What is POTS?
Postural orthostatic tachycardia syndrome (POTS) is a form of dysautonomia—a condition where the autonomic nervous system doesn’t function properly. Affecting millions across the U.S. and beyond, POTS can significantly interfere with daily life. While it can affect anyone, it’s most frequently seen in women of childbearing age. Symptoms often intensify with simple postural changes, particularly when moving from lying down to standing.
Types of POTS
There are two primary forms:
- Primary (Idiopathic) POTS: Occurs without any identifiable underlying condition.
- Secondary POTS: Develops alongside or following another condition such as a viral infection, autoimmune disease, or prolonged illness.
Diagnosing POTS
Accurate diagnosis is crucial, yet often delayed due to the wide range of symptoms. The gold standard test is the Tilt Table Test, which tracks heart rate and blood pressure in response to changes in posture. A key indicator is a heart rate spike of 30+ beats per minute (or >120 bpm) within 10 minutes of standing, without a significant drop in blood pressure.
Common Symptoms of POTS
- Lightheadedness or fainting upon standing
- Rapid heartbeat or palpitations
- Fatigue and exercise intolerance
- Brain fog or poor concentration
- Headaches
- Nausea
- Discoloration in the legs (red-purple hue when standing)
How Physical Therapy Supports POTS Recovery
Physical therapy plays a central role in POTS management by gradually improving cardiovascular tolerance, strengthening muscles (especially in the lower body), and addressing movement dysfunctions or secondary pain.
Graded Cardiovascular Exercise
Structured programs like the Dallas POTS Exercise Protocol and CHOP’s modified approach guide patients through low-intensity, horizontal-based cardio, such as:
- Recumbent biking
- Swimming or pool walking
- Rowing or supine stepping
These activities are performed with heart rate monitoring or using the Rate of Perceived Exertion (RPE) scale, especially in patients using beta blockers. The gradual buildup of cardiovascular strength can help reduce the dramatic heart rate spikes that characterize POTS.
Strength Training and Muscle Pump Activation
Lower-body resistance training is critical because strong leg muscles help pump blood back to the heart. Therapists teach safe, progressive strengthening routines tailored to individual tolerance levels, focusing on:
- Glutes
- Quadriceps
- Calves
- Core stability
This also improves orthostatic tolerance and postural control, which are often impaired in individuals with POTS.
Mobility Work and Postural Retraining
Tight muscles and poor posture can amplify symptoms of dizziness, fatigue, or nerve irritation. PTs use manual techniques and targeted stretches to:
- Improve circulation
- Reduce tension
- Increase thoracic mobility
- Encourage upright tolerance over time
Incorporating Dry Needling into POTS Treatment
Dry needling is another valuable technique, particularly when chronic pain or muscular tension is present. Many POTS patients develop compensatory movement patterns or chronic tightness due to fatigue or deconditioning.
Dry needling:
- Relieves myofascial trigger points in overactive or painful muscles
- Reduces local inflammation
- Increases blood flow to the affected area
- Enhances muscle recovery alongside exercise
It is particularly helpful for managing headaches, neck pain, and persistent muscular tension in the shoulders or back, which often co-occur with POTS.
Ongoing PT Support and Monitoring
Because symptoms vary and fluctuate over time, a long-term relationship with a physical therapist can be invaluable. Your therapist will:
- Adjust the program based on daily tolerance
- Monitor for red flags (such as abnormal heart rate responses or dizziness)
- Coordinate with your healthcare team
- Reassess progress regularly and modify goals as needed
You Don’t Have to Manage POTS Alone
POTS is a complex condition, but it can be managed with a personalized approach that prioritizes gradual improvement, education, and whole-body support. Physical therapy offers a safe, research-backed path to improving daily function and reducing symptom severity—without pushing the body beyond what it’s ready to do.
If you or someone you love is navigating POTS and unsure where to start, we’re here to help. With guided exercise, dry needling, and a compassionate team of movement experts, you can move forward confidently, one step at a time.
