In-Hospital Support for POTS & EDS
Over the weekend, we received an urgent request for support for someone navigating EDS and POTS in an acute stage. While this isn’t a phase we typically treat in the clinic, I wanted to share a few research-informed recommendations that may help support the body during this time.
For individuals with POTS and EDS, the body is not simply deconditioned; it’s often dysregulated and under-supported.
If you or someone you care for has Postural Orthostatic Tachycardia Syndrome (POTS) and Ehlers-Danlos Syndrome (EDS), a hospital stay can feel especially overwhelming. The combination of frequent position changes, reduced movement, and a more stimulating environment can easily increase symptoms like dizziness, fatigue, and pain.
The goal during this time is not to push the body; it’s to support it, calm it, and move forward gradually.
Start with Stability
Before focusing on exercise, the priority is helping the system feel safe and supported. This means minimizing symptom flares, supporting circulation, and allowing the nervous system to settle.
This approach is supported by research showing that non-pharmacologic strategies, especially gradual reconditioning and volume support are first-line in managing POTS.
Supportive Positioning
Upright posture can be challenging with POTS, and unsupported positions can strain joints in EDS.
Leaning into more supportive positions—such as lying down or being slightly elevated with the legs supported—can help reduce stress on the system. From there, movement into sitting or standing can happen gradually, with time for the body to adjust.
This mirrors the progression used in established protocols like the Levine/Dallas approach, which emphasizes starting in recumbent positions and slowly progressing upright as tolerance improves.
Gentle Circulation Support
Before movement, simple strategies like ankle pumps, heel slides, or light muscle engagement can help encourage blood flow back to the heart. These small inputs support what’s known as the “muscle pump,” which plays a key role in improving venous return and circulation.
The Role of Abdominal Compression
One of the most helpful (and often overlooked) tools is abdominal support.
A large portion of blood volume sits in the abdominal region, and in POTS, this is a common area for blood pooling, especially when upright. When that happens, less blood returns to the heart, and the body compensates with an increase in heart rate.
Research has shown that abdominal and lower-body compression can reduce heart rate, improve stroke volume, and enhance symptoms in individuals with POTS by helping return blood to the heart. This is why compression is often recommended as part of first-line conservative management.
Because the abdomen holds such a large volume of blood, targeting this area can be more effective than leg compression alone in some cases.
Clinically, this often translates to:
Improved tolerance to sitting and standing
Less dizziness or fatigue
A greater sense of stability overall
We’ve also had patients share positive experiences with the Jellie Bend compression garment, which offers a more comfortable and wearable option for abdominal support throughout the day.
Keep Movement Gentle and Supported
When introducing movement, staying in more supported or reclined positions is often best.
Short, manageable bouts, just a few minutes at a time, can be more effective than pushing through longer sessions. Over time, this helps the body build tolerance without triggering setbacks.
Research supports that structured, gradual exercise programs can improve blood volume, cardiac function, and overall tolerance in POTS, reinforcing the importance of consistency over intensity.
Prioritize Stability for EDS
With EDS, the focus is less on intensity and more on control and support.
Gentle strengthening of the core and hips, along with avoiding end-range strain, helps provide external stability to joints that may already be more vulnerable.
Nervous System Support Matters
In POTS, the autonomic nervous system is already working hard. The hospital environment can amplify that. Simple tools like slow nasal breathing with longer exhales can help calm the system and reduce overactivation.
Positioning the ribcage over the pelvis to support diaphragm function, along with gentle grounding strategies, can further support autonomic regulation.
A Supportive Environment
Hydration, electrolytes, and compression all support circulation. Just as important is creating space for rest, reducing overstimulation when possible, and allowing time between activities.
The Takeaway
Progress during a hospital stay doesn’t mean pushing harder. It looks like:
Fewer symptom spikes
Better tolerance to position changes
Feeling more supported and regulated
For individuals with POTS and EDS, the body often needs support before it can build capacity.
When we slow things down, support circulation, and prioritize nervous system regulation, we create the conditions for healing, both during the hospital stay and beyond.
Do you want to learn more or see if Mind Body Physiotherapy can help you? Schedule your free 15 minute phone consult.
References:
Fu Q, et al. J Am Coll Cardiol. Effects of compression on hemodynamics in POTS
Shibata S, et al. Exercise training vs propranolol in POTS
Levine BD et al. Dallas/CHOP POTS exercise protocols
Raj SR. Postural Tachycardia Syndrome (POTS) – Circulation & pathophysiology
Wells R, et al. Journal of the American Heart Association – Compression and POTS management
