Sam Gladnick is a PT who works with individuals in our community! She realizes that balancing exercise in combination with your daily life can be challenging. Depending on your level of mobility, movements as simple as sitting up or standing, or as challenging as running, can all provoke symptoms such as dizziness, lightheadedness, nausea, pre-syncope or syncope - or any combination of the above (and not inclusive of all). Because of this, her hope is that physical therapy can serve as an ally to you and help you reach your goals, whatever those may be!

We hope you can use her words of wisdom as a guide to begin discussions with your medical team specific to what PT may look like for you, how it could help you, and what their various recommendations may be for you.

What Can Physical Therapist’s Assess?

7 Helpful Physical Therapy Considerations For A Diagnosis Of POTS

• 10 minute stand test:

  • Assesses the response of heart rate, blood pressure, and symptom provocation for diagnostic purposes and the assessment of tolerance to standing. Standing balance can also be screened for here depending on your overall stability.

• Strength testing:

  • With sensations of deconditioning or weakness, physical therapists can check both arm and leg strength to assess for areas of weakness or areas that may be contributing towards pain experienced.

• Balance testing:

  • They may check for standing, walking, and/or sitting balance depending on the level of difficulty regarding your balance and their individual assessments.

• Flexibility:

  • They can assess specific areas to evaluate for muscle tightness and limitations.

• Nervous system testing:

  • The assessment of nerve tension which could be contributing towards areas where you experience tightness, even if you stretch regularly.

• Beight Index:

  • This is an assessment tool that can be used to check for areas of hypermobility that may contribute towards your joint pain. This is also important so they can ensure that they have the needed insight; this can minimize the risk that they recommend exercises that would otherwise be modified for someone who experiences hypermobility.

• Cardiovascular tolerance:

  • Sam, personally, uses the Balke Treadmill test often used to assess for cardiovascular endurance with concussions (this is specifically for walking tolerance, not everyone may tolerate this). It can provide a simple assessment of timed tolerance - go until tired or until symptoms require a break.

How Do I Start Exercising?

We must first say that exercising, and what is recommended, should be passed by your medical team to ensure all aspects of your health and various diagnoses are taken into consideration. This being said, we do hope that the guide listed below gives you and your team the added insight to help you in the most significant way.

4 Helpful Considerations

• CHOP Dallas protocol:

  • This can be a great starting tool to help determine baseline tolerance. This can also provide you with a schedule to help you get started. There are certainly limitations to this protocol specific to various recommendations and limited access to needed equipment. Click below for access to the protocol to pass by your medical team.

• Strengthening:

  • Start with the most tolerable positions which may include laying down and/or sitting with minimal changes of position.

  • As you can gradually tolerate more, increase the number of times you change positions (which can help with your overall tolerance with time).

  • Progressively increase reps and sets based on tolerance.

  • Increase the amount of time when you are in a standing position.

  • Increase the amount of time when you are in a standing position and the involvement/frequency of positional changes.

  • Increase the weight resistance, as is possible, in each position you are in as tolerated.

• Cardio - Walking:

  • Start with your baseline tolerance, whatever it may be.

  • Change 1 to 3 things which can include time, distance, and/or intensity. Changes in intensity may decrease your time or overall distance, which is not bad, just different and important to be mindful of.

  • Make adjustments to the time by trying to increase by 1-2 minutes per week if tolerated. You can always continue at the same time or distance depending on your overall tolerance and what is recommended.

• Brain fog:

  • Brain teasers can provide you with a helpful way to keep your brain active especially when navigating mental fatigue.

  • You can also talk with your PT to help you incorporate simple methods to help you maintain concentration or prevent forgetfulness. One example includes using a calendar! See our Brain Fog section for more helpful tips, and a helpful handout.