STRATEGIES: Physical therapy tools to reduce crashes and improve quality of life for POTS, Post-Exertional Malaise (PEM), EDS, MCAS, and infection-associated chronic conditions such as ME/CFS and Long Covid.
Many patients are told that they have anxiety or depression, or they just need to exercise, and that there is little that can be done to help their symptoms. In this episode, Dr Clayton Powers, physical therapist and leading expert in complex chronic illness management, explains why patients should not be dismissed in this way, and what can be done to help.
Dr Powers specializes in treating ME/CFS, Long Covid, EDS, Fibromyalgia, POTS, and MCAS, and trains other healthcare providers to do the same. While he doesn't promise a cure, his "pacing, not pushing" approach helps patients achieve measurably shorter, less intense, and less frequent crashes. These are outcomes his patients consistently report over months of care.
In this episode, we discuss:
- Why pacing remains one of the hardest skills for chronic illness patients to learn, and how to start
- The key difference between POTS and POTS with post-exertional malaise (PEM), and how Dr Powers assesses it
- Why standard graded exercise programs (like the CHOP/Levine Protocol) can worsen PEM symptoms
- Dr Powers' nervous system toolbox: cold therapy, compression boots, vibration devices, and supplemental oxygen
- How physical therapy can support people with mast cell activation syndrome (MCAS)
- How wearables like Visible, and trained service dogs, can flag an impending crash before it fully hits
- Why "permission to rest" needs to be built into clinical care, rather than treated as an afterthought
Dr Clayton Powers works with the Bateman Horne Center, is a contributor to many of their free resources including the Clinical Care Guide, Therapy for Patients with PEM series and Coffee with a Clinician series. He has contributed extensively to education and research, including a feasibility studies on wearables for POTS management and a systematic review on the impact of exercise on POTS.
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