Postural Orthostatic Tachycardia Syndrome (POTS): What Most PT Clinics Get Wrong
5-min read
Written by: Dr. Kathryn, PT, DPT, NCS
If you or someone you love has been diagnosed with Postural Orthostatic Tachycardia Syndrome, you have probably already learned that POTS is not your average condition. It is also not something a standard PT program is designed to handle. At Atomic PT Dr. Kathyrn works with POTS patients through a neurologic lens, and the difference in approach matters a lot.
What is POTS?
POTS is a disorder of the autonomic nervous system, the system that automatically regulates your heart rate, blood pressure, and circulation. When someone with POTS stands up, their heart rate spikes excessively and their body struggles to compensate. This can show up as:
Dizziness and lightheadedness
Fainting or near-fainting
Brain fog
Fatigue
Exercise intolerance
The root issue is not a muscle or joint problem. It is nervous system dysregulation, and that distinction shapes everything about how we treat it.
Why a neurologic PT and not a general PT?
General PT is built around orthopedic problems: injuries, surgeries, movement limitations. POTS does not fit that model. Here is what a neurologic PT brings to the table that a general PT typically does not.
Understanding autonomic dysfunction
Neuro PTs are trained to work with orthostatic intolerance, dysautonomia, abnormal heart rate responses, and blood pressure instability. These are not concepts most general PT programs cover in depth. When your nervous system is the problem, you need someone who understands nervous system rehab.
Graded exercise that does not trigger crashes
This is where a lot of POTS patients get burned with general PT. Push too hard, too fast, and heart rate spikes, symptoms flare, and you can crash for days. Our approach starts with recumbent exercise (think bike or rowing) before progressing to standing. We use slow, structured progressions, careful heart rate monitoring, and symptom-guided pacing throughout. Nothing gets pushed until your body is ready.
Nervous system retraining
Treatment often includes breathing retraining, vagal tone work, lower-body strengthening to improve venous return, tilt tolerance training, and core stability work to support blood flow. The goal is to improve your autonomic regulation, build upright tolerance, and reduce the frequency and severity of flare-ups over time.
Education and lifestyle strategy
Managing POTS well extends beyond the clinic. We work alongside your medical team to help you understand compression strategies, salt and fluid approaches, energy conservation, and activity pacing so that you can manage your day-to-day with more confidence and fewer surprises.
Ready to find out if neurologic PT is the right fit for your POTS? Dr. Kathryn sees patients across our Boulder and Broomfield locations and has experience working with autonomic nervous system conditions.
What does treatment actually look like?
Every POTS presentation is different, which is why we start with a thorough evaluation before building your plan. Some patients come in barely able to stand for a few minutes. Others are managing okay day to day but hitting a wall any time they try to exercise. Wherever you are starting from, we meet you there.
Progress with POTS is real, but it takes the right approach, the right pacing, and someone in your corner who understands what your nervous system is doing. That is exactly what neurologic PT is designed for.
If you have been told to just exercise more and it has not been going well, there is a reason for that. Let us figure it out together.
Dr. Kathryn, PT, DPT, NCS is accepting new patients for POTS and dysautonomia rehab at Atomic Physical Therapy in Boulder and Broomfield, CO.
