Key Insights On A Novel Addition To The Stand-Up Workstation

I have just discovered a positive enhancement to stand-up workstations. Up until now, I have been critical of this new fad in the workplace as I have seen a surge of foot, ankle and leg complaints from patients in my practice who now use stand-up workstations. 

I previously wrote a DPM Blog outlining my concerns about the challenges imposed upon the lower extremities when people stand all day in the workplace.¹ In this blog, I noted that prolonged standing poses a risk of causing venous stasis and varicosities. I also pointed out that when we stand upright, we do not engage any of the dynamic mechanisms that support the arches of our feet, most notably the tibialis posterior, the peroneus longus, the plantar intrinsics and the windlass mechanism via the plantar aponeurosis. As a result, we see more patients complaining of heel pain and arch pain after using stand-up workstations.

I also recently wrote about conservative care for ankle sprains and the challenge of implementing an effective protocol for home treatment and recovery from an ankle sprain.² The cornerstone of rehabilitation for the ankle sprain is balance training.³ The National Athletic Trainers Association has given balance training the highest rating of supportive evidence validating its efficacy in treating the ankle sprain and chronic ankle instability.⁴ An essential part of any balance training protocol is the use of a wobble board. Standing and balancing on a wobble board for as little as ten minutes per day can significantly improve balance after 12 weeks and greatly decrease the chance of a future ankle sprain.⁵

What does this have to do with people who now use stand-up workstations? Well, I was looking for an address of a nearby restaurant on a Google search when, low and behold, a Google Ad pops up, advertising a wobble board by FluidStance. It is amazing to me that my own Google profile shows that I am an ankle sprain geek!

Even better, I decided to click on the ad for the wobble board and learned that it is actually designed for use at a stand-up workstation.⁶ Furthermore, the wobble board is actually intended to provide a form of exercise for calorie burn. I went through the website and was impressed that researchers had actually done some studies at the Mayo Clinic. These studies showed that when standing on the wobble board for 20 minutes, patients’ heart rate increased by 15 percent while energy expenditure increased by 19.2 percent.⁶

My interest in this advertisement was the potential to bring balance training into the workplace in a convenient and beneficial application. One challenge we have when implementing a balance training program for patients recovering from an ankle sprain is getting them to do the exercises daily, not just when they are at the physical therapy clinic. Balance training must happen every day for 12 weeks to be effective. One strategy to improve adherence is to get patients into a routine of doing their simple exercises daily. I often recommend patients do single leg stance exercises when standing in the bathroom and brushing their teeth at the start and end of their day. 

Now patients who insist on using a stand-up workstation can get the benefits of cardiovascular exercise and balance training by simply standing on a wobble board for 20 minutes for several sessions per day. I am not connected in any way to the FluidStance company although I applaud its creativity and vision to carry balance training to an all new level.

Certainly, any patient can purchase a balance board from any number of vendors who are visible on the Internet. The key to success is that the referring practitioner provides patients with proper instruction and training on using balance boards. Once this happens, the potential benefits are enormous, particularly if the patient has failed to ever recover from a previous ankle sprain any time in the past. Research shows that balance training can effectively treat chronic ankle instability in patients who have suffered the condition for many years.³

References

1. Richie D. Taking a stand against stand-up workstations. Podiatry Today DPM Blog. Available at https://www.podiatrytoday.com/blogged/taking-stand-against-stand-workstations . Published March 30, 2016.
2. Richie D. A guide to conservative care for ankle sprains. Podiatry Today. 2016; 29(7):44–54.
3. McKeon PO, Hertel J. Systematic review of postural control and lateral ankle instability, part II: is balance training clinically effective?J Athl Train. 2008;43(3):305–315.
4. Kaminski TW, Hertel J, Amendola N, Docherty CL, Dolan MG, Hopkins JT, Nussbaum E, Poppy W, Richie DH. National Athletic Trainers’ Association position statement: conservative management and prevention of ankle sprains in athletes. J Athl Train. 2013;48(4):528–45.
5. Wester JU, Jespersen SM, Nielsen KD, Neumann L. Wobble board training after partial sprains of the lateral ligaments of the ankle: a prospective randomized study. J Orthop Sports Phys Ther. 1996;23(5):332–336.
6. Available at https://fluidstance.com/ .
7. FluidStance: enhancing the standing experience. Available at https://balance.fluidstance.com/white-paper#optimal .