Counter Maneuvers For POTS

Counter maneuvers are a series of exercises that can be used in the treatment of POTS symptoms. They are designed to prevent syncope or passing out. They can be used preventatively, every time you change positions, or you can use them only when you are experiencing POTS symptoms while upright.

I’m absolutely positive that I don’t know all the counter maneuvers that exist for POTS but I wanted to share the ones I know of and have used for those that haven’t heard of this. The absolute most basic counter maneuver is to flex your leg muscles when you start to feel faint. The idea here is that blood is pooling in your legs when you are upright and for whatever reason your body isn’t able to pump enough of it up to your brain. Your body solves this problem by causing you to pass out, thereby making you become horizontal and restoring blood flow. If you can restore the blood flow before passing out you can avoid the passing out part altogether.

Anything that causes the large muscles in your legs to flex can be used as a counter maneuver but some patterns seem to be more effective than others. For instance, if you get light headed every single time you stand up you can start the leg flexing before you even stand up. I’ve found it is often helpful to start by flexing my feet and ankles for a few seconds, then adding in my calf muscles for a few seconds, then adding in my thigh muscles for a few seconds. After that standing up is usually not as difficult. Another method that my cardiologist taught me is to spend 30 seconds in a sitting position kicking your legs up to horizontal (alternating legs). After that you stand and cross your legs and flex the muscles in your legs, butt, and abs for another 30 seconds. That method takes a little longer but it has been very helpful to me when my symptoms are particularly bad.

Counter maneuvers can also be used while standing for longer periods of time. I often need to do them while waiting in line at the grocery store or while I’m cooking dinner. In those instances I usually either do some squats or some calf raises. This can be a little strange when out in public so if you’re uncomfortable with full on squats you can just make sure to fidget a lot while intentionally flexing your leg muscles.

Just as a disclaimer, if you feel like you are actually going to pass out you should absolutely sit or lay down wherever you are. These counter maneuvers are designed to reduce symptoms but they are not a silver bullet that will save you from passing out in every situation. As with all things dealing with POTS, this is just one more tool you can use.