Dominic Stone
Postural Orthostatic Tachycardia Syndrome (POTS) is a poorly understood condition that affects an estimated one to three million Americans, with symptoms ranging from lightheadedness to muscle cramps, fatigue, nausea and vomiting. The exact causes of POTS are unknown, but researchers have identified multiple subtypes with different causes, including neuropathic POTS, hyperadrenergic POTS, and hypovolemic POTS. The condition is often misdiagnosed, and patients may experience chronic pain and muscle aches. Treatments for POTS include biofeedback, meditation, balanced nutrition, and exercise.
| Characteristics | Values |
|---|---|
| Muscle Cramps | 50-65% of patients with POTS experience muscle cramps |
| Cause of Muscle Cramps | Orthostatic changes in muscle excitability, inadequate perfusion of the lower extremities, pooling of blood, poor circulation |
| Treatments | Compression sleeves, deep tissue massage, drinking more water, medical marijuana or CBD, exercise, isometric exercises, reclined aerobic exercise, strengthening core and leg muscles |
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What You'll Learn
POTS is a form of dysautonomia
Postural Orthostatic Tachycardia Syndrome (POTS) is a common autonomic nervous system disorder, a form of dysautonomia. It is characterised by an excessively fast heart rate and symptoms of lightheadedness upon standing. POTS is often diagnosed by a Tilt Table Test, which measures the heart rate and blood pressure of the patient in a tilted position. Cardiologists tend to keep patients tilted for longer (30 minutes or more), while autonomic specialists tend to tilt for just 10 minutes. The information from the tilt table test that is most important is what the heart and blood pressure do during the tilt.
The diagnostic criteria for POTS is a heart rate increase of 30 beats per minute (bpm) or more, or over 120 bpm, within the first 10 minutes of standing, in the absence of orthostatic hypotension. In children and adolescents, a standard of a 40 bpm or more increase has been adopted. POTS can also be diagnosed with bedside measurements of heart rate and blood pressure taken in the supine (laying down) and standing up position at 2, 5 and 10-minute intervals. This is called the Active Stand Test. However, this test may miss some cases of POTS, so caution should be used in ruling it out with this method.
The most commonly associated symptoms with POTS (>70%) include lightheadedness, specifically with standing, headache, fatigue, sensitivity to changes in temperature, palpitations, pain and difficulties with concentration. Fifty to 65% of patients experience muscle cramps, blurry vision, facial flushing or rashes. About half the patients experienced early-morning and night-time awakenings. Similarly, half experienced joint pain, leg pain, difficulties with memory and breathing, and lightheadedness with sitting. Less than 30% have a history of physical or emotional abuse, hearing loss, fainting episodes, or a family history of low blood pressure.
The goal of treatment is to reduce pain and improve function so that patients can resume daily activities. While it is difficult to completely cure pain syndromes, they can be managed. Often a combination of medical, psychological, and self-management works best in managing pain. Biofeedback, meditation, balanced nutrition, good humour, good sleep hygiene, and meaningful free-time activities are some self-management strategies that can help reduce pain and improve function.
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Muscle cramps are a common symptom
The exact causes of POTS are not yet known, but researchers have identified multiple factors that contribute to its development. These have been grouped into different subtypes of POTS, including neuropathic POTS, hyperadrenergic POTS, and hypovolemic POTS. Neuropathic POTS occurs when peripheral denervation leads to poor blood vessel muscle function, particularly in the legs and abdomen. Hyperadrenergic POTS is caused by an overactive sympathetic nervous system, while hypovolemic POTS is associated with reduced blood volume. There is also growing evidence that POTS may be an autoimmune disease, where the body's immune system attacks healthy tissue.
The symptoms of POTS vary widely and can include muscle cramps, lightheadedness, fatigue, headaches, joint pain, leg pain, and sleep disturbances. Many people with POTS experience muscle aches and body pain that can be intense and flu-like. These symptoms can be managed through various strategies such as deep tissue massage, drinking plenty of water, medical marijuana or CBD, and chiropractic care. Exercise, particularly reclined aerobic exercise and strengthening the core and leg muscles, can also help improve POTS symptoms.
Given the wide range of symptoms associated with POTS and its unfamiliarity to many doctors, diagnostic errors are common. POTS is often misidentified as other conditions such as chronic fatigue syndrome, fibromyalgia, anxiety disorder, or irritable bowel syndrome. It is important for individuals experiencing POTS symptoms to seek multiple opinions if they feel that something is physically wrong, as early and accurate diagnosis is crucial for effective management of the condition.
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Leg pain is associated with altered muscle membrane properties
Postural orthostatic tachycardia syndrome (POTS) is a poorly understood condition commonly seen in young adults. It is associated with a variety of symptoms, including muscle cramps, lightheadedness, headaches, fatigue, and joint pain.
Neuropathic POTS is a subtype of POTS caused by peripheral denervation, or loss of nerve supply, leading to poor blood vessel muscle function, especially in the legs and abdomen. This can result in orthostatic leg pain, which has been found to be associated with altered muscle membrane properties.
A study by Arnold et al. (2021) examined muscle excitability in patients with neuropathic POTS and healthy subjects in different body positions. The study found that muscle excitability was increased in the supine position and decreased during and after head-up tilt in patients with neuropathic POTS compared to healthy subjects. This decrease in muscle excitability was paralleled by an increase in lower leg circumference and leg pain levels.
The study provides evidence for orthostatic changes in muscle excitability in patients with neuropathic POTS, which may be associated with inadequate perfusion of the lower extremities. Inadequate perfusion, or blood flow, can lead to muscle pain. Additionally, the decrease in muscle excitability during head-up tilt indicates progressive muscle membrane depolarization, which may be caused by an ischemia-like state. This altered metabolic condition not only affects muscle activity during standing but also leads to non-orthostatic changes in muscle membrane properties.
In summary, leg pain in neuropathic POTS is associated with altered muscle membrane properties, specifically progressive muscle membrane depolarization and orthostatic changes in muscle excitability, which may be caused by inadequate perfusion of the lower extremities and an altered metabolic condition. Further research is needed to fully understand the underlying mechanisms and develop effective treatments for orthostatic leg pain in patients with neuropathic POTS.
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Blood pooling and poor circulation may be a cause
Postural orthostatic tachycardia syndrome (POTS) is a common condition affecting an estimated one to three million Americans, and millions more worldwide. It is a form of dysautonomia that is more common in women than men and is more likely to develop in adolescents and young adults.
People with POTS experience a range of symptoms, including muscle pain and cramps. While the exact cause of POTS is not yet known, researchers have identified multiple causes, which they have grouped into different subtypes of POTS. One of these subtypes is neuropathic POTS, which occurs when peripheral denervation (loss of nerve supply) leads to poor blood vessel muscles, especially in the legs and core (abdomen).
Studies have found that patients with neuropathic POTS show signs of progressive muscle membrane depolarization, likely caused by an ischemia-like state. This altered metabolic condition affects muscle activity during standing and delays muscle recovery. Additionally, patients with neuropathic POTS experience increased pooling of blood in the lower legs due to impaired vasoconstriction caused by peripheral sympathetic dysfunction. This increased blood pooling can lead to inadequate perfusion of the lower extremities, resulting in orthostatic leg pain.
Overall, while the exact mechanisms are still being studied, blood pooling and poor circulation are likely contributing factors to muscle cramps in people with POTS, particularly in those with the neuropathic subtype.
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Muscle cramps could be linked to tachycardia
Muscle cramps are painful, involuntary, and unpredictable contractions and tightening of the muscles. They can occur anywhere in the body and are common, affecting anyone at any time. While muscle cramps are usually not serious, they can sometimes indicate an underlying neurological condition.
Postural orthostatic tachycardia syndrome (POTS) is a type of dysautonomia commonly seen in young adults. It is characterised by a decrease in cerebral blood flow when changing positions, resulting in symptoms such as tachycardia, lightheadedness, muscle cramps, headaches, fatigue, and palpitations. Approximately 50% of people with POTS suffer from chronic nerve pain, which can manifest as a burning or shooting pain, allodynia, or hyperalgesia.
The exact cause of POTS is not yet known, but researchers believe there are multiple factors contributing to its development. These include neuropathic, hyperadrenergic, and hypovolemic subtypes, as well as a potential autoimmune component. The condition can be challenging to diagnose due to its varied symptoms, which can take months or years to appear.
There is a range of treatments available to help manage POTS symptoms, including biofeedback, meditation, a balanced diet, laughter, good sleep hygiene, meaningful free-time activities, and support groups. Additionally, specific exercises such as reclined aerobic exercises (swimming, rowing, recumbent bicycling) and isometric exercises can help improve health and manage POTS.
While muscle cramps can be a symptom of POTS, it is important to note that muscle cramps have various potential causes and are not always indicative of an underlying condition.
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