Activity and Exercise Intolerance After Concussion: Identification and Management of Postural Orthostatic Tachycardia Syndrome.
Nicole A Miranda, Jeffrey R Boris, Kristen M Kouvel and 1 others
PMID 29864098WHAT IT FOUND
Concussion patients with exercise intolerance may have postural orthostatic tachycardia syndrome (POTS), not just poor recovery.
Screen with a 10-minute standing test and adjust heart rate targets. Standard return-to-play zones often exceed POTS tolerance, risking symptom exacerbation.
Key findings
01Postural orthostatic tachycardia syndrome (POTS) can cause exercise intolerance and dizziness in concussion patients, mimicking prolonged recovery.
02Standard concussion exertion protocols may be too intense for patients with undetected POTS, requiring modified recumbent exercise and adjusted heart rate zones.
03A 10-minute active standing test is proposed for screening, though it is not validated for diagnosing POTS, which requires medical confirmation.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
This is a narrative review, not a systematic review or clinical trial, so it does not provide high-level evidence for the proposed screening or treatment protocols. The proposed 10-minute standing test is explicitly stated as not validated for diagnosing POTS. Management recommendations are based on expert opinion and a single case report, not controlled trials in the concussion population. The review conflates symptoms of POTS with concussion sequelae, which may lead to over-diagnosis without careful medical workup.
Declared interests
The authors declare no conflict of interest.
The easy way to misread this
Do not diagnose POTS based solely on a standing test in your clinic. The active standing test is a screening tool that is not validated for diagnosis; a positive result requires referral for medical evaluation and passive tilt-table testing to confirm POTS.