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Postural Orthostatic Tachycardia Syndrome (POTS) Orthostatic Intolerance (OI)

Postural Orthostatic Tachycardia Syndrome (POTS) & Orthostatic Intolerance (OI) Physio & OT Support

Are you experiencing dizziness, rapid heart rate, or fatigue upon standing? At Evolving Pain, we specialise in the management of Postural Orthostatic Tachycardia Syndrome (POTS) and Orthostatic Intolerance (OI), conditions that affect the autonomic nervous system and blood circulation. Our experienced physiotherapists and occupational therapists provide evidence-based strategies to help improve daily function and quality of life.

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What is POTS and Orthostatic Intolerance?​

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POTS and Orthostatic Intolerance (OI) are disorders of autonomic function, impairing the body’s ability to regulate blood pressure and heart rate in response to changes in posture.

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Postural Orthostatic Tachycardia Syndrome (POTS)

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POTS is characterised by an excessive heart rate increase of 30+ beats per minute in adults (or 40+ beats per minute in adolescents) when transitioning from lying down to standing, without a corresponding drop in blood pressure.

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This leads to symptoms such as:

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  • dizziness, light-headedness, and brain fog

  • tachycardia (rapid heart rate) and palpitations

  • fatigue and exercise intolerance

  • chest discomfort and headaches

  • nausea, bloating, and gastrointestinal symptoms

  • cold extremities and thermoregulatory issues

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POTS often affects more women than men, with 85% of cases occurring in females. It is commonly diagnosed in adolescence or early adulthood. Triggers include viral infections (such as long COVID), concussion, hormonal changes, or gradual symptom progression over time.

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Orthostatic Intolerance (OI)

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Orthostatic Intolerance is a broader term encompassing conditions where standing triggers symptoms due to blood flow abnormalities, including:

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  • neurally mediated hypotension (NMH) – a delayed drop in blood pressure upon standing

  • orthostatic hypotension (OH) – a significant drop in blood pressure immediately upon standing

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Symptoms improve when lying down and can vary in severity, leading to fluctuating “flares.”​​​​​​

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Meet our physios and OT’s for chronic pain and POTS/OI

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Rachael Sheat

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Martina Egan

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Amy Gowland 

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Nikki Knighton

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Marie Pham 

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Elmie Hoevenaars

How we manage POTS and Orthostatic Intolerance​

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Our multidisciplinary approach integrates physiotherapy, occupational therapy, and lifestyle modifications to optimise symptom management.

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Understanding Your Symptoms

  • education on autonomic dysfunction and how it affects circulation

  • identifying symptom triggers such as dehydration, stress, and temperature changes

  • symptom tracking to develop personalised management plans

 

Improving Circulation and Blood Flow Regulation

  • compression therapy, such as wearing compression garments to reduce blood pooling

  • hydration and salt intake strategies to increase blood volume

  • safe positional changes to prevent dizziness and fainting episodes

 

Physical Conditioning and Pacing

  • graded exercise programs that begin with recumbent or seated exercises before progressing to standing

  • lower body strength training to enhance venous return and reduce symptom severity

  • pacing techniques to prevent overexertion and manage fatigue cycles

 

Lifestyle Modifications for Symptom Control

  • nutritional guidance, including high-salt diet modifications and hydration strategies

  • sleep optimisation to improve recovery and reduce daytime fatigue

  • environmental adaptations for home, school, and workplace accommodations

 

Comprehensive Symptom Management

  • cognitive strategies for managing brain fog and improving focus

  • mindfulness and stress-reduction techniques to support autonomic stability

  • addressing co-occurring conditions such as ME/CFS, fibromyalgia, and migraines

 

Diagnosis and Treatment Approach

 

Diagnosis is based on a sustained heart rate increase during an active standing test. Symptoms must be present for at least three months before confirming POTS, with other possible conditions (such as dehydration, hyperthyroidism, or anemia) ruled out.

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While first-line treatment focuses on lifestyle modifications, medications such as beta-blockers, midodrine, or fludrocortisone may be used in severe cases to reduce symptom burden.

 

At Evolving Pain, we provide a compassionate and evidence-based approach to POTS and Orthostatic Intolerance management, helping you regain confidence and stability in daily life.

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