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Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 39 Resources Grigoriou, Emmanouil, Jeffrey R. Boris, and John P. Dormans. "Postural Orthostatic Tachycardia Syndrome (POTS): Association with Ehlers- Danlos Syndrome and Orthopaedic Considerations." Clinical Orthopaedics and Related Research 473, no. 2 (February 2015): 722–28. Gurme, Mohini. "Idiopathic Orthostatic Hypotension and Other Autonomic Failure Syndromes: Practice Essentials, Background, Pathophysiology." 2019. Johns Hopkins Medicine. "Postural Orthostatic Tachycardia Syndrome (POTS)." 2019. diseases/postural-orthostatic-tachycardia-syndrome-pots. Medical News Today. "Dysautonomia: Symptoms, Types, and Treatment." (July 27, 2017). National Dysautonomia Research Foundation. "What is Dysautonomia?" Accessed November 2019. National Institute of Neurological Disorders and Stroke. "Dysautonomia Information Page." 2019. Dysautonomia-Information-Page. National Institute of Neurological Disorders and Stroke. "Postural Tachycardia Syndrome Information Page." 2019. All-Disorders/Postural-Tachycardia-Syndrome-Information-Page. PATHOLOGY PERSPECTIVES However, with a few key accommodations, massage therapy can be as safe, restorative, and supportive for people with POTS as it is for the rest of the population. Give shorter sessions. POTS symptoms are worse after being horizontal for prolonged periods. Clients with POTS will probably do best with relatively short sessions, rather than long, languid ones. Don't overheat the room. Many people with POTS and other forms of dysautonomia are sensitive to heat. It may be a good idea to not overheat the session room for people with this challenge. Finish the session with stimulating strokes. While it can be lovely to finish a massage session with relaxing forms of touch that promote peace and tranquility, clients with POTS are more likely to benefit from a session that finishes with techniques that promote alertness. Whether that's tapotement, rapid effleurage strokes, or something else is up to the individual practitioner. In addition, coaching clients to contract their leg and arm muscles before they sit up can help promote healthy blood flow to minimize symptoms. Stay close at the end of the session. Because of both the condition and the medications used to treat it, it is a good idea for the massage therapist to attend the client when they come up to a seated position, and to be in the room long enough for them to feel confident about standing up. After we leave the room for clients to dress, we should stay close by in case they have any distress or need any help. These are also clients who may need extra time during their transition back to full function; it may be necessary to make adjustments in the daily schedule for this need. Encourage electrolytes. While the idea of encouraging clients to drink water after a massage to "flush toxins" has largely been debunked, people with POTS need to drink substantially more liquid than others to maintain appropriate blood pressure. Also, plain water is less useful than water with salt or other electrolytes that promote fluid retention. So, encouraging a client to enjoy an electrolyte drink after a session is an especially supportive measure for their well-being. Overall, some simple accommodations can make massage therapy a safe, enjoyable, and helpful experience for people who live with POTS. While we don't expect massage therapy to make a difference in the experience of this condition, our work may help improve the quality of life for people who live with a condition that can be frustrating, challenging, and limiting. Author note: For more information on living with POTS and massage therapy accommodations for this population, please enjoy my conversation with Kelly Thompson, a massage therapist whose teenage daughter was diagnosed with POTS five years ago. I want to offer special thanks to Jason Erickson, a massage therapist who is close to a person with POTS. He can be contacted at www. for more information. And Kelly Thompson, who so generously allowed me to record her input for our video, can be reached at Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology (available at, now in its seventh edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner. com or

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