Understanding POTS and Autonomic Dysfunction: Symptoms and Treatment Options
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If you’ve ever stood up and suddenly felt dizzy, lightheaded, short of breath, or like your heart was racing and were told your tests were “normal, you’re not alone.
Many patients with POTS (Postural Orthostatic Tachycardia Syndrome), a type of autonomic dysfunction, spend months (or years) searching for answers. Symptoms can feel vague, unpredictable, and scary, especially when they interfere with work, school, or daily life.
Let’s walk through what POTS and autonomic dysfunction actually are, what symptoms to look for, and how targeted treatment, including physical therapy, can help.
Understanding The Autonomic Nervous System
Your autonomic nervous system (ANS) controls all the things your body does automatically, including:
- Heart rate
- Blood pressure
- Breathing
- Digestion
- Temperature regulation
- Blood flow when you change positions
When the autonomic nervous system isn’t regulating these functions effectively, symptoms can appear, especially with position changes, exertion, or stress.
What is POTS
Postural Orthostatic Tachycardia Syndrome (POTS) is a form of autonomic dysfunction characterized by an abnormal increase in heart rate with prolonged upright positions including standing, and in some individuals, even with sitting upright.
In simple terms:
Your body has difficulty adjusting to upright posture.
To meet diagnostic criteria, heart rate typically increases 30+ beats per minute (or exceeds 120 bpm) within 10 minutes of standing, without a significant drop in blood pressure.
POTS can occur after:
- Viral illness (including COVID)
- Concussion or head/neck injury
- Prolonged inactivity or bed rest
- Pregnancy
- Surgery
- In people with hypermobility or connective tissue disorders
Common Symptoms of POTS
Symptoms can vary widely and may fluctuate day to day. Common complaints include:
- Dizziness or lightheadedness when standing
- Rapid heart rate or palpitations
- Exercise intolerance or feeling worse after activity
- Fatigue that doesn’t improve with rest
- Brain fog or difficulty concentrating
- Shortness of breath
- Chest tightness
- Headaches or migraines
- Nausea or GI discomfort
- Temperature sensitivity
- Anxiety-like sensations that don’t match emotional triggers
Many patients are told symptoms are “just anxiety” when in reality, the autonomic nervous system is under strain.
These symptoms can vary in intensity and may be exacerbated by certain conditions like heat or dehydration.
Diagnosis of POTS
Diagnosing POTS involves a comprehensive evaluation including medical history, a physical examination, and specific tests like the tilt table test. A doctor may also check for underlying conditions contributing to the symptoms.
Why POTS Often Feels Worse After Concussion or Illness
After a concussion, viral illness, or prolonged stress on the nervous system, the body may struggle to regulate blood flow and heart rate efficiently.
This can lead to:
- Poor tolerance to upright activity
- Worsening symptoms with exertion
- Delayed recovery when rest alone doesn’t help
Importantly, this does not mean permanent damage, it means the system needs retraining.
Treatment Options
While there is no cure for POTS, several treatment options can help manage symptoms:
- Medications: Beta-blockers, fludrocortisone, or midodrine may be prescribed to help regulate heart rate and blood pressure.
- Dietary Changes: Increasing salt and fluid intake can improve blood volume and circulation.
- Physical Therapy: Gradual exercise programs can help improve cardiovascular fitness without overwhelming the body.
Physical Therapy for Autonomic Dysfunction
Physical therapy plays a critical role in recovery, especially when symptoms limit activity.
At Virginia Concussion & Pain Physical Therapy, treatment focuses on:
Graded Exercise Therapy
Carefully structured programs that:
- Begin in supported positions (lying or seated)
- Progress gradually to upright activity
- Improve cardiovascular tolerance without symptom flares
Breathing Retraining
Optimizing breathing mechanics can reduce:
- Heart rate spikes
- Shortness of breath
- Nervous system overactivation
Autonomic Regulation Strategies
- Including pacing, recovery planning, and symptom-aware progression.
Neck, Vestibular, and Visual Assessment
- Because cervical spine dysfunction, dizziness, and visual strain often worsen autonomic symptoms.
What Recovery from POTS Can Look Like
Recovery is not always linear and that’s okay.
Many patients experience:
- Improved tolerance to daily activities
- Reduced dizziness and heart rate spikes
- Better exercise confidence
- Increased clarity and stamina
With the right plan, most people make meaningful progress.
Managing POTS requires a multi-faceted approach that includes lifestyle adjustments. Patients often benefit from wearing compression garments, avoiding prolonged standing, and implementing a tailored exercise regimen.
Support groups and counseling may also be beneficial for emotional support and coping strategies. Understanding and patience from family and friends are crucial as individuals navigate the complexities of living with POTS.
You’re Not Imagining Your Symptoms
If you’ve been struggling with unexplained dizziness, fatigue, or exercise intolerance, your symptoms deserve thoughtful evaluation and individualized care.
A comprehensive assessment can help determine:
- Whether autonomic dysfunction is contributing
- What systems are driving symptoms
- How to safely rebuild tolerance and confidence
Compassionate, Specialized Care in Glen Allen, VA
At Virginia Concussion & Pain Physical Therapy, I provide one-on-one, extended evaluations to assess autonomic function alongside vestibular, cervical, and neurologic systems.You don’t have to navigate this alone and improvement is possible!