POTS and Physical Therapy: What Hoover, AL Patients Need to Know

POTS and Physical Therapy: What Hoover, AL Patients Need to Know

If standing up too fast makes your heart race, your vision blur, or leaves you needing to sit back down — you're not imagining it, and you're not alone. Postural Orthostatic Tachycardia Syndrome, or POTS, affects an estimated 1 in 500 people, most commonly women between their teens and their 40s. And yet many patients spend years bouncing between providers before anyone puts a name to what they're feeling.

If you're in Hoover or the greater Birmingham area and searching for answers, here's what the current research says about POTS — and why physical therapy, done the right way, is one of the most effective tools we have.

What Is POTS, Really?

POTS is a condition of the autonomic nervous system — the part of your body that runs on autopilot, regulating things like heart rate and blood pressure without you thinking about it. When you stand up, your body is supposed to automatically adjust blood flow so your brain stays well-supplied. In POTS, that system misfires. Blood pools in your legs, your heart rate spikes to compensate, and symptoms follow: lightheadedness, rapid heartbeat, brain fog, fatigue, nausea, and sometimes fainting.

It's diagnosed when your heart rate increases by more than 30 beats per minute within 10 minutes of standing, without a drop in blood pressure. Many people living with POTS also have joint hypermobility or a connective tissue condition like Ehlers-Danlos Syndrome (EDS) — more on why that matters below.

Why "Just Exercise More" Feels Impossible (and Isn't the Right Advice)

If you've been told to exercise more and it made you feel worse, that's not a failure on your part — it's a sign the exercise wasn't dosed correctly for a body with POTS. Standard workouts ask your cardiovascular system to fight gravity right away, which is exactly what a dysregulated autonomic system struggles with.

The research-backed approach works differently. It starts you lying down or seated — recumbent bike, rowing, swimming — so your heart doesn't have to work against gravity while it reconditions. Over weeks and months, activity is gradually shifted toward upright positions as your tolerance builds. This isn't a shortcut; it's a deliberate, evidence-based sequence used in programs developed at institutions like UT Southwestern and Children's Hospital of Philadelphia, and it's backed by current systematic reviews identifying exercise as a first-line treatment for POTS.

It's also normal to feel a little worse before you feel better in the first few weeks. That's your nervous system recalibrating — not a sign to stop, but a sign to go slow and stay consistent.

The Daily Habits That Make the Biggest Difference

Alongside exercise, current guidelines point to a few non-negotiables:

• Fluids — most guidelines target around 3 liters a day

• Sodium — roughly 10 grams a day, which is more than most people expect

• Compression — waist-high compression garments to reduce blood pooling in the legs

• Positioning — sleeping with your head slightly elevated, and learning counter-pressure techniques (like crossing your legs or tensing your muscles) for symptom flares

None of these replace a supervised reconditioning program, but they make the exercise progression easier to tolerate.

The Connection Most Providers Miss: POTS, Hypermobility, and Your Pelvic Floor

Here's where our practice's background matters. A growing body of research points to significant overlap between POTS, joint hypermobility (including hypermobile EDS), and pelvic floor dysfunction. If you have POTS and you've been dealing with pelvic pain, bladder urgency, or a pelvic floor that never quite feels "right," those two things may not be separate problems.

In hypermobile connective tissue, pelvic floor muscles often aren't weak — they're overworking, trying to create stability your connective tissue isn't providing on its own. That means the standard advice (strengthen it, do more Kegels) can actually make things worse. What helps instead is retraining how your diaphragm, deep core, and pelvic floor coordinate together — which also happens to support better blood pressure regulation and symptom control for POTS itself.

This is a piece of the puzzle that a general cardiac rehab program or a standard physical therapy clinic usually isn't trained to see.

What This Looks Like in Practice

A well-built POTS program should include:

1. A real assessment — orthostatic vitals, a hypermobility screen, and (when relevant) a pelvic floor and breathing evaluation

2. A recumbent-first exercise progression, individualized to your own baseline rather than a generic chart

3. Education on the fluid, salt, and compression habits that support your progress

4. Ongoing communication with your physician, since POTS management often involves a care team

You Don't Have to Figure This Out Alone

If you're in Hoover, Birmingham, or the surrounding area and you're dealing with POTS symptoms — especially alongside pelvic floor issues, hormonal changes, or joint hypermobility — we'd be glad to talk through what a personalized program could look like for you.

This post is for educational purposes and isn't a substitute for individualized medical advice. Please work with your physician to confirm a POTS diagnosis before starting a new exercise program.

Postpartum Tailbone Pain: When to Worry (and When It’s Normal)

If you had a baby and now can't sit through a meal, a car ride, or a nursing session without wincing, you're not imagining it — and you're not alone. Tailbone pain after childbirth is common, but that doesn't mean you have to just wait it out.

Why Childbirth Affects the Tailbone

During vaginal delivery, the coccyx (tailbone) has to move out of the way to make room for the baby to pass through the pelvis. In most deliveries, it flexes and returns to its normal position without lasting issue. But in some cases:

• The coccyx is bruised or strained from the pressure of delivery

• It becomes excessively mobile or shifts out of alignment

• In rarer cases, it fractures or dislocates

• The surrounding pelvic floor muscles tighten and guard in response to labor, referring pain to the tailbone even when the bone itself is fine

That last point is one people miss most often. Postpartum tailbone pain isn't always about the tailbone — it's frequently about the pelvic floor muscles that attach around it.

What's Normal in the First Few Weeks

Some tenderness and discomfort sitting during the first two to six weeks postpartum is common as tissues heal. Ice, supportive cushions, and avoiding long stretches of sitting on hard surfaces can help in this early window.

When It's Worth Getting Evaluated

Consider a pelvic floor physical therapy evaluation if:

• Tailbone pain is still significant beyond six to eight weeks postpartum

• Sitting pain is getting worse rather than better

• You notice pain radiating into the hips, low back, or with bowel movements

• Standing up from sitting is sharply painful

• You feel like something "shifted" during delivery and hasn't felt right since

These aren't signs to push through — they're signs a proper evaluation can identify what's actually going on and get you on a faster path to relief.

What a Pelvic Floor Evaluation Looks At

A thorough postpartum tailbone assessment considers the coccyx itself, but also:

• Pelvic floor muscle tone and symmetry

• Scar tissue from delivery (including perineal or C-section scarring, which can refer tension to the pelvic floor)

• Sitting posture and weight-bearing patterns

• Core and hip strength as they relate to pelvic support

Treatment is typically hands-on and gradual — manual therapy, guided breathing and relaxation work for the pelvic floor, scar mobilization when appropriate, and a return-to-activity plan that doesn't aggravate the area.

The Bottom Line

Tailbone pain after childbirth is common, but "common" doesn't mean you have to live with it for months. If it's not improving on its own, a pelvic floor physical therapy evaluation can pinpoint the cause and get you moving — and sitting — comfortably again.

Learn more about tailbone pain and coccydynia treatment at Sharp Ortho & Pelvic Physical Therapy, or call 205-515-0258 to schedule an evaluation.

Sharp Ortho & Pelvic Physical Therapy Kaye Sharp, MPT, WHC | 2481 Valleydale Rd, Hoover, AL 35244 | 205-515-0258 | sharpphysicaltherapy.com

That aching outer hip isn't just "getting older" — here's what's really going on (and how to fix it)

Why are your hips hurting??

That aching outer hip isn't just "getting older" — here's what's really going on (and how to fix it)

If you're a woman in your 40s, 50s, or beyond and you've been dealing with persistent pain on the outside of your hip — especially when you lie on that side at night, climb stairs, or sit for too long with your legs crossed — there's a good chance your gluteus medius tendon is involved.

Gluteus medius tendinopathy is one of the most under-diagnosed causes of lateral hip pain in women, and menopause is one of the biggest reasons it develops. At Sharp Ortho & Pelvic Physical Therapy, we treat this condition every week — and the good news is that with the right approach, it responds very well.

What is the gluteus medius, and why does it hurt?

The gluteus medius is the muscle on the outer part of your pelvis that keeps you from wobbling side to side when you walk. Its tendon attaches to the bony point on the outside of your hip (the greater trochanter). When that tendon becomes overloaded or compressed, it becomes painful and irritated — a condition called tendinopathy.

Why menopause makes this so much more common

This isn't random timing. After menopause, estrogen — which directly supports tendon strength and collagen production — drops dramatically. That means the tendon becomes less resilient, more vulnerable to overload, and slower to recover. Combine that with natural muscle loss (sarcopenia), changes in body composition, and shifts in how we move, and the gluteus medius tendon is under real stress.

As a Women's Health Coach and pelvic PT with 30 years of orthopedic experience, I also see something many providers miss: the connection between hip pain and the pelvic floor. The muscles and fascia that surround the hip are directly linked to the pelvic floor. When the hip isn't working well, the pelvic floor often isn't either — and vice versa. That's why our treatment always looks at the whole picture.

Signs you may have gluteus medius tendinopathy

• Aching or sharp pain on the outside of one or both hips

• Pain that worsens when lying on your side — or on the opposite side

• Discomfort when sitting with your legs crossed or in low chairs

• Hip pain going up stairs, walking hills, or standing on one leg

• Pain that seems to come and go but never fully resolves

What does treatment actually look like?

Contrary to what many women are told, rest is not the answer. Tendons need the right kind of movement to heal. Our evidence-based program progresses through three stages:

• Phase 1: Gentle isometric exercises that calm pain without aggravating the tendon — no stretching, no compression

• Phase 2: Progressive strengthening to restore hip and pelvic control, including retraining how your body moves in daily life

• Phase 3: Functional loading — building tendon capacity for walking, stairs, exercise, and everything you want to do

We also address posture habits, sleep positions, and — because this is a postmenopausal issue — nutritional factors like protein intake, collagen support, and vitamin D that directly affect how well your tendon can heal.

You don't have to just live with this

Lateral hip pain is incredibly common in women after menopause, but it isn't inevitable — and it's very treatable. Most of our patients see meaningful improvement within the first 3–4 weeks when they commit to the program.

If you're dealing with outer hip pain and want answers, we'd love to help. Sharp Ortho & Pelvic Physical Therapy serves women at every stage of life from our Hoover, AL clinic. Call us at (205) 515-0258 or visit sharpphysicaltherapy.com to schedule your evaluation.

Tags: lateral hip pain, gluteus medius, menopause and hip pain, pelvic floor physical therapy, women's health Hoover AL, postmenopausal pain, hip tendinopathy