor, not on the plate.

Did you fall? Normally not!... Yet your eyes were closed and your otoliths disturbed… What was left to give the vertical? Was there another contact with external environment except the sole of your feet? Is not it the contact of your feet that made you able to stand upright? What else information but the change of pressure under your feet has allowed you to know you were leaning on one side or another and about to fall?




-We have experimented that the sight makes us stand upright.

-We have experimented that the otoliths in inner ear makes us stand upright.

-We have experimented that the feet makes us stand upright. 


The conclusion is obvious: to stand upright, we use 3 sources of information concerning the vertical of the place, they come from eyes, inner ears and feet. We have the use of these 3 verticals.

We also have experimented that without sight, inner ear and feet information we cannot stand upright.


So we can also conclude: the system that makes us stand upright has no other information but the ones coming from eyes, inner ear and feet, since without them we fall inevitably.


Actually this last conclusion is not really true! Standing upright is much more complicated than that, we need many other information to make the 3 verticals agree together! It is always the same vertical of the place but it is perceived by 3 different organs: eye, inner ear and foot, and these organs are located at different places in the body, each one moving independently. And that is the big matter as we will see, but it is quite difficult to realize it.


Exercise 3: The gaze 


It is impossible to succeed this exercise if you do not control perfectly the primary position. 

Once you are in control of exercises 1 and 2, you can start this one.


Stand on the plate in primary position.

When you are stabilized with automatic control, the motions have short amplitude, they are not sharp but quiet and harmonious.


Then turn your eyes completely  on the right side and keep them like that completely turned (your head must not turn)


You must feel that your automatic control has changed. If you did feel well at the first time, try again!


The motions are less harmonious, a bit sharper, you may feel sometimes slight jumps or vertical vibrations of your whole body that make you more instable. 


Now train with the gaze turned left, without moving your head, then up and down and even diagonally if you want, up and right for instance. 


Every time your gaze is no more in primary position, you feel that your automatic control is no more the same. 


What has changed?


If you did well the exercise, without moving your head, only the position of your eyes has changed. 

That means that only the information of eyes position was intervening to help you standing upright?


Indeed this system that make us stand upright is weird; What about the eyes position?


Let’s try to explain: Your ocular globes are like cameras, they take images of that is only straight in front of THEM, in their axis. If your eyes are turned left, they take only images of what is in THEIR axis, straight before THEM, that is your left, they do not take images of what is before YOU.


Straight before THEM, straight before YOU, it is not the same, not always the same, it depends on the position of your ocular globes in their eye-socket.


The brain receives all the images taken straight before the eyes; to be able to interpret them, it actually needs to know where the eyes are turned at the very moment they catch the image. The brain must know the position of the eyes to interpret the information the eyes provide it, especially the movement information.


If the eyes say: “We are detecting a movement in this direction, you understand that the brain ask: “Which direction are you turned?”


But you could say: “The brain itself do order the eyes movements, it should know which direction it directs them!”


That is right! But the brain is mistrustful… It really wants to know whether the eyes are well in the direction it ordered them.


And it especially uses this information, coming from the eyes muscles; these 6 muscles say: “We are well contracted/stretched in order that the eyes we are moving be in the direction the brain has ordered”.


It is why the muscles moving the eyes are involved in the standing position control. When your body loses just a little bit its balance, the eyes detect this movement of imbalance, and the eyes muscles let know which direction the body loses its balance.


If the brain does not know which side the body is going to fall, how can it order the muscles that can prevent this fall?


Exercise 4: The neck


For this one too, you must control first perfectly the primary position.


Stand on the plate in primary position. When you are stabilized with automatic control, when the motions are short, not sharp but quiet and harmonious, then turn your head completely on the left side and let it like that completely turned, without turning your eyes (that are also directed on the left side)


You must feel that your automatic control has changed. If you did feel well at the first time, try again!


The motions are less harmonious, a bit sharper, you may feel sometimes slight jumps or vertical vibrations of your whole body that make you more instable.


Turn then your head completely on the right side, then tip it back. Every time your head is no more in primary position, you feel that your automatic control is no more the same. 


What has changed?


If you did well the exercise, without moving the eyes (it is not so easy), the position of your head is the only thing that has changed. That means that the information of your head position intervene to make you stand upright.


Indeed this system is weird! What about the head position? 


I think you are catching the meaning: when the head turns, the eyes also turn! It is exactly the same explanation as the eyes movements: the brain needs to know the eyes position to interpret the information provided by the eyes, so it needs to know the position of the neck if it is this one that made change the position of the eyes.


Then the neck muscles send to the brain the information back about their state of contraction/stretch to make safely know the head position that means the eyes one. 



Various exercises:


Exercises of gaze, neck… You can imagine all kind of various exercises that changes the eyes position: shoulders or pelvis exercises for instance. Do not forget the multiple combinations between all parts of the body; for example, imagine the eyes turned on the right in their eye socket and the head turned on the left and shoulders on the right to complicate the situation!


For each exercise you imagine, you will find out that when the position of the different parts of the body changes, the quality postural control also change. 


Every time you turn one part of the body, the eyes follow… Then the brain needs to know the position of any part of the body (head, shoulder, pelvis…) to know the position of the eyes.


And what about feet? 


Indeed, in this very simple presentation of the mechanisms that make us stand upright, feet are considered as the main reference. They are in contact with the ground, and anchor us to our place.


But actually the feet can move too! We cannot consider them as an absolute immutable basis. Since the feet move, then the argument would stand no more? Indeed it does, we just have to consider the eyes position and the feet position like relative positions in comparison with each other, and not like fixed absolute positions. 


So we can say that the system that makes us stand upright supervises the relative position of every parts of the body in comparison with each other, in order to know how to combine all the set of information it receives from the eyes, the inner ear and the feet, these 3 vertical it uses: visual vertical, otolithic vertical and sole vertical.


Amazing! Can you realize that? “The system that makes us stand upright supervises the relative position of every parts of the body in comparison with each other to combine the 3 vertical it uses.”


Can you imagine what an amount of information that means... and the brain has to treat? Not only it has to extract the information it receives from eyes, inner ear and feet, the 3 verticals of the place it uses, but in order to use together these 3 verticals, it must also treat all the information it receives about the reciprocal position of the eyes in comparison with the skull, the skull with the cervical vertebras, the cervical vertebras between themselves and with the dorsal vertebras, the 12 dorsal vertebras between themselves and with the lumbar vertebras, the 5 lumbar vertebras between themselves and with the pelvis, the thighbones between themselves and with the pelvis, the shinbones between themselves and with the thighbones, and with all the bones of the feet, and the feet between themselves! And all these information have to be treated in real time in order to provide a suited response to the perceived imbalance, and an almost immediate response not to let you fall! 


What an amazing mechanic this system that keeps us upright! The engineers who build humanoid robots struggle to try to imitate it… without cheating!


Why fall?


That is why the elderly lose so often their balance: Their brain works less quickly; when there is too much information changing all the time, their brain cannot treat them quickly enough and… they fall!


I recently had the opportunity to observe an elderly woman to fall, that fortunately ended up in my arms. 

She had bent down to take a pan in the lower shelves of her cupboard, then she stood up and turned back to put the pan on a table on the right and a bit behind her. When she was bent in her cupboard, the joints of her ankles, knees and hips were a bit flexed, her lumbar vertebras were more flexed forward and cervical vertebras too, and all the sudden she stretched out all these joints, and not only she stretched them out but she also made them rotate on the right. We can imagine the amount of information of reciprocal changing position caused by this stretch/rotation sequence!... 

The upright postural system of the elderly lady failed to treat quickly, in real time, the variations in postural information caused by this sequence of movements. The lady actually felt she was losing her balance, going backward, she made 3 or 4 little steps backwards to try to catch her balance but without success. 

If I had not been there, her head would have hurt the stove.


I cannot absolutely maintain that that fall was bound to a deficient postural system, a slow running of this lady’s brain. But apparently nothing could explain her fall. She did not bump her feet into a carpet. She did not show any sign of minor brain poor circulation trouble, and even though such thing had escaped my notice, it would be actually the brain that would have worked wrongly. There is no reason to think that all the sudden, and temporarily, her eyes, ears, or feet have provided wrong information about the vertical of the place, since she actually has reacted like a person who feel she is losing her balance, she tried to stop herself falling by doing some steps backwards, but it was too late. 


Slowed down functioning of that elderly’s brain is the most probable hypothesis.


Another experience comes to help that hypothesis.


I was helping that elderly woman to overcome her fear of falling by offering her to walk together on a very quiet road, without cane or crutch, to let her see she could stand upright alone. I was holding her hand very slightly, with a minimum of contact, just to remind her of my presence and ability to intervene in case of necessity. All was doing well, the lady was putting her feet greatly the one before the other, controlling her balance alone, without cane, and without problem. The road was winding, we could not see or hear the cars from far. All the sudden, a car came out from a curve, appealing the lady’s attention, in addition to all she had to do to stand upright; this simple extra work to her brain that focused for a while on an added task made her to sway, discreetly but really. This hypothesis of slow brain I have just explained is not the only cause of elderly falls, indeed.


They can bump their feet into a carpet because they do not see well, their inner ears may not work, or their feet are not sensitive enough. Some psychologists even say they unconsciously feel like to die so they find out many opportunities to fall in their environment. In short, slow brain hypothesis is not the unique explanation of elderly fall.


Down with falls! 


To stop the carnage, a lot of things are possible, many recommendations are useful: Removing all obstacles in home, checking one’s sight, treating one’s feet, equipping them with good shoes, enjoying life, etc…


But there is also a thing you were never told, never explained: you must train the system that makes you stand upright, to keep it effective, to stand upright all alone, until the end, without cane or walker.



The game is simple: Train every day, with different positions than the primary one, specially positions that are more difficult to get an automatic control of your balance, and practice this position to achieve to be the closest to the automatic control. Two minutes each day are enough… That’s all !


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