POTS & Exercise

Exercise, POTS, and the Art of Doing Hard Things: A No-B.S. Guide to Moving Forward

Let’s get real for a minute: if you’re living with Postural Orthostatic Tachycardia Syndrome (POTS), exercise can feel like the cruelest joke.

It’s supposed to help you feel better, right?

So why does it sometimes make you feel like you’ve been hit by a truck?

And why does every rehab plan out there seem like it was designed for someone with a completely different body?

This isn’t just frustrating—it’s one of the greatest challenges of your recovery journey.

The problem?

Most exercise protocols for POTS are rigid, cookie-cutter, and completely out of touch with the messy, unpredictable reality of how your body responds.

But here’s the thing: you’re not broken.

Your body isn’t a failure.

It’s just stuck in a loop it hasn’t yet learned how to break.

And today, we’re talking about how to change that—without toxic positivity, fluff, or empty promises.

Let’s dive into the real science, the struggles, and why hope isn’t just a cliché when it comes to your recovery.

Why Exercise Can Feel Like Your Worst Enemy

First, let’s validate what you’ve been through. If you’ve tried to follow a traditional exercise program and felt worse, it’s not because you didn’t try hard enough. It’s because most rehab plans don’t account for what’s really happening in a body with POTS.

The Science of “Why Do I Feel Worse After Exercise?”

When your body is “unconditioned”—which is common if you’ve had to limit activity due to POTS—exercise can actually cause inflammation.

Here’s why:

• Inflammatory Storm: Your muscles release chemicals (cytokines) that irritate nerves and trigger pain. It’s like your body’s alarm system is on overdrive​

• Hyperactive Pain Signals: Your nervous system hasn’t learned how to regulate itself yet, so it amplifies every signal—making soreness, fatigue, and dizziness feel 10 times worse​

• Emotional Fallout: Let’s not ignore this. When exercise leaves you bedridden or flaring, it’s not just physical—it’s emotionally crushing. You start to wonder, “What’s wrong with me? Am I ever going to feel normal again?”

But here’s the thing: this isn’t permanent.

Your body can learn to respond to exercise differently.

You just need a smarter, more compassionate approach.

Moving Beyond Rigid Rehab: A Smarter, Science-Backed Way Forward

The old way of exercising for POTS goes something like this: start slow, progress in fixed stages, and hope for the best.

Sounds harmless, right?

Wrong.

For many people, these programs feel like a one-way ticket to symptom flare-ups.

It’s time to move on from one-size-fits-all.

Here’s how we make exercise work for you, not against you:

1. Start Horizontal—Seriously

Forget about jumping straight into standing exercises. Your body needs to build tolerance without gravity messing things up. Supine or recumbent exercises, like cycling or leg lifts, are the best place to start.

“Programs should begin with horizontal exercises to minimize orthostatic stress while building tolerance.” (Ziaks et al., 2024)

2. Understand the Transition to Anti-Inflammatory Exercise

When you stick with gentle, regular movement, something magical happens: your body adapts.

Over time:

• Your muscles start producing anti-inflammatory chemicals that calm pain sensors.

• Your nervous system learns to stop amplifying pain signals and starts calming down instead.

• Your immune system shifts from a “fight” mode (inflammatory cytokines) to a “heal” mode (anti-inflammatory cytokines).

This is why exercise feels hard at first but gets easier the more conditioned you become.

Reference: Exercise-induced pain and analgesia? Underlying mechanisms and clinical translation

This diagram shows how your muscles, immune cells (called macrophages), and pain sensors (nociceptors) interact.

When your body is under stress or inactive for long periods, more macrophages take on the “M1” role.

These M1 macrophages release chemicals that cause inflammation, which makes your pain sensors more active and leads to pain.

However, when you do regular, gentle exercise, your immune system starts shifting.

More macrophages become “M2” instead, which release anti-inflammatory chemicals.

These chemicals calm down your pain sensors, reducing pain and helping your body feel better.

The takeaway?

Over time, consistent movement can teach your body to create more M2 macrophages, reducing inflammation and improving how your body handles stress and pain.

3. Go at Your Own Pace—No Timelines

Progression isn’t about rigid timelines. It’s about listening to your body. You’re ready to move to seated or standing exercises when you can handle 20 minutes of horizontal movement without flaring up. Not before.

4. Use Interval Training for Recovery

If steady-state exercise feels overwhelming, try intervals: short bursts of effort followed by rest. For example, 30 seconds of light movement and 1–2 minutes of rest. It’s a gentle way to build endurance without overloading your system​.

The Philosophical Side of Doing Hard Things

Here’s the tough truth: recovery is hard.

Exercise with POTS forces you to face both physical and emotional challenges head-on.

It’s uncomfortable, messy, and often feels like two steps forward, one step back.

But what if the struggle is the point?

Every time you listen to your body and adjust instead of pushing through, you’re practicing self-compassion. Every time you show up, even when you’re scared of flaring, you’re building resilience. And resilience isn’t just physical—it’s emotional, too.

By focusing on small, consistent actions instead of fearing the big picture, you’re taking back control.

Hope, Without the Fluff

Let’s get one thing straight: this isn’t about toxic positivity. Hope doesn’t mean pretending everything is fine when it’s not. Hope is understanding that your body isn’t your enemy—it’s just trying to protect you in ways that aren’t helpful right now.

With the right approach, exercise can go from being a trigger to being a tool. It can become something that strengthens you—physically, emotionally, and even spiritually.

So, start small. Stay consistent. And remember: every step forward, no matter how tiny, is progress.

You’ve got this. One rep, one breath, one day at a time.

References:

Exercise-induced pain and analgesia? Underlying mechanisms and clinical translation

Adaptive Approaches to Exercise Rehabilitation for Postural Tachycardia Syndrome and Related Autonomic Disorders

Could Your Plantar Fasciitis Pain Actually Be Coming from Your Soleus Muscle?

Here’s a surprising twist: That sharp heel pain you’ve been blaming on plantar fasciitis might not just be about your foot. According to Travell and Simons’ Trigger Point Model, the soleus muscle—a key calf muscle—could be playing a major role by referring pain to your heel or arch.

Let’s break it down:

🔍 How the Soleus Muscle Can Mimic Plantar Fasciitis

• Referred Pain Areas: Trigger points in the soleus can send pain signals to the heel, arch, and sometimes the back of the ankle. This pain often feels like classic plantar fasciitis but originates higher up in the calf.

• Aggravating Factors: Activities that load the soleus muscle, like running, walking uphill, or prolonged standing, can worsen the pain. Tight footwear and poor ankle mobility can also contribute.

• Contributing Factors:

  • Poor circulation or metabolic health in the muscle.

  • Overuse or repetitive strain without proper recovery.

  • Weakness or lack of flexibility in the calves, leading to muscle tension.

✅ How Heel Raises Can Help

The Rathleff 2014 Protocol, which focuses on slow, controlled heel raises, doesn’t just target the plantar fascia—it also helps resolve soleus-related pain by:

1. Boosting Circulation: Improved blood flow helps flush out metabolic waste, which can contribute to trigger points.

2. Releasing Trigger Points: Repeated contraction and relaxation of the soleus during heel raises reduces muscle tension and referred pain.

3. Building Strength: Strengthening the soleus enhances its endurance, reducing the likelihood of overloading and developing new trigger points.

🔑 What to Look For and Avoid

• If you have tight calves or experience heel pain after calf-loading activities, the soleus might be the hidden culprit.

• Avoid aggravating factors like poorly fitted shoes, sudden spikes in activity, or skipping recovery after workouts.

🎯 Ready to Tackle the Real Source of Your Pain?

Addressing soleus health is just one part of the puzzle in my multi-dimensional Foundation First™ Plantar Fasciitis Recovery Protocol.

Whether it’s improving your gait, boosting circulation, or resolving trigger points, we focus on treating the root cause—not just the symptoms.

Drop a comment or email me if you want to learn more (dan@kinfolkwellness.com.au)

Let’s get to the sole(us) of the problem and put you on the path to pain-free steps! 💪✨

#PlantarFasciitis #SoleusTriggerPoints #ReferredPainRelief #TravellAndSimons #PainFreeFeet

Plantar Fasciitis - Take The Right Step Towards Recovery

Plantar Fasciitis: Take The Right Step Towards Recovery

Plantar fasciitis can feel like a constant battle—sharp heel pain, stiffness, and discomfort that make even walking a challenge.

Many turn to cortisone injections or hard orthotics for relief, but these treatments often do more harm than good in the long run.

Cortisone can weaken tissues, and rigid orthotics may increase compression loads, making the pain worse.

Instead, let’s talk about a smarter, evidence-based way to manage plantar fasciitis—one that focuses on strengthening, load management, and a multi-dimensional approach to recovery.

This method not only helps reduce pain but empowers you to build long-term resilience.

What Does the Research Say?

A 2014 study by Rathleff et al. provides compelling evidence for a strength-based approach to plantar fasciitis. In this study:

• Patients who performed high-load strength training (heel raises with a towel under the toes to engage the plantar fascia) experienced faster pain relief and better foot function compared to those who did plantar-specific stretching.

• At 3 months, the strength-training group reported significantly better outcomes, with reduced pain and improved foot function.

• This approach taps into the body’s ability to adapt and heal by gradually increasing the load on the plantar fascia, promoting tissue remodeling and increased strength.

While the study focused on strength training, recovery isn’t just about doing one exercise. It’s about addressing the whole system—your foot, your body, and how you move. That’s why I take a multi-dimensional approach to plantar fasciitis management.

My Multi-Dimensional Approach

1. Education

• Understanding plantar fasciitis reduces fear and empowers you to make informed decisions.

• I’ll explain why treatments like cortisone injections and hard orthotics may worsen the condition by increasing compression loads on the foot.

2. Strengthening (Based on the Rathleff Study and Beyond)

• Foot-Specific Strength: Exercises like heel raises with a towel target the plantar fascia and Achilles tendon, promoting tissue health and function.

• Kinetic Chain Strength: Strengthening the calves, hamstrings, glutes, and core helps distribute loads evenly, reducing strain on the plantar fascia.

3. Load Management

• Gradually reintroduce activities that challenge your foot, like barefoot walking or walking on soft surfaces (e.g., sand).

• Monitor 24-hour pain levels to adjust activity and avoid overloading your tissues.

4. Mobility Work

• Foam rolling and self-massage for the calves and hamstrings can relieve tightness and improve tissue health.

• Gentle stretching and mobility exercises to improve range of motion in the ankle and foot.

5. Physio Dry Needling

• Targeting trigger points can relieve pain, improve blood flow, and enhance recovery.

6. What to Avoid

• Hard Orthotics: These restrict movement and may increase harmful compression loads on foot tendons.

• Sudden spikes in activity, such as intense running or long walks without preparation.

7. Pain Education

• Learning to interpret pain as a sign of load tolerance—not damage—helps reduce fear and builds confidence in your recovery.

8. Personalized Footwear Recommendations

• I’ll guide you toward shoes that allow natural foot movement and reduce strain on the plantar fascia.

9. Lifestyle Integration

• Incorporating barefoot walking, time on soft surfaces like the beach, and a gradual return to activities you love.

Why This Works

The Rathleff study showed the power of a strength-based approach to reducing pain and improving function.

When combined with education, mobility work, and personalized strategies, the effects are amplified.

This multi-dimensional approach doesn’t just treat the symptoms—it builds resilience and prevents recurrence.

Take the First Step Toward Recovery

You don’t need to rely on cortisone shots, rigid orthotics, or endless visits to specialists. By focusing on strengthening, managing load, and understanding your body, you can take control of plantar fasciitis and recover on your terms.

If you’re ready to explore a smarter way to heal, I’m here to guide you with personalized support, evidence-based strategies, and a commitment to your long-term health.

Let’s take that first step—stronger, healthier, and pain-free.

Why Less is More for Functional Strength

Why Less is More for Functional Strength

“When a measure becomes a target, it ceases to be a good measure.”

— Goodhart's Law

Lately, I’ve found myself frustrated with the oversimplified, isolated approach to strength training that some groups have been promoting.

While machines and methods promising maximal strength gains may seem appealing, they often miss the bigger picture.

Strength isn’t just about how much you can lift on a specific machine or grinding your muscles to failure.

Real strength is about function, resilience, and the ability to move well in life—not just in the gym.

Why Too Much Strength Can Be Harmful

There’s a tipping point where adding more strength can backfire.

Beyond a certain level, muscles become rigid and lose their natural pliability, leading to a cascade of issues:

• Increased joint compression: Tight, overactive muscles place unnecessary pressure on joints, reducing mobility and increasing the risk of injury.

• Trigger points and muscle pain: Over-trained muscles often develop low pH environments, leading to trigger points and persistent soreness.

• Reduced performance and adaptability: When muscles become overly rigid, they limit fluid movement and restrict your ability to react dynamically—exactly what you need to prevent injury during real-life activities.

Paradoxically, more strength isn’t always better—it can make the body more vulnerable to imbalances and injuries.

The Minimal Viable Dose: Function Over Intensity

Our approach at the Kinfolk Physio focuses on optimal, not maximal strength.

This means finding the right balance of strength, mobility, and endurance to move efficiently and without pain.

You don’t need heavy lifting, machines, or training to failure to achieve this.

Instead, we emphasize:

• Hill walking and running: These activities naturally build strength and endurance across multiple muscle groups without overloading your joints.

• Bodyweight exercises: Functional movements train your muscles to work together efficiently, mimicking real-life demands.

• Resistance bands: Bands provide progressive resistance and engage stabilizing muscles that machines miss, helping you build strength with control and flexibility.

This approach ensures that you build the capacity to move well without tipping into harmful territory where muscles become overtrained and joints are overloaded.

Conclusion: Resilience Through Smart, Sustainable Strength

Strength training shouldn’t be about pushing your body to the max—it’s about building functional capacity through the minimal viable dose.

At Kinfolk, we aim to help you move better, feel better, and live better by finding the optimal balance of strength and mobility.

By avoiding the pitfalls of overtraining and focusing on sustainable, functional movement, you’ll develop the kind of resilience that lasts for life.

Unlock the Power of Your Body: 5 Tips to Heal Persistent Knee Pain and OA

Unlock the Power of Your Body: 5 Tips to Heal Persistent Knee Pain and OA

Your body is the most powerful tool in the world—a healing machine that, when used wisely, can overcome challenges like persistent knee pain or osteoarthritis (OA). But often, we use it for the wrong reasons, getting stuck in overcomplicating things, avoiding movement, or relying too much on external solutions. The secret lies in tapping into your body’s natural abilities. Below are five actionable tips to help you unleash your body’s power and make real progress in managing knee pain and OA.

1. Load is Medicine: Movement as a Healing Tool

Pain often makes us want to rest, but tendons and joints thrive on strategic movement. Light, functional exercises like walking, cycling, or water aerobics can build strength, mobility, and endurance without overloading your knees. Research shows that gradual loading not only reduces pain but also boosts cartilage health and tendon resilience.

How to apply it:

• Start with low-impact movements and gradually increase intensity.

• Use the barbell strategy—alternate easy movement (like walking) with short bursts of intensity (like stair walking).

2. Build Capacity, Not Just Strength

Traditional rehab often focuses on strengthening muscles, but capacity matters more. Capacity is your ability to handle life’s demands—whether it’s playing tennis, hiking, or running after your kids. Overemphasizing strength alone can create rigidity, whereas functional exercises build pliability and confidence to move freely.

How to apply it:

• Test your capacity through activities you love (e.g., a light jog or game of tennis).

• Track how your body feels 24 hours after—this feedback helps you adjust load.

3. Manage Inflammation with Recovery Practices

Inflammation can block the body’s ability to heal, causing flare-ups that derail progress. Instead of waiting for pain to subside, use intentional recovery practices to calm inflammation and reset capacity.

How to apply it:

• Incorporate RICE: Rest (active), Interpret (pain vs. overload), Capacity (balance load), Experiment (adjust).

• Hydrate well, eat anti-inflammatory foods, and prioritize sleep to reduce systemic inflammation.

4. Rethink Pain: Feedback, Not Failure

It’s easy to see pain as a sign of failure or damage, but it’s actually valuable feedback. Pain tells you when your body is under stress, signaling that it’s time to adjust your load, not stop altogether. Reframing pain as information allows you to stay engaged in the healing process without fear.

How to apply it:

• Use the Traffic Light Model:

  • Green Zone (0-3/10): Safe to continue.

  • Orange Zone (4-5/10): Pay attention; adjust next time.

  • Red Zone (6+/10): Scale back temporarily but stay active.

• Embrace discomfort—it doesn’t mean you’re failing; it means you’re adapting.

5. Align Mind and Body: Mental Resilience Fuels Physical Recovery

Your mindset can either drive recovery or hold you back. Fear of pain, frustration with slow progress, or rigid thinking can create mental roadblocks. Shifting your mindset to one of curiosity and self-compassion builds the resilience needed to trust your body and keep moving forward, even during setbacks.

How to apply it:

• Replace fear-based thoughts (e.g., “I’ll never recover”) with empowering ones (e.g., “This is part of the process”).

• Celebrate small wins—every step counts, even when progress feels slow.

• Use mindful breathing and visualization techniques to calm your nervous system and stay present.

The Bottom Line: Use Your Body Wisely to Unlock Its Power

Healing from knee pain or osteoarthritis isn’t just about following the perfect rehab program—it’s about learning to trust your body’s natural ability to adapt and thrive. By using movement as medicine, building capacity, managing inflammation, rethinking pain, and fostering mental resilience, you unlock the full power of your body.

This journey isn’t about fixing yourself but growing through the process. Remember, every step—whether a jog, a walk, or a mindful stretch—moves you closer to freedom of movement and rediscovering the joy your body is capable of.