Fatigue is one of the most common — and most misunderstood — symptoms experienced by people living with hypermobility syndromes and Postural Orthostatic Tachycardia Syndrome (POTS).
Many people describe feeling completely drained by tasks that others seem to do effortlessly. Showering, grocery shopping, standing in the kitchen, attending work, or even holding a conversation can sometimes feel overwhelming. For many, this exhaustion has existed for years before a diagnosis is ever considered.
Unfortunately, people are often told they are “just stressed”, “unfit”, “anxious”, or simply need to push through. In many cases however, there is a genuine physiological reason behind these symptoms.
At Mornington Peninsula Family Physiotherapy, we regularly work with people experiencing hypermobility syndromes, autonomic dysfunction, persistent fatigue and chronic pain to help improve function, confidence and quality of life.
What Is POTS?
POTS (Postural Orthostatic Tachycardia Syndrome) is a form of autonomic nervous system dysfunction.
The autonomic nervous system controls many of the body’s automatic functions, including:
- heart rate
- blood pressure
- breathing
- digestion
- circulation
- temperature regulation
In people with POTS, the body struggles to regulate blood flow effectively when moving into upright positions such as sitting or standing.
This can lead to symptoms including:
- dizziness or lightheadedness
- rapid heart rate
- palpitations
- shakiness
- nausea
- brain fog
- headaches
- exercise intolerance
- overwhelming fatigue
Many people with POTS also live with hypermobility conditions such as Hypermobile Ehlers-Danlos Syndrome (hEDS) or Hypermobility Spectrum Disorder (HSD).
Why Are Hypermobility and POTS Linked?
Research into the relationship between hypermobility and autonomic dysfunction is continuing to evolve, however several contributing factors are thought to play a role.
In hypermobility conditions, connective tissues can be more elastic and less supportive. This may affect blood vessels, leading to increased blood pooling in the legs and abdomen when upright. The body then has to work significantly harder to maintain circulation and blood flow to the brain.
This often contributes to:
- increased heart rate
- reduced exercise tolerance
- fatigue after relatively minor activity
- prolonged recovery after exertion
For many people, the nervous system is effectively working overtime all day.
Common Symptoms of POTS & Hypermobility Fatigue
People living with POTS and hypermobility may experience:
- persistent fatigue
- dizziness when standing
- rapid heart rate
- brain fog
- headaches
- nausea
- poor exercise tolerance
- muscle heaviness
- pain flares
- reduced recovery capacity
- difficulty tolerating heat
- increased symptoms after physical or mental exertion
Symptoms can fluctuate significantly from day to day and are often worsened by stress, illness, dehydration, heat or overexertion.
When Fatigue Isn’t “Just Tiredness”
One of the most frustrating aspects of POTS-related fatigue is that rest does not always feel restorative.
People may sleep for long periods yet still wake feeling exhausted. This is because fatigue in POTS and hypermobility is often more complex than simple tiredness. It may reflect:
- altered nervous system regulation
- poor circulation
- chronic muscle overactivity
- persistent pain
- deconditioning
- poor sleep quality
- increased energy expenditure during everyday activities
Many hypermobile individuals also use significant muscular effort simply to stabilise their joints throughout the day. Muscles often remain tense and overactive as the body attempts to create stability where connective tissue support is reduced.
Understanding the “Boom-and-Bust” Cycle
A common pattern experienced by people with POTS and hypermobility is the “boom-and-bust” cycle.
On a better day, people often try to catch up on:
- exercise
- housework
- errands
- social events
- work tasks
The challenge is that this frequently pushes the nervous system beyond what it can currently tolerate, resulting in a significant symptom flare afterwards.
This may lead to:
- several days of exhaustion
- increased dizziness
- headaches
- pain flares
- poor sleep
- reduced function
Learning pacing strategies can therefore become an important part of long-term management. Pacing does not mean avoiding activity altogether — it means building consistency without repeatedly triggering crashes.
Why Exercise Can Feel So Difficult
Many people with POTS are told they simply need to exercise more. While movement is important, traditional exercise approaches often fail because they progress too quickly or rely heavily on upright cardiovascular exercise early on.
For someone living with autonomic dysfunction, activities such as:
- running
- HIIT classes
- prolonged standing exercise
- fast positional changes
can significantly worsen symptoms initially.
Instead, rehabilitation often begins with:
- recumbent or semi-recumbent exercise
- gradual cardiovascular conditioning
- lower limb strengthening
- breathing retraining
- pacing and load management
- nervous system regulation strategies
Strengthening the calf and lower limb muscles can also help improve circulation and venous return.
Other Strategies That May Help
Management of POTS and hypermobility is highly individual, however strategies may include:
- increasing fluid intake
- increasing salt intake (where medically appropriate)
- compression garments
- sleep optimisation
- strength training
- pacing strategies
- nutrition support
- persistent pain management
- multidisciplinary care
Because symptoms often overlap across multiple body systems, many people benefit from collaborative care involving:
- GPs
- physiotherapists
- exercise physiologists
- psychologists
- dietitians
- medical specialists
When To Seek Support
If you experience persistent fatigue, dizziness, exercise intolerance or feel your body struggles to recover from normal daily activities, it may be worth seeking assessment and support.
Many people live with symptoms for years before understanding the role that autonomic dysfunction or hypermobility may be playing in their health and function.
With appropriate education, rehabilitation and gradual support, many people can improve their movement tolerance, confidence and quality of life over time.
Looking for support with POTS, hypermobility or persistent fatigue?
Dr. Alex Hansford-Smith works with people experiencing autonomic dysfunction, hypermobility syndromes, dizziness, pelvic health concerns and persistent pain to help create realistic, sustainable pathways back to movement and daily life.
Management is tailored to the individual and may include:
- pacing and load management strategies
- strength and conditioning support
- nervous system regulation approaches
- education around symptom management
- rehabilitation for dizziness, fatigue and exercise intolerance
Book an appointment online or call 03 5976 4944
No referral needed
