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We live in an incredibly visually dependent society. Medicine has trained both doctors and patients alike to rely heavily on imaging, and visual examinations to obtain a diagnosis. The push towards telehealth medical care has reinforced these evaluation strategies even more. While most doctors also run other tests such as a variety of labs, listening to your heart/lungs, and feeling your pulse, the testing is not all inclusive. Any honest physician would agree, that we are constantly learning new things about medicine and the human body. There are diseases that we couldn't test for 100 years ago, that we have since been able to identify and develop tools to diagnose today. As a result, many patients come to their physical therapists' office frustrated that they are in pain, and their physician has told them that nothing is wrong on their imaging. While most people don't undergo testing hoping for something to be wrong, they are usually hoping that something will be found that justifies and explains their symptoms. Ideally, the doctors will find something that can be easily fixed. If all of the tests come back negative, patients are often confused. They believe that must be some kind of mistake. When the pain they experience is so significant and persistent, surely, something must be wrong. To answer the question of why doctors can't see pain, we have to first understand that no one can really see pain at all. While almost every human being can say they've experienced the sensation of pain in one form or another, it isn't a sense that we experience through our eyes. While there can be signs of damage to our bodies that we associate with pain on the outside, that isn't all of pain. The experience of pain actually happens inside of our bodies. Pain is complicated, and verbal language has a hard time describing just how complex pain is. For example, if you were to Burn your hand on the oven rack Step on a Lego Prick your finger on a sewing needle Stub your toe Shock yourself on a loose electrical wire All of those things could be described as "painful". They do not, however, all feel the same. The pain from a burn is different than the sharpness of a sewing needle, or the tingling pain that shoots through your nerves from the loose electrical wire. To make it more complicated, some of these painful experiences leave physical signs of injury like a burn on your hand, while others like an electrical shock may not be visible at all. The truth is that we are better off thinking of pain like a "sixth sense", if you will, rather than trying to make it fit into a box of one of our other senses. In fact, pain can touch all of our other senses. If a sound is loud enough, it becomes painful. If a coffee cup is hot enough, it burns your hand and becomes painful. If the light is bright enough after walking out of a dark movie theater, we say that it "hurts my eyes". A pain signal in your body is better described as your body's way of saying, "That's too much!" of another sense, and usually signals your body's belief "That's so much that it's dangerous." So how do doctors test your Much-ness Meter? Doctors and scientists run studies where they perform the same test on a large number of people to decide what is considered to be normal. Doctors then use those studies to compare your body to other people who are considered normal or average. For example, we know that the average person will experience pain if they have a broken ankle. We can see broken ankles on an x-ray, and so we use imaging as a test to explain a person's pain. That does not mean, however, that everyone with a broken ankle will have pain. For example, if the nerves in the spinal cord are damaged, a person may be unable to feel their legs, and therefore won't have pain even though their ankle is broken. Unfortunately, many of us don't fit into the "average" category in one way or another for a variety of reasons. Have you ever noticed that some people can tolerate spicy food better than others? Or perhaps you know that some people are more easily startled by loud noises? How about the fact that one person can pick up a hot bowl out of the microwave while another person cannot without feeling they burned their hand? The fancy term for this is medicine is a threshold. There are entire scientific studies dedicated to assessing what is called a pain pressure threshold in different populations of people. Receiving a diagnosis of fibromyalgia, according to the American College of Rheumatology's 1990 diagnosis criteria, is largely dependent on having a pain pressure threshold that is low enough that a pain response is triggered if certain points on the body are touched with 3lbs of pressure. While a new diagnosis criteria was proposed in 2010 (proof that medicine does attempt to learn and improve over time), the 1990 criteria is a good example of just how limited the medical field truly is in it's ability to assess pain. Doctors are entirely dependent on the patient to report to them whether the pressure applied is painful or not. It is not an objective test like an x-ray which either shows a break in a bone or it doesn't. It is what we would call a subjective test that is dependent on the individual to self report their experience. (1) The medical community is still learning how pain is processed in your body. While we believe that pain is processed in your nervous system, admittedly, it is one of the systems in your body we know the least about. (See The Nervous System Whisperer: Where does pain come from?) The electrical shock from a loose wire is a good example of why your doctor cannot see your pain. Your nervous system communicates messages in your body with electricity. Think of your nervous system like the wiring in your house. If you were to take a picture of the wiring in your house and show it to your electrician, it would have limited value. While they may be able to see if a wire had been completely crushed, or disconnected, the photo would not tell them much about what the wires in your house do. In order to see that, an electrician would use a different tool to assess electrical current in the wires. They would have to problem solve and test in multiple places, to determine if the problem with your wires was happening locally by the outlet that isn't working, at the breaker to see if you've blown a fuse, and perhaps even outdoors in the wires that lead to your home from the power company. Processing pain in your nervous system works similarly, but is even more complicated. The wires in your house don't send as many kinds of messages as your nerves do, and the human brain, that is the boss of the nervous system, is not as well understood as your local power plant. (See: How Nerves Work: Simplifying Complex Neuroscience) In summary, just because your doctor cannot see your pain, does not mean that your experience of pain is not real. In fact, one of the best analogies to help doctors and patients understand pain is the simplest one. Every medical student at some point watches a video on standard precautions to prevent the spread of infections. The typically dated looking video usually shows a person doing the wrong thing like touching a wound without gloves, or a simple cough into their hands. A green blob to symbolize germs then spreads onto their hands. The person will then touch something in the hospital like a phone or a door handle before they wash their hands and the infamous green blob will spread. Then someone else comes along and touches the same door handle unaware of the germs present there. That person touches a few more things and before you know it, the whole hospital is covered in green blobs because the germs have spread everywhere. The truth is that pain, like germs, is an invisible illness, but that does not mean that it is not real. Most doctors would say that they believe that germs existed before we were able to see them on a microscope. They didn't miraculously appear for the first time when we developed the technology to be able to see them. My encouragement to patients and providers alike is that pain is the invisible disease of our day. While medicine's ability to objectively test for pain at this point in time is limited, that does not mean that pain is not real. This article is intended for educational purposes. In light of the fact that pain is processed in the brain and every person's brain and nervous system are unique, this article is not intended as a replacement for individual medical advice. If you are looking for support in living life with chronic pain and are interested in physical therapy services to evaluate your case individually, click Book Online above to schedule an appointment. (1) Due to the subjectivity of this testing, it must be acknowledged that while many patients who report pain are honest, some individuals may report pain that are disingenuous and medical professionals may appropriately exercise caution in relying solely on subjective symptom reports when making a diagnosis in individual cases.

Dry needling is gaining popularity amongst patients and physical therapists alike. In the midst of the opioid epidemic, it is gaining national attention in the United States. This is due to articles like the segment by NPR in 2018, which featured an Emergency Room that reduced their opioid prescriptions by 58% using strategies like dry needling (1). Dry needling is rapidly moving from being considered alternative medicine like acupuncture, to a mainstream treatment option. The Cleveland Clinic, Mayo Hospital, and WebMD all have informational webpages on dry needling. This post is dedicated to answering some frequently asked questions, and giving you a provider's perspective on dry needling, so you can make informed decisions about your healthcare treatment options. We'll discuss: What is dry needling? How is dry needling different from acupuncture? How is dry needling different from injections? Is dry needling safe? Who can benefit from dry needling? Where can I get dry needling? Is dry needling covered by insurance? What is dry needling? Dry needling involves the insertion of a thin monofilament needle into the body. Dry needling is believed to influence blood flow and inflammation in the body. When a new micro tissue injury is created by the needle, the body naturally directs blood flow and inflammation accordingly to heal the injury and protect the body. How is dry needling different from acupuncture? To practice acupuncture, a provider must be a licensed acupuncturist and meet the requirements of their respective state governing accrediting body. Acupuncture is based on traditional Chinese medicine (though Japanese methods and influences from other nations also exist). Generally speaking, acupuncturists seek to utilize their needles to influence chi, a type of energy in traditional Chinese medicine, to improve various components of health. Acupuncturists choose the locations for needle placement in consideration of meridian lines along which energy is believed to flow. This system is based on hundreds of years of eastern medical tradition. Dry needling is based in a more western approach. Needle placement locations and sizes are chosen based on nerve anatomy, as well as our understanding of blood flow and the inflammatory system. Therapists typically place needles locally in the area the patient is experiencing symptoms, or along the nerve distribution that supplies that region. For example needles may be place near the spine to address pain that is radiating down the leg from the back. Dry needling methods are based on available evidence in research, and the experience of the clinician providing the treatment. The providers that are legally permitted to administer dry needling can vary by state. How is dry needling different from injections? Dry needling involves the use of a thin monofilament needle. Dry needling is called dry because there is no medication being used like in "wet needling", more commonly called injections. Unlike needles used for injections, which are larger and hollow to allow medication to pass through them into the body, dry needles are smaller, thin, and solid. Is dry needling safe? While all medical procedures carry some degree of risk, dry needling is relatively safe. The needles come in sterile packaging, and are discarded after use. Needles are not reused between patients. The size of the needle is also so small that the risk of infection is even lower than with other common place medical procedures, like getting a blood draw or taking an insulin shot. For individuals with metal allergies (e.g. nickel), stainless steel needles are available that reduce the likelihood of allergic reactions. Your therapist should have a form about informed consent that will discuss risks and benefits to dry needling. You should have an opportunity to ask questions before signing to consent and receiving the treatment. Who can benefit from dry needling? If the condition is associated with nerve pain or inflammatory problems, dry needling may be a potential treatment option. Dry needling can be beneficial for a variety of conditions including: Migraines/headaches Jaw pain Whiplash Neck pain Low back and pelvic pain Tennis elbow Carpal tunnel Plantar fasciitis Chronic nerve pain Inflammatory conditions like tendonitis or arthritis Where can I get dry needling? Ally Total Physical Therapy offers dry needling services with the convenience of concierge care in your own home. If you're looking to be evaluated by a therapist to determine if dry needling is right for you, click the book online option above. If you are not in the Toledo area and are looking for a provider, reputable companies, like Integrative Dry Needling that educate therapists on dry needling and provide continuing education specialty coursework, typically have practitioner directories on their websites. You can search for a certified provider here: Practitioner Directory - Integrative Dry Needling (2) Is dry needling covered by insurance? This can vary widely from one state to another and from one insurer to another. As of 2023, federal insurance plans like Medicare and VA insurance plans, do not cover dry needling. It is always best to check with your insurance provider regarding your plan's coverage. If dry needling is not covered by your insurance, most clinics will offer dry needling on a cash pay basis. Patients should be aware, that due to frequent changes in insurance billing requirements, therapists may attempt to bill for dry needling under different treatment codes. Some therapists will bill for dry needling under the manual therapy code, or another code for surgical needle insertion that some insurers consider only appropriate for use during surgeries. This may or may not be allowed by an individual insurance company. You may want to ask how your insurance company wants to be billed so you don't get a surprise bill at the end of your treatment. If you have more questions about dry needling, post them in the comments below, or send us a message and we'll do our best to help you find answers. As a general disclaimer, the content in this article is not intended to replace individualized medical advice. You are advised to schedule an evaluation with your healthcare provider to discuss if this is the right treatment for you. (1) Opioid Use Reduced By Half In An ER That Has Found Good Alternatives : Shots - Health News : NPR (2) Practitioner Directory - Integrative Dry Needling

When working as a clinician that specializes in chronic pain, it doesn't take long before patients begin to ask you questions about their children: "The doctor says my child has growing pains, but do you think they could have fibromyalgia like I do? How young can I have my child tested?" "My little girl's knees hurt all the time, is it normal that I have to give my 5 year old Motrin this often?" "My son's teacher thinks he's faking it to get out of doing things at school, but I had headaches as a kid too. How do I manage to keep him in school, but still take his headaches seriously?" "My child has Ehlers Danlos like me. Is it ok for her to do gymnastics? She loves it, but I worry I should put her in a different sport." While the questions that arise when raising children seem endless, and all parents have a hard job, raising kids with chronic pain presents some unique challenges. Like most parents, you probably want to correct the wrongs that you suffered from as a child and learn from your parents' mistakes. You most likely want to protect your child, and for them to grow up to live successful and happy lives. So how do you walk the tight rope of helping your child succeed while not ignoring their illness? (See: Helping Kids With Chronic Pain Grow Into Successful Adults) How do you know when to make your child a doctor's appointment and when to wait it out? Here are a few rules for when it is time to see a specialist: If your child is avoiding activities they usually enjoy doing. If your child is waking up with pain at night. If your child's pain is accompanied by other symptoms such as fevers, joint swelling, rashes, fainting. If your child's pain is weather dependent and comes with the cold, or a drop in the barometric pressure before a storm. If your child has been complaining about pain for more than 3 months. If your gut tells you something isn't right. Even more so than adults, children will generally ignore pain to engage in activities they enjoy. If your child only develops headaches in math class and they don't like math, it's different than if your child has a headache that keeps them from going out to play at recess. While your child's pain may still be real, even if they notice it only during math class, it is definitely worthy of your attention if it's limiting their ability to participate in activities they enjoy. Pain that is impacting your child's quality of life is worth a doctor's appointment. Waking from sleep to complain about pain is not typical in children. If you are a parent who has chronic pain, this might surprise you, because you may have woken up with pain yourself as a child. Therefore, you may not even realize that it is not something children typically do. For parents who didn't experience pain at night as children themselves, this behavior in children can be frustrating. Most parents are tired themselves, and don't want to be woken up at 2am to complaints from their children on a regular basis. While some children who complain of pain are accused of attention seeking, this is highly unlikely if your child is waking up at night. As an adult, you wouldn't naturally wake up in the middle of the night without an alarm, and then go complain to someone about pain because you wanted attention. A child wouldn't do that either. Pain at night that is significant enough to wake your child is significant enough to make a doctor's appointment. Pain that comes with other symptoms that are more visible are easier to identify as a reason to see a doctor. Swollen joints, fevers, significant changes in appetite, rashes, fainting, or any other symptom that would normally clue you in that something is not right that accompany your child's pain are signs it's time to make an appointment. It may be a sign they have some underlying inflammation. Inflammation can be a sign of many different disorders. When our body perceives an injury, it sends oxygen and nutrient rich blood, called inflammation, to that area to try and heal the injury. It also sends antibodies and other immune cells to fight any infections that it may find there. If your child has an injury or an autoimmune disorder that is lurking below the surface, you may not see swelling and inflammation to the naked eye. It may be deeper inside their bodies than you can see. When the barometric pressure drops before a storm blows through, the pressure of the air against your body tissues decreases. This means that the inflammation isn't squished out of your tissues back into circulation as easily. When the inflammation sits in your tissues, it presses on the nerves which can make you feel achy and stiff. Some children may also be temperature sensitive. If cold is painful, it can be a sign your nervous system is unhappy. Most adults with chronic pain tend to prefer heating pads over ice packs (although there are some, particularly those with visible swelling, that do prefer the cold). In older adults, we know that many retirees with aching arthritic joints frequently try to move towards warmer weather if they can afford it. While children can't move to another climate on their own, they may avoid certain activities. If your child doesn't want to play in the snow like other kids, or complains more about their pain in certain seasons of the year, these may be clues that something more is going on. As a general rule, if your child has the same pain complaint, even intermittently for 3 months, it's time to see a doctor. While there are aches and pains in life that come and go, if your child consistently complains about their knees every other week for 3 months, it most likely isn't going to go away on its own. If your body is going to be able to heal an injury on it's own, it will usually do it within 3 months. Even when children break a bone, they usually wear a cast for 6-8 weeks. If you can honestly go to your child's doctor and say that the problem has been ongoing for 3 months, they should take you seriously. Lastly, if your gut tells you something isn't right, trust it. You know your child best, and there is something to be said for a parent's instincts. (See, 3 Rules of Raising Kids with Chronic Pain) Even if you go to the doctor and they don't find anything, that is a better outcome than living with the regret of not having taken your child seriously if an issue is found later. Most people won't regret spending the money on a doctor's appointment in exchange for peace of mind. There are many parents who regret not trusting their instincts if their kids are later found to have had a legitimate medical issue. For parents who have genetic health issues, seeing the signs of the same disorders in their children is easier. They recognize the symptom patterns from their own experiences. In these situations, some parents question when is the right time to get the issue formally diagnosed. (See: Is Getting Diagnosed Worth It?). It is worth acknowledging that the timing of getting a diagnosis for your child can impact how they view themselves. If you aren't sure about this, you can always send a message to your pediatrician to ask their opinion about how this impacts children. The content written above is intended for educational purposes. These suggestions are intended to help validate parents' concerns when there are legitimate reasons to seek medical attention for their children. The above reasons to seek care are not an all inclusive list. If you are unsure, we encourage you to consult your medical provider for individual advice for your specific situation. If you are interested in scheduling a physical therapy evaluation, click the book now button at the top of the page.

Introduction: Holly Zappala, RN, was once a child with chronic pain. As an adult, when she received a formal diagnosis with a chronic pain disorder, she was already a nurse, a wife, and a mom of three children under the age of four. In the next decade, two of her three children were diagnosed with chronic pain disorders. We asked her to share her thoughts on raising kids with chronic pain. We hope that her perspective as a nurse, a chronic pain patient, and a mom of kids with chronic pain can help others as they walk the difficult road of parenting kids with chronic illness. Rule #1 Understand that experts have limitations. In my mother’s day in the 1970's, raising a child with the complaint of chronic pain was simpler—you deferred to an expert. You didn’t doubt or question doctors even if your “Mom Logic” had doubts. I was a child in pain. My mom was a good mom; she took me to the “expert” better known as my pediatrician. He completed a comprehensive exam and made his pronouncement, expecting not to be doubted or questioned. Unfortunately for me, he pronounced me small for my age, overly tired, and an overly sensitive child, with normal growing pains. My mother was told that all children have growing pains. She was instructed that I needed an earlier bedtime, and tough love when I complained. I said it was simpler — I didn’t say it wasn’t easier, especially if you were the 7 year old child in pain. I went home from that doctor's appointment still in pain with the perception that I might grow soon. My mom followed the doctors' orders. I was tucked into bed long before the streetlights came on and while my friends were still outside playing. As I laid in bed I prayed, “Please God, let me fall a sleep so I won’t feel the pain.” Years later “The overly sensitive child theory” was completely debunked as I stoically endured a painful procedure. After the procedure the new doctor asked, “Which hurts more, the pain in your joints or the procedure?” I immediately answered, “My joints.” We all learned a lesson in pain that day. I learned that my pain was real and that I was the “expert” in feeling my pain. My mom had always had some doubts about the pediatricians’ theory. She regretted forgetting she was an “expert” in being my mom. And the doctor learned to be an “expert” you need to ask the right questions. We are all experts in something, but it's important that we recognize that all experts have limitations. We need to work as a team and seek to understand each other's perspective if we want to succeed. Rule #2 Being the smartest and fastest are great qualities. But the real secret to persevering to win at life is based on your point of view, determination, endurance, and steadfastness. If you have ever watched a toddler learn to walk you know it requires determination and a lot of falling down. Parents frequently offer a kiss and reply, “All better.” With a little encouragement, before you know it, your child is out trying to conquer the world again. My daughter didn’t just walk — she ran, climbed, and fearlessly took on the world. But at age ten something wasn’t right. Just like the generation before me, I scheduled a doctor appointment for my daughter. I came to the appointment armed with my perception, my medical pain history, determined to help her, and a steadfast belief that her pain was real. The first doctor didn’t have an answer and sent us to the second doctor. The second doctor, a pediatric rheumatologist didn’t diagnose her with growing pains or hysteria. He stated, “The pain is all in her head, but it is very real.” I wasn’t 100% sold on his perception, but he was willing to treat her child size body for a pain syndrome that was in it’s infancy of being recognized in adults. He offered a plan of hope and a treatment that did not cure her, but did greatly reduced her symptoms. Still, I had to face the fact that I couldn’t “make it all better.” Soon after her younger brother also received the same diagnosis. My two children with the same diagnosis were perceived by others very differently. If you asked her teachers perceptions, they would say, "she is hyperaware of her surroundings". His teachers would say, "he has attention deficits". In truth their condition was making them both highly sensitive and overwhelming their nervous systems. Just like walking, I couldn't do it for them. Instead, it was my job to validate their experiences as being real. It was my job to offer encouragement, and to believe in them that they could succeed in the world. Lastly, it was my responsibility to be persistent in advocating for them in their schools and the healthcare system, even if those systems found my children's needs inconvenient. In our family, my son is famous wrestling with his dad, definitely outmatched, but for saying defiantly, “Never give up, never surrender." Rule # 3 You aren’t just raising a child with chronic pain, you are building the foundation of adulthood. Building a foundation is not a spectator sport. It is hard, dirty work that parents do down in the trenches, and you may not see the results for years. If you are a parent, you don’t need to read about trenches. You are probably buried under laundry, multiple to-do lists, homework assignments (yours and your child’s), and have a calendar full of demands. Some days it takes all your energy just to make it to bedtime. This is especially true if you're a parent who also lives with your own chronic pain. Take a deep breath. Step off your rat race hamster wheel and ask yourself, “What am I building long term?” All children (and adults) have limitations, some more than others. Your child’s pain is not fair. In order to become a successful adult, we have to learn that while the obstacles may vary, all people encounter unfair obstacles. What defines a person is how they overcome unfair obstacles. Your child’s pain may keep them from becoming a celebrity, but it may make their compassion famous. Pain can teach empathy if we demonstrate empathy to our kids. Pain can teach endurance to push through hard tasks if we walk through the tough times together and don’t skirt around them. Pain teaches a parent to relentlessly seek answers for their child, which in turn teaches persistence to their children. Persistence sneakily turns into the most valuable thing of them all, hope. Pain taught both of my children not to give up. Pain taught my son to be highly aware of the needs of others, which allows him to thrive as a peace maker and excel at customer service. Pain taught my strong willed, fearless wild child, to give people hope through physical therapy. When the pain can’t be eliminated, ask what positive lessons can pain teach you and your child? My rules are simple and most definitely not easy. But a parents' love can make all the difference in overcoming life's obstacles. Disclaimers: This article is intended for educational purposes and is not intended to serve as or replace individual medical advice from a healthcare provider. If you are seeking personalized medical advice, please contact our office to schedule an appointment with a licensed medical provider.

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.

While most people consider taking a shower to just be part of their daily hygiene routine, for people with POTS, it can be a major commitment. Showering can leave your heart thundering in your chest as if you are running a marathon, make you dizzy (or even risk passing out), and leave you laid up and exhausted for 30 minutes or even hours afterwards. It's no wonder that some people with POTS prefer to wait a couple of days between taking showers. So why is showering so difficult on your body and what can you do about it? A good first step is checking out our post POTS University to help you better understand the "why". The more you know about how blood works in your body, the more you'll be able to adapt to help tell your body to send it where you need it during all kinds of activities. For showering specifically however, we hope that this helps give you some fresh ideas to take back your showers and enjoy them again without paying for it later. Showering sitting down can reduce the demands on your heart to try and pump blood up against gravity to get it back to your heart and your brain. This is one way to help avoid dizziness and reduce your risk of falling. Getting a shower bench can make all the difference. If you're more mobile, you can also utilize the POTS Squat when showering. Bending over to wash your hair can make it easier for your body to get the blood you need to the muscles in your arms and hands so they can move to help you wash without stealing it from your heart and your brain. When you bend over, your heart can pump to all of these places on a horizontal playing field; it's easier than doing it against gravity. If you're standing upright, your heart has to pump blood against gravity to get it up to your brain and arms. Change the water temperature from hot to luke warm. The warmer the water, the more your body is going to send blood to the surface of your skin to dissipate heat and control your internal body temperature. More blood towards your skin means less for your brain, and heart. Change the water temperature slowly when you get out. If you decrease the temperature of the water from hot, to luke-warm, or even cold if you can tolerate it, your body has a chance to adjust. If you move from a hot shower to a cooler air outside quickly, your body can by shocked by the rapid transition. In the confusion of trying to decide where to send your blood, you end up feeling exhausted. Making a more gradual transition can help you avoid the fatigue after your shower. Keep a glass of cold water handy. Drinking cold water during your shower, or as soon as you get out can help redirect blood flow internally for your body to help maintain your internal body temperature. That means more blood flow to your insides and a better chance your heart is getting what it needs to function. Don't dry off right away. Leaving water on your skin can help move the heat away from your body faster. This can let your body recover quicker and send blood internally to your organs faster, reducing your fatigue level. Wait to get dressed. If you put clothes on right away, it traps the heat in. This means your body will work harder to send blood to the surface of your skin to get it out. If you have to get dressed right away because you share a public bathroom in a college dorm, wear light clothing like shorts and a tank top. Try to avoid heavy sweatshirts or fleece pajama pants. Don't brush your hair or blow dry it as soon as you get out. Doing exercise with your arms will make you more fatigued. While lifting your arms up to brush your hair may not sound like intense exercise to some, every time you use your muscles, your body has to adjust to provide them the blood and oxygen they need. For people with POTS, brushing your hair can feel like an Olympic sport. When you get out of the shower, you're supposed to feel clean and refreshed, not fresh out of energy. We'd love to hear from you. Do you have any other tips? Feel free to write them in the comments below. This article is intended to serve as educational material and should not be a replacement for individual medical advice. If you'd like to schedule a consultation with a physical therapist for personal recommendations, click the book now button at the top of the page.

If you have frequent symptoms of a urinary tract infection, like burning, urinary frequency, or urinary urgency, your doctor will most likely order some testing to check for bacteria. If however, your doctor says the urine culture came back negative for an infection, throwing more antibiotics at your body probably isn't the answer. Patients often aren't sure where to turn next. Some people who chronically struggle with urinary frequency will even try restricting water to avoid having to go to the bathroom as often. Unfortunately, this can actually make the problem worse because the chemical irritants become more concentrated in your bladder. This can trigger urges to empty the bladder to get rid of the chemicals. While working with a pelvic floor therapist that focuses on the influence that your nerves and your muscles have on your urinary symptoms is a great place to start, there are some things you can do on your own. It is important to learn what makes your bladder tick. While we all have a few "pet peeves", some of our bladders are more sensitive than others. Most common irritants: Alcohol (wine, beer, liquor) Artificial sweeteners (saccharin, aspartame, high fructose corn syrup, etc.) Chocolate Coffee (with or without caffeine) Colas/soft drinks/carbonated beverages Tea (with or without caffeine, especially black and green) Tobacco/cigarettes Other potential irritants Acidic foods Caffeine Citrus fruits and juices: oranges, lemons Dairy: cheese (especially aged cheeses), milk, sour cream, and yogurt Fruits and juices: apples, bananas, cantaloupe, cranberries, figs, grapes, guava, peaches, pineapple, plums, prunes, raisins, and strawberries Grains: brewer's yeast, rye and sourdough breads Meats/fish: chicken livers, corned beef, pickled herring Medications and supplements: check with your pharmacist about your specific medications and supplements Muscles: trigger points in your pelvic floor muscles can trigger urges to go to the bathroom Nuts: hazelnuts, peanuts, pecans, pistachios, walnuts Sauces/condiments: hot sauces, mayonnaise, soy sauce, vinegar Vegetables: chili peppers, fava beans, lima beans, onions, peppers, tomatoes Most people don't want to give up all of those things forever, and many people don't need to in order to feel better. While the bolded items above irritate almost everyone's bladder, the other irritants can vary from one person to another. Most of us don't want to give up more than we have to, so how can you know which ones aggravate your bladder? Start with an elimination diet for 7-10 days. During that time, the goal is to cut out all of the things listed above. You will likely find that you feel better and have less urinary frequency at that time. Once all the irritants are out of your system, choose one at a time to add back into your diet. As you add them back in one by one, pay attention to your bladder habits. Look for patterns of which foods/drinks make you have to go more often. Decide how strict you want to be. Some people find that they don't enjoy alcohol enough to keep drinking it. Others really enjoy a glass of wine with a nice meal, and decide that on special occasions, it's worth the consequences of needing to go to the bathroom shortly after dinner. It is ultimately up to you to decide how much you want to restrict your dietary intake of certain foods and drinks. The goal of identifying bladder irritants is to help you make educated choices about what you consume, not to take all the fun out of your diet. So what are some tips for getting started? Keep a bladder log. You may want to write down how often you are going so you can get a sense of what your normal is during the elimination phase. Then you'll have something to compare to when you start adding foods back in one at a time. During your elimination period, it's easiest to commit to only drinking regular water. Limit the number of pre-made processed foods you eat. They tend to be higher in artificial sweeteners. Plan to cook at home for the week and make yourself a meal plan. Eating out gives you less control of what goes into your food and makes you less aware of all the ingredients. Remember, this isn't permanent, just a temporary diet for one week. If a full elimination diet is too much for you, you can always try eliminating the irritants one at a time and monitoring your symptoms. It may be more difficult for you to determine what is causing the symptom change with this method, but it can still be helpful in identifying the irritants that bother you the most. Lastly, keep in mind that this article is to be used for educational purposes and is not intended to replace individual medical advice from a licensed medical provider. There are many ways to treat bladder irritation, including dietary changes, pelvic floor physical therapy, and medications, to name a few. You are encouraged to work with a medical professional to determine the best treatments for your body. How did your elimination diet go? We'd love to hear from you; comment below to share your story.

Millions of people across the country have found themselves planning their lives around their bathroom stops. It can become such a problem that some people will avoid making plans at certain times, or in new places, because they don't know if they'll be able to access a bathroom when they need it. In some cases, people even become afraid to leave the house. If you feel like your bladder is bossing you around, this article is especially for you. Soldiers have certain physical fitness requirements they have to meet. So for our bladders, we should pause to consider, "what is normal?" For a healthy adult: Urinating once every 2-3 hours during the day is considered normal. Waking to urinate once during the night is normal only after age 65. Urinating right before bed, and when first waking in the morning is normal. Bladder urges to empty/void are normal, but don't mean you have to go right away. They just alert the brain that the bladder is beginning to stretch; it doesn't always mean your bladder is full. Initiating urination once sitting on the toilet should take only a second or two. Urine flow should happen easily without straining or pushing. Emptying the bladder fully should take less than 30 seconds. Our bladder is a creature of habit, but it's also a very trainable organ. If your bladder isn't following the normal rules, there are some things you can do to retrain it to have better habits. Next, we'll talk about some common objections people have and misconceptions about their bladder. Myths & Misconceptions Some people think, "If I drink less, I won't have to urinate as often". This is a myth. In fact, it can make you have to urinate more often. If the urine in your bladder is too concentrated with chemical irritants, it will trigger the urge to need to go. That is why drinking 8 ounces of coffee, or alcohol frequently makes you need to go to the bathroom sooner than drinking 8 ounces of water. Having enough water in your system to dilute the chemical irritants in your urine can actually help you have to go to the bathroom less often. "My diet doesn't matter, only what I drink." Foods have moisture in them too, and many of our foods have chemicals in them that have been added during processing for flavoring or to act as a preservative. Even if you aren't eating processed food, sugar content and acidity can affect our bladder too. Food choices can absolutely influence your bladder. "Before I leave the house, I should go to the bathroom just in case." What pelvic floor therapists call "just in case peeing" is not a good idea. Doing this often can train your bladder to go more often than it needs to. This can increase urinary frequency over time. You should only go to the bathroom if you have an urge to go, or it has been 3 hours since your last void. "I've had babies, so it's normal for me to leak and need to pee more often. It's just the price you pay for having kids." - While urinary incontinence is more common after having children, not all women have this problem. You don't have to (and shouldn't) just live with it. "I just have a small bladder" - This is typically not the case, even when people say it runs in their family. Remember, we inherit more than genetics from our parents, we learn a lot of habits from them too. When doing imaging studies of the bladder, many people who report feeling they have a small bladder don't actually have a different size bladder. More often, the pelvic muscles just have a hard time supporting their bladder, or people have adopted learned behaviors of going frequently and trained their bodies to do it from childhood. "Waking up multiple times a night happens to everybody with age." - While waking up once is normal later in life, more than one time is not normal. Especially in men, this can be a sign of prostate problems and should be evaluated by a medical provider. Now for the fixing-it part. Tips for where to begin: Make appointments with appropriate healthcare providers for individual medical advice (see below). Keep a bladder log for a couple of days. It's important to know where you are starting. (sample log & instructions) Get your fluid intake right. Drink 4-6 ounces of water every hour, sipping on it throughout the day. If you have a hard time tracking your water intake, or you forget the drink, try using a water bottle to measure out what you're drinking. If you're tech savvy, there are even bottles that will remind you when it's time to drink (See product recommendations) Avoid drinking bladder irritants (See list), and consider the foods you are eating too. Plan out a schedule and set yourself a bladder alarm. If you are someone who goes to the bathroom too frequently, gradually start to increase the time you hold it before you go (i.e. if you normally go every 15 minutes, start trying to wait for 20 minutes, and gradually increase your time intervals). If you are someone who forgets to go to the bathroom all day, plan to go on your lunch break. If you need to, put an alarm on your phone to remind you it's time to go. Tips for seeking care: Each provider will have different treatments to offer you. You should consider what type of treatment you want before choosing a provider. You may also want to schedule appointments with providers while you try the tips above. It can sometimes take time to get in to see a specialist. Pelvic floor physical therapists: Treat pelvic floor muscle dysfunction that contributes to bladder issues, provide patient education on lifestyle habits and changes to improve bladder health naturally. Primary care doctors: Can prescribe medication management, order testing for urinary tract infections, screen for cancer and prostate problems, and write referrals to other specialists. Pharmacists: Can review your regular medications to see if any of them may be impacting your bladder Urologists: Specialists who treat urinary tract problems. They can prescribe medications and may do surgical procedures. OBGYNs: Check for pelvic organ prolapse, screen for pelvic cancers, may perform surgical procedures. Lastly, don't forget to ask about cost. See our tips for Navigating Healthcare Billing to learn how to be sure you're paying a fair price. Disclaimers: This article is intended for educational purposes and is not intended to serve as or replace individual medical advice from a healthcare provider. If you are seeking personalized medical advice, please contact our office to schedule an appointment with a licensed medical provider.

Tinnitus, more commonly known as ear ringing or buzzing, can be a rather maddening symptom. People who suffer from tinnitus complain of difficulty falling asleep at night due to the sound. The loss of sleep can negatively impact their general health. To make matters more complicated, it can also cause problems hearing and being able to focus during conversations. This can have a negative impact on the individual's social relationships. Tinnitus can also quickly become a problem that is costly to manage because patients aren't sure who to turn to for help. The internet is full of suggestions about noise machines, meditation programs, supplements, and medications. Some patients seek out care from an audiologist, assuming it to be a hearing problem. Others go to an Ear, Nose, and Throat (ENT) specialist seeking answers and relief. If unsuccessful there, patients sometimes read about jaw problems as a potential cause and ask their dentist for help. When other providers are unable to help, some patients ask if physical therapy might offer the answer. The truthful answer to that question is, "It depends." Patients should always be wary of providers who promise to fix their tinnitus. It's called the "practice of medicine" for a reason; there are no guarantees in healthcare. Doctors make decisions based on statistical probabilities, and there are very few things in the world for which the probability is 100%. In fact, research is often lacking on exact statistics for what percentage of patients benefit from a given treatment. While there is evidence that physical therapy targeted to the TMJ (1, 2) and the cervical spine (1, 2, 3, 4) can improve tinnitus, there are certain patients more likely to benefit than others. In order to treat a symptom successfully, it is best to know and treat the root cause rather than cover up the symptom whenever possible. To better understand our ears, we have to start back at the beginning. When a human embryo is developing in the womb, the same preliminary tissues will form both the ear and the jaw (5). The two structures are intimately related. You can even stick your finger in your ear and feel the condyle of your jaw moving while you open and close your mouth. Because of this close relationship, the function of your jaw can impact your ears. The muscles, bones and nerves all need to be taken into consideration. If you use your jaw muscles for extra things beyond eating and talking, your muscles can develop inflammation and tension from overuse. People who have a tendency to clench or grind their teeth are more likely to develop jaw problems and/or tinnitus. Parafunctional oral habits such as fingernail biting, gum chewing, or smoking (6) can also increase the amount of work your jaw muscles are doing in a given day. TMJ specializing physical therapists can provide targeted manual therapy treatments for your muscles, as well as teach you exercises to help reduce the strain on your muscles. (See Choosing a PT for TMD) If age related changes, poor posture, or past injuries have caused stiffness in the joints of either your jaw or your upper cervical spine, it can also impact your ear. The tissues in our bodies need a certain degree of flexibility to move like they should and allow forces to pass through them. The alignment of your joints can also play a role in how forces are absorbed in your body. That includes sound waves. That's why your voice sounds different in your own head than on a recording. Sound waves pass through the tissues in our skulls as they are generated by our vocal cords, so we hear them differently. Some individuals may also experience tinnitus after a viral infection like COVID 19 (7). Viral infections can prompt your body to generate swelling and inflammation while fighting the virus. If this inflammation occurs close to a nerve, the function that nerve provides can be damaged. This can be visibly observed in conditions like Bell's Palsy, in which half of the facial muscles experience paralysis due to swelling around the facial nerve. It is possible that this can occur for the nerves that allow your jaw and ears to function. This may be why some people with tinnitus report that cardiovascular exercise can impact their symptoms. In this instance, physical therapists may utilize exercise, manual therapy treatments, or targeted treatments like dry needling to influence blood flow and inflammation responses to improve your symptoms. Your nervous system can be strained by swelling and inflammation, but other injuries like concussions, or chronic nervous system related disorders like migraines can also influence tinnitus. The nerves that supply your inner ear and your jaw muscles are called cranial nerves, meaning that they come directly from the brain instead of taking an indirect route through the spinal cord first. Physical therapists can help patients recover from concussions and can also help with treatment of some types of migraines. In summary, your tinnitus may benefit from physical therapy especially if: You also have jaw pain, popping, clicking, or your jaw locks in place. You habitually clench or grind your teeth. You also have neck pain. (8) Poor cervical/neck posture worsens symptoms. (8) You have a history of concussion. You also have headaches or migraines. Cardiovascular exercise influences your symptoms. This article on TMJ and tinnitus is intended for educational purposes and is not a replacement for professional medical evaluation and advice. As a word of caution, tinnitus is not well understood and can be caused by a variety of underlying conditions. It is recommended that patients do work with some of the specialty providers discussed above to rule out conditions like Meniere's disease, vascular blockages like atherosclerosis, or rare tumors like acoustic neuromas that can cause ear ringing. References (1) The Effect of Physical Therapy Treatment in Patients with Subjective Tinnitus: A Systematic Review - PubMed (nih.gov) (2) Does Conservative Temporomandibular Therapy Affect Tinnitus Complaints? A Systematic Review - PubMed (nih.gov) (3) Physical therapy treatment in patients suffering from cervicogenic somatic tinnitus: study protocol for a randomized controlled trial - PubMed (nih.gov) (4) Does multi-modal cervical physical therapy improve tinnitus in patients with cervicogenic somatic tinnitus? - PubMed (nih.gov) (5) BGD Lecture - Face and Ear Development - Embryology (unsw.edu.au) (6) Analysis of the prevalence and associated risk factors of tinnitus in adults - PubMed (nih.gov) (7) Tinnitus in patients recovering after COVID-19: observational and cross-sectional study - PubMed (nih.gov) (8) Prognostic indicators for decrease in tinnitus severity after cervical physical therapy in patients with cervicogenic somatic tinnitus - PubMed (nih.gov)

Physical therapy may not be the first thing that comes to mind when a person experiences jaw pain, but it can be a valuable conservative management tool. Many treatments offered for temporomandibular joint dysfunction (TMD) have limited evidence available for their safety and efficacy. In light of the limited research available, providers should encourage patients to consider the treatments with the best evidence, and the lowest risks first. Generally speaking, treatments like physical therapy that are minimally invasive, are lower risk than surgical or dental procedures that make permanent changes, or injections and medications that carry potential side effects. (See our other posts for more information on PT for the TMJ) Finding a physical therapist who treats jaw problems well can be challenging. Many physical therapists receive minimal training on managing TMD in their entry level education, and continuing education courses focusing on the temporomandibular joint are uncommon. Unfortunately, some therapists are pressured by their employers to accept all patients for the financial benefit of the company, even if they may not be the best qualified clinician in town to care for the patient. At this time, there aren't any provider registries for physical therapists who specialize in jaw problems so patients are left on their own to find a provider. Choosing a PT for TMD can be challenging. Here are 5 tips to help you interview your potential provider and avoid wasting time and money seeing a therapist who doesn’t specialize in TMD. Ask to speak to the therapist directly before your evaluation. Front office staff are often trained to reassure patients that the company provides excellent care, but they are not clinicians and may not be aware of the experience of every clinician at the clinic. This is especially true for larger facilities like hospitals and physical therapy chains that utilize call centers. Ask the therapist if they evaluate inside of your mouth. PTs who regularly treat jaw problems should be comfortable performing joint mobilizations and muscular/soft tissue assessment inside your mouth. If the therapist is not able/willing to do this, they are most likely not a TMJ specialist. Ask what kind of jaw problems the therapist typically treats. According to the National Institute of Dental and Craniofacial Research, there are over 30 disorders that fall into the category of TMD (1). While your physical therapist may not treat every problem, they should be able to tell you about a few categories of patients they see. These might include people with joint degeneration/pain, disc problems, hypermobility disorders, muscle imbalances, and people with decreased/impaired mobility. Ask how long the therapist has been treating jaw problems and be ready to interpret the response. Some therapists may deflect by simply giving you the number of years they’ve been in practice. Press in to ask about how long they’ve specifically worked with jaw patients, or how many they have seen. If they’ve been practicing 15 years and have only seen 50 patients, 3 patients a year is not a lot. While most therapists’ whole caseloads are not TMJ patients, people who work with it regularly should at least see one patient in a given month. The benefit of working with older clinicians is in their experience level. If they don’t work with a condition regularly, and don’t pursue continuing education on the subject, their knowledge may be out of date for current best practices. Some therapists may be hesitant to tell you they’ve only been practicing for a year. This does not mean they are not a qualified clinician if their schooling gave them added preparation for treating TMD, or they’ve sought out continuing education. Perhaps they even have a personal background of having TMD. Keep in mind that there are some benefits to working with younger clinicians in that they tend to have been educated on the most recent research available while in school. They may also be more motivated to do research outside of work to seek answers for how to better treat their patients because they are trying to fill in their knowledge gaps and establish themselves as a competent therapist. 5. Look into the therapist’s bio on their clinic website if it’s available. Is there dedicated space on the company website for TMD patients? Therapists who explicitly state that they treat jaw problems are ideal, but if you can’t find one, individuals who specialize in neck pain, headache management, dizziness, and chronic pain are sometimes familiar with treating jaw patients. If a therapist holds a board specialty certification in orthopedics or an OCS, they may not specialize in jaw problems, but they will have at least had to study the jaw in a little greater detail than the average physical therapist. Resources: (1) TMD (Temporomandibular Disorders) | National Institute of Dental and Craniofacial Research (nih.gov)

While most people casually discuss that the weatherperson says it's going to rain tomorrow, people with Postural Orthostatic Tachycardia Syndrome (POTS) have bodies that are like human barometers. Things that might seem like simple small talk events to some can make a big difference in the daily lives of people with POTS. To be fair, feeling the storm coming in some contexts before the development of modern day meteorology may have been an advantage. In modern society however, not only is it not very useful, but it can be pretty inconvenient. People with POTS can have a wide variety of symptoms that come with the weather change including headaches, dizziness, swelling, brain fog, and muscle/joint soreness to name a few. There is a general consensus amongst people with POTS and other dysautonomia conditions that things like weather changes, altitude and airplane rides affect their symptoms. Unfortunately, finding answers to questions like: "Why does the weather change affect me?" and the even more important question "What can I do about it?" Have gotten very little attention and research funding. For those who need to understand the "why" let's take a look at the available evidence and delve into some possible explanations. We suspect that the barometric pressure on the outside of your body effects the pressure on the inside. While POTS specific research isn't available yet, there are studies that suggest that the barometric pressure impacts some other conditions like arthritis and fibromyalgia. (1, 2) There are many functions in our bodies that depend on pressure. Your lungs use negative pressure to suck air inward when you inhale. You also have a blood pressure of the force of your blood pressing against your veins and arteries. Then there is what we call "interstitial pressure", or the pressure of the blood that has moved out into your body's tissues to supply them with oxygen and nutrients. There has to be balance between this interstitial pressure and the pressure in your veins to control how long the blood stays out in your tissues before being transported back to the heart and lungs in your veins to pick up more nutrients again. When the mechanisms your body uses to control these pressures aren't working properly for a person with POTS, their symptoms start to appear. If the pressure against the skin on your legs decreases because of a weather change outside, it can allow the blood to sit in your tissues, rather than being pushed back into circulation in your veins. That's how swelling happens. If the pressure in your legs isn't doing what it should, then your blood pressure might not be high enough to force the blood all the way up to your brain. Gravity will always pull blood down, so our bodies have to work to get it up higher when we're standing. If we think about how blood works in our bodies, the reason weather changes affect us may not be such a mystery after all (See POTS University). As the barometric pressure drops around us with the changing weather, suddenly the external pressure against our bodies decreases. That means that internally, your body has to be able to adjust to the change in order to continue moving the blood in your tissues back into circulation. If it can't do that effectively, you may start to experience swelling in your arms and legs as well as other POTS symptoms. The barometric pressure changes with storms, but altitude can have a similar effect. When you ride in an airplane, they attempt to control the cabin pressure. Your ears are very sensitive to pressure too. Most people will chew gum or yawn to "pop their ears" and allow for the pressure in their ears to adjust. For infants and small children that haven't figured out how to do this yet, they often cry and are uncomfortable of flights. Living in a body that has POTS, can be uncomfortable like that too. The difference is, POTS isn't something that everyone grows out of. We are still learning the best ways to treat it. Unfortunately, when it comes to flying in a plane, or long car rides, there are a couple of other factors that make things worse. First, the dry air can dehydrate you. As the car or airplane attempts to maintain a consistent temperature within the heating and cooling system has to circulate the air. If the air is not humidified in the process (which it generally isn't) then your body has to add moisture to the air as it moves into your lungs. This uses up extra fluid. If your body doesn't have enough fluid to go around, it may not be making as much blood as it should. If there is less blood to go around, then it can aggravate your POTS symptoms. Second, when you are flying on a plane or sitting for a long car ride, you aren't moving much. When we move around, our bodies naturally increase our heart rates and try to circulate blood more quickly to supply our muscles with oxygen and nutrients. At the same time, as you contract your muscles, you compress the interstitial fluid and veins that run into those muscles which helps to pump the blood. Now that we better understand the problem, we are able to start coming up with solutions. The big question everyone asks is: "So what can I do about it?" As promised here are some tips and tricks for navigating weather changes, plane rides, and managing pressure changes with POTS Wear your compression garments. If the atmosphere is not going to accommodate you by providing barometric pressure on your tissues, you can add some extra of your own. (See product recommendations for ideas on compression wear) Manage fluid and electrolyte intake. Make sure that your body has enough building blocks to keep your blood volume up. The more blood you have to go around, the less it will affect you that the pressure isn't helping the blood move where it needs to be as efficiently. This is important both before you travel and after you arrive. Cross your legs or squat on your seat. This restricts blood flow down to your legs and keeps it up closer to your heart and brain (See The POTS Squat) Take breaks from driving if you're able to get up and move. If you're flying, exercise in your seat or get up and move if possible. As you do, you help your body pump the blood in your system. Exercise regularly. Regular aerobic exercise helps encourage your body to store more blood volume. Doing it in a pool, or consulting your POTS specializing physical therapist can help if you're having a hard time exercising. They can teach you targeted exercises that are specifically for people with POTS. Wear cool clothing. If you're overheated, your body will sent blood to the surface of your skin to get rid of the heat. Talk to your doctor about medication. There are pharmacological treatments available that can help manage POTS. As always, this article is intended for educational purposes and is not a replacement for individual medical advice. If you are interested in seeking personalized recommendations for managing POTS or other conditions with physical therapy, call or Book Online to schedule your consultation.