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The POTS Squat

Updated: Feb 19

The POTS Squat: A little girl squats on a stool, and a teenager squats on a chair. "Why do kids and adults with POTS feel better when they sit in a squat?"

While you may think it's a cute and catchy rhyme, it drives some parents crazy about their kids with POTS. They just won't sit properly at the dinner table, and they insist on squatting with their feet up on the couch. So why is it that kids are so stubbornly stuck in the POTS Squat?

When you squat, you change the flow of blood in your body. The bend at your hips puts some low grade compression on your femoral artery, mildly restricting blood flow down to the legs. This can be convenient for people with POTS because it keeps their blood up in their trunk where their heart and other organs are, and closer to their brain. While kids may not be able to articulate what in medicine we call "malaise" or a general feeling of unwellness and that something is wrong, they can usually tell you that they are just more comfortable sitting in a squat.

In pop culture, you can see a similar squatting technique in a movie called "Something the Lord Made". The film is a biographical drama showcasing issues of race and medicine, following the story of Vivien Thomas and Alfred Blalock. Dr. Blalock is a surgeon, who with the help of his research partner Thomas, decides to take on the challenge of correcting a congenital heart problem called Tetralogy Fallot, more commonly known as "blue baby syndrome". While successful heart surgeries are common today, at the time, the two men were trying to do what was deemed impossible. 30 minutes into the film, they show a scene of some of the children who have been diagnosed with holes in their hearts, squatting on hospital beds. When Thomas asks why, he's told that a child once told a pediatric cardiologist at the hospital that sitting that way helped them to breathe easier. That physician was wise enough to recognize that her patient knew their own body well. Soon all the other children began to squat, to help their hearts function better so they could feel like they could breathe a little easier.

If you have kids with POTS, this might be a good film to show them to validate that sometimes they know more about their bodies than their doctors do. It's important for kids to know that doctors should respect their experiences. While doctors may be experts in the anatomy and physiology of the human body, they do not live in your body. Doctors should always be listening to their patient's experiences and looking to learn from them. This is especially true when studying health conditions that are not well understood.

While the POTS squat has definite advantages, it hasn't been well researched. There isn't any definitive evidence to suggest that it has negative consequences, but there are a few things we do know about squatting that you might want to consider.

Squatting has some mechanical effects on your pelvic muscles. Prior to the modern era where we sit on toilets to go to the bathroom, for most of history, people would squat to do their business. If you are a POTS patient who also has gastrointestinal problems, this might be important for you to consider. You may also want to check out some of the research on the Shark Tank famous Squatty Potty.

From a circulatory perspective, sitting in a squat all the time may also present some challenges if you also have chronic pelvic congestion syndrome. As you restrict blood flow down into your legs, it is possible that it creates an increased congestion effect in your pelvis. If you are someone who struggles with swelling in your pelvis, you may want to consider if squatting to improve your POTS symptoms makes an impact on your pelvic swelling.

Lastly, just because sitting in a POTS squat might make you feel better doesn't mean doing squats is easy. So why is doing squats at the gym so hard? If you think back to the intro concepts we discussed in POTS University, it all comes down to blood flow. POTS bodies struggle to get blood where they need it when the demands in the body change. This is true of position changes, exercise demand changes, and temperature changes.

Squats are especially challenging. First, the position change involved moves your body restricts blood flow to your lower extremities as you flex your hips and sink down into the squat. Then the squat movement demands that the muscles in those lower extremities work hard to lift your body weight to stand up again, while they have less oxygenated blood to do it with. Once you make it to upright, your body has to then adjust your blood pressure to pump blood against gravity, all before you decide to lower back down into another squat again. This is very confusing for your circulatory system and can make squatting feel particularly exhausting.

While you may be able to work up to doing squats again later, it isn't typically a good first exercise when trying to get in better shape if you have POTS. If squatting is a goal you want to work towards, you are best off working individually with a physical therapist that has specialty expertise in POTS. Every patient case is unique and this article is not intended to replace individual medical advice. If you want a physical therapist to provide you medical advice for your specific needs, we'd encourage you to schedule an appointment.

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