Postural Orthostatic Tachycardia Syndrome (POTS) and other dysautonomia conditions are usually difficult to diagnose efficiently, and even more challenging to find the appropriate treatment plan. Traditionally, most people experiencing POTS or similar symptoms are told to increase their daily water and salt intake, use compression socks, take medications off-label (including low dose beta blockers, midodrine, and SSRIs, among others) and exercise (usually cardiovascular in nature)1. Sometimes these therapies can provide a benefit and help POTS symptoms. However, most people unfortunately find that these are more “management” strategies rather than treatment strategies designed to heal and recover from these symptoms. This leads us to the inevitable question, “What should I do to correct my POTS symptoms if these other strategies don’t work?”
At our clinic, we initially perform a complete neurological evaluation and take into consideration other factors that could be contributing to POTS symptoms (metabolic concerns, musculoskeletal concerns, etc.) If a neurological basis of the POTS symptoms is found, our treatment plan is created that generally is targeted toward two main goals in resolving the POTS symptoms. We think of them as different “levels” of POTS treatment.
Our “level 1” treatment is designed to address and correct foundational integrity of the nervous system. In our opinion, if a person struggles with standing up, remaining upright for extended periods of time, or moving around without feeling symptomatic, it is near impossible to utilize therapies such as exercise initially in their recovery. Most people, in our experience, will try to exercise early on, but if their system is neurologically unstable, their symptoms will typically flare up and they feel worse. Instead, the initial approach of our “level one” therapies are specifically designed to retrain and recalibrate the neurological networks involved in standing, movement of the head and body, and rapid postural changes of the body. There are various therapies that can help promote this recovery, but one of the most important is tilt table therapy. Therapy performed while tilting at different angles of gravity allows the body to experience the postural changes at a range, frequency, and intensity that does not overload and over-stress the system. If performed correctly, this “level one” treatment can successfully help a person regain the ability to stand, remain upright, and move throughout the world without feeling dizzy, lightheaded, or experience other symptoms like brain fog, blurry vision, and floating/disorientation sensations.
Once this level of healing is achieved (both subjectively, and usually with objective changes in heart rate variability with postural changes), treatment is progressed to “level 2”. The approach of “level 2” therapies is to train the system and brain to return to normal activities of life. With the health and stability of the nervous system improved from the “level 1” therapies, the “level 2” therapies are designed to be more challenging and stressful on the nervous system and brain. Exercise is the main activity that is utilized as therapy in “level 2”. In the realm of exercise, there are many different forms and ways to train; running, stationary bike activity, rowing machines, interval training, resistance training, bodyweight exercises, etc. While everyone is different, there are certain types of exercise that are more targeted to healing and recalibrating the nervous system, and those applications are carefully administered and evaluated for this training period.
Generally speaking, we think of “level 1” therapies as therapies that you cannot perform on your own; they are mostly administered in a clinic setting in which the therapies are performed passively (for example, tilt table therapy is performed with the person not moving; they are tilted at different angles without coordinating the movement themselves). In contrast, “level 2” therapies are generally activities that you can perform at home and involve active movement and coordination of activity (such as exercise). We have seen many successful outcomes and recovery from POTS symptoms employing this method of treatment therapy. If you or someone you know suffers from POTS symptoms or similar symptoms of dysautonomia, please feel free to contact us at our website or book a free consultation with one of our doctors so we can speak with you directly about our recommendations.
References:
1. Postural Tachycardia Syndrome: Beyond Orthostatic Intolerance. Garland EM, Celedonio JE, Raj SR. Curr Neurol Neurosci Rep. 2015 Sep;15(9):60.
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