With POTS, standing can feel like running a marathon. It doesn’t have to. We can help you understand why this happens and what to do about it.

POTS

We Do Physical Therapy Differently

Postural Orthostatic Tachycardia Syndrome

POTS? Like cookware? Not quite!

POTS (Postural Orthostatic Tachycardia Syndrome) is a form of dysautonomia which typically causes an increase in heart rate upon sitting or standing. Why does this occur? In somebody without POTS, standing up typically causes blood to flow to the legs, feet, and hands. The body senses this change and tells the blood vessels to constrict and send the blood back to the heart and brain. In POTS, this message often gets interrupted. In addition, the heart isn’t very efficient at pumping your blood back to your center. This causes blood to pool in the legs and feet and the body’s heart rate to skyrocket, sometimes 30-40 or even more beats beyond what is normal.

In addition to increased heart rate, individuals often experience symptoms including but not limited to:

    • Lightheadedness/dizziness
    • Fainting
    • Brain fog or difficulty concentrating
    • Nausea/vomiting
    • Extreme fatigue
    • Headaches
    • Difficulty with memory
    • Exercise intolerance
    • Blood pooling and discoloration in the hands and feet
Think you might have POTS?

An experienced medical doctor can diagnose you with POTS. The current diagnostic criteria for POTS is a heart rate increase of 30-40 beats per minute (bpm) or more, or over 120 bpm, within the first 10 minutes of standing, in the absence of orthostatic hypotension. Typically, a Tilt Table Test is used to confirm this but may be accompanied by other tests as well.

If you haven’t seen a medical doctor yet but suspect your symptoms align with POTS there is testing we can do in the clinic to point you in the right direction. We can discuss your symptoms, take orthostatic vitals or do the NASA lean test to begin to assess what your body’s response to change of positions is.

Yes, exercise IS medicine!

Physical therapy is one of the most important components of POTS recovery. With POTS, because the autonomic nervous system isn’t functioning properly the heart isn’t very efficient at pumping blood, which causes many of the symptoms you feel. While you feel the symptoms related to the increased heart rate the root cause of the POTS symptoms is a product of the autonomic nervous system, which controls involuntary processes in the body like heart rate, not functioning properly. In order to improve your tolerance to upright positions, we have to improve the autonomic nervous system’s control over your heart. But how do we do that?

Progressive, cardiovascular exercise is an important component in improving your symptoms. We adopt multiple methods including adapting the principles in the Children’s Hospital of Philadelphia (CHOP)/Dallas and Levine Protocols to meet your needs. We start with gentle exercise in tolerable positions such as on a rowing machine, swimming, or recumbent bike. We gradually push your heart rate and progress into the positions that aggravate you most so that you can better tolerate them in your everyday life.

We also incorporate strengthening and stability exercises, particularly in the lower body. Your muscles have a close relationship with your blood vessels and act as their own “pumps.” As you walk and move, your muscles contract and compress your blood vessels, which returns blood to the heart. Bigger, stronger muscles means a more efficient pump!

Finally, we use mobility exercises and manual therapy to improve your overall blood flow and circulation.

Exercise isn’t the only solution – below are some treatments an experienced physician may provide.
  • Increased salt and water intake, including salt supplements
  • Compression stockings and elevation to improve circulation and blood return to the heart and brain.
  • Diet changes to prevent triggers.
  • Medications to improve your heart’s efficiency including but not limited to: Fludrocortisone, Beta Blockers, Midodrine, Clonidine, Pyridostigmine, Benzodiazepines, SSRIs, SNRIs, Erythropoietin and Octreotide.
There are many conditions that are frequently associated with POTS.

EDS/HSD, mast cell activation disorders, post-COVID syndrome, infections, and other autoimmune conditions are often found in relation to POTS. At SetPT, our therapists are knowledgeable of the many associated conditions and diagnoses associated with POTS and can help you manage your symptoms.

Postural Orthostatic Tachycardia Syndrome

POTS? Like cookware? Not quite!

POTS (Postural Orthostatic Tachycardia Syndrome) is a form of dysautonomia which typically causes an increase in heart rate upon sitting or standing. Why does this occur? In somebody without POTS, standing up typically causes blood to flow to the legs, feet, and hands. The body senses this change and tells the blood vessels to constrict and send the blood back to the heart and brain. In POTS, this message often gets interrupted. In addition, the heart isn’t very efficient at pumping your blood back to your center. This causes blood to pool in the legs and feet and the body’s heart rate to skyrocket, sometimes 30-40 or even more beats beyond what is normal.

In addition to increased heart rate, individuals often experience symptoms including but not limited to:

    • Lightheadedness/dizziness
    • Fainting
    • Brain fog or difficulty concentrating
    • Nausea/vomiting
    • Extreme fatigue
    • Headaches
    • Difficulty with memory
    • Exercise intolerance
    • Blood pooling and discoloration in the hands and feet

Think you may have POTS?

An experienced medical doctor can diagnose you with POTS. The current diagnostic criteria for POTS is a heart rate increase of 30-40 beats per minute (bpm) or more, or over 120 bpm, within the first 10 minutes of standing, in the absence of orthostatic hypotension. Typically, a Tilt Table Test is used to confirm this but may be accompanied by other tests as well.

If you haven’t seen a medical doctor yet but suspect your symptoms align with POTS there is testing we can do in the clinic to point you in the right direction. We can discuss your symptoms, take orthostatic vitals or do the NASA lean test to begin to assess what your body’s response to change of positions is.

Yes, exercise IS medicine!

Physical therapy is one of the most important components of POTS recovery. With POTS, because the autonomic nervous system isn’t functioning properly the heart isn’t very efficient at pumping blood, which causes many of the symptoms you feel. While you feel the symptoms related to the increased heart rate the root cause of the POTS symptoms is a product of the autonomic nervous system, which controls involuntary processes in the body like heart rate, not functioning properly. In order to improve your tolerance to upright positions, we have to improve the autonomic nervous system’s control over your heart. But how do we do that?

Progressive, cardiovascular exercise is an important component in improving your symptoms. We adopt multiple methods including adapting the principles in the Children’s Hospital of Philadelphia (CHOP)/Dallas and Levine Protocols to meet your needs. We start with gentle exercise in tolerable positions such as on a rowing machine, swimming, or recumbent bike. We gradually push your heart rate and progress into the positions that aggravate you most so that you can better tolerate them in your everyday life.

We also incorporate strengthening and stability exercises, particularly in the lower body. Your muscles have a close relationship with your blood vessels and act as their own “pumps.” As you walk and move, your muscles contract and compress your blood vessels, which returns blood to the heart. Bigger, stronger muscles means a more efficient pump!

Finally, we use mobility exercises and manual therapy to improve your overall blood flow and circulation.

Exercise isn’t the only solution – below are some treatments an experienced physician may provide.

Due to joint hypermobility, patients with hEDS and HSD often experience debilitating muscle spasms. These muscle spasms occur as your body attempts to stabilize an unstable joint, because the ligaments are too stretchy to do so. A knowledgeable therapist is able to help relieve these spasms and give you the advice and tools you need on how to manage your painful spasms at home.

  • Increased salt and water intake, including salt supplements
  • Compression stockings and elevation to improve circulation and blood return to the heart and brain.
  • Diet changes to prevent triggers.
  • Medications to improve your heart’s efficiency including but not limited to: Fludrocortisone, Beta Blockers, Midodrine, Clonidine, Pyridostigmine, Benzodiazepines, SSRIs, SNRIs, Erythropoietin and Octreotide.

There are many conditions that are frequently associated with POTS.

EDS/HSD (link to EDS/HSD page), mast cell activation disorders, post-COVID syndrome (link to post-covid page if we make one), infections, and other autoimmune conditions are often found in relation to POTS. At SetPT, our therapists are knowledgeable of the many associated conditions and diagnoses associated with POTS and can help you manage your symptoms.