POTS · Dysautonomia · Orthostatic intolerance
POTS and dysautonomia: a measured, structured plan alongside your medical care.
When the system that regulates heart rate, blood pressure and blood flow can't keep up, standing in line, taking a shower or climbing stairs can feel like a marathon. We provide structured autonomic rehabilitation that complements, never replaces, the care you get from your physicians.
Look closer. Recover forward.
Sounds familiar?
- A racing heart or pounding when you stand up
- Lightheadedness or near-fainting, especially in heat or after standing still
- Exhaustion or "crashes" after activity
- Brain fog that is worse when upright
- Exercise intolerance
- Feeling shaky, short of breath or overheated
- Poor sleep and waking unrefreshed
You're not imagining it, and you're not alone. These symptoms are real, and many of the systems behind them can be measured.
Why symptoms can persist
Your autonomic nervous system works in the background to keep blood flowing to your brain every time you sit up or stand. In postural orthostatic tachycardia syndrome (POTS), that automatic response falters: heart rate rises excessively on standing, without a drop in blood pressure, along with symptoms that last for months. Expert consensus describes the diagnosis as a sustained heart-rate rise of at least 30 beats per minute in adults (40 in teens) within ten minutes of standing.
POTS often begins after a viral illness, concussion, surgery, pregnancy or a period of illness and deconditioning, and it frequently overlaps with other conditions. Researchers describe several contributing mechanisms, and the condition is still not fully understood. What is well established is that education and non-medication strategies are the first line of management, and that a gradual, structured approach to activity matters.
Because autonomic problems can also affect eye movements, balance and concentration, we look at the whole picture rather than heart rate alone.
What we'll evaluate
Testing is chosen for you based on your history and what you can comfortably tolerate, with rest breaks built in.
Active stand testing
Heart rate and blood pressure measured lying down and then standing over time, to see how your system responds.
Breathing and heart-rate variability
How your heart-rate rhythm responds to paced breathing, a window into autonomic balance.
Exertion tolerance
A careful, graded look at how much activity your body tolerates, with screening for post-exertional crashes.
Eye movements and balance
Screening for visual and vestibular involvement, which commonly overlaps with dysautonomia.
Cognition
Processing speed and attention, which can change when you're upright.
Symptoms and records
Validated autonomic symptom questionnaires and a review of prior tilt-table, cardiac and lab testing.
Our assessments guide rehabilitation and don't replace medical diagnosis. More about our testing
How care will work
Medical diagnosis and medications remain with your physicians. Our role is rehabilitation. Depending on your testing, your program may include graded reconditioning that starts lying down or reclined and moves gradually toward upright exercise, breathing and pacing strategies, practical techniques for standing and daily tasks, and help with energy management. Hydration, salt and compression guidance is discussed in coordination with your physician, since it isn't right for everyone.
We screen for post-exertional symptoms before progressing and never ask you to "push through." If activity causes a crash, the plan is scaled back, not forced forward.
Intensive program
Several shorter sessions per day, with planned rest, over a block of consecutive days. Designed for people traveling in or who want focused care in less time.
Outpatient program
Regular visits over several weeks with a home program in between. A good fit if you live nearby or prefer a gentler pace.
What to expect
- Before your visitWe review your records and prior testing, then talk on a short fit call so you know whether we're a good match before you book.
- EvaluationAn in-depth neurological exam and objective testing, paced to your tolerance.
- Report of findingsA plain-language explanation of what we found and what we recommend, with a written summary.
- Your programIntensive or outpatient rehabilitation, dosed and progressed as you respond.
- Re-test & home planWe repeat key measures to check progress and send you home with a program you can keep using.
Autonomic rehabilitation is usually gradual. We track heart-rate and blood-pressure responses, symptom scores and the daily activities you want back, and share updates with your medical team.
When to seek urgent care
Seek urgent medical care for fainting with injury, chest pain, shortness of breath at rest, palpitations with fainting, or new or rapidly worsening symptoms. If you think you are having a medical emergency, call 911.
This page is educational and is not medical advice. Please talk with your physician about your symptoms. We work alongside your medical team and never ask you to stop medications or replace medical care.
Frequently asked questions
Can you diagnose POTS?
Diagnosis is made by your physician, often with a tilt-table or active stand test. We perform standing heart-rate and blood-pressure testing to guide rehabilitation and share findings with your medical team.
Will I have to stop my medications?
No. We never ask patients to stop medications. Any medication decisions stay with your prescribing physician.
Is exercise safe with POTS?
Structured, gradual exercise is a widely recommended part of POTS management, but it has to start where you are. Many programs begin with reclined or seated exercise. We test your tolerance first and progress slowly.
What if exercise makes me crash?
Then the plan changes. We screen for post-exertional symptoms and scale activity down when needed. Pushing through crashes is not part of our approach.
Do you work with my cardiologist?
Yes. With your permission we'll send clear written updates and coordinate with your cardiologist, primary care physician or autonomic specialist.
Does POTS get better?
Many people see meaningful improvement over time, but the course varies widely and no one can promise an outcome. We'll share an honest view of what we find and what is realistic for you.
Be first to know when we open
We're opening fall 2027. Join the waitlist to hear our location first, get early scheduling access and receive free education about dysautonomia & POTS.
Look closer. Recover forward.
Related conditions
Many people have more than one of these. We look at how the systems interact.
Long COVID & post-viral
Fog, dizziness, heart-rate changes and exhaustion that began after COVID-19 or another viral illness.
Concussion & TBI
Headaches, fog, light sensitivity or dizziness that linger months or years after a concussion or mild TBI.
Visual & cognitive processing
Eye strain, reading trouble, screen intolerance and slow processing that make busy places exhausting.
Selected research
These sources describe the conditions and rehabilitation principles discussed on this page. They are not studies of our clinic, which is not yet open.
- Vernino S, et al. Postural orthostatic tachycardia syndrome (POTS): state of the science and clinical care from a 2019 National Institutes of Health expert consensus meeting, part 1. Auton Neurosci. 2021;235:102828. doi.org/10.1016/j.autneu.2021.102828 (opens in a new tab)