Dysautonomia – the invisible illness
Dysautonomia is often described as an “invisible illness” because many people look well on the outside, while their body is working extremely hard on the inside.
For many patients, symptoms can be confusing, unpredictable and difficult to explain. It is common for people with dysautonomia to see multiple health professionals, have many tests, and still feel as though they do not have clear answers. Some people are told their symptoms are “just anxiety”, “just stress”, or something they simply have to live with.
At Inline Physio, we recognise that dysautonomia is real, complex and often life-changing. While physiotherapy does not “cure” dysautonomia, the right approach can help many people understand their symptoms, reduce flare patterns, and gradually rebuild tolerance for daily life.
What is Dysautonomia?
Dysautonomia is an umbrella term used to describe dysfunction of the autonomic nervous system.
The autonomic nervous system controls many of the automatic functions of the body, including:
- heart rate
- blood pressure
- breathing regulation
- digestion
- temperature control
- sweating
- blood flow
- pupil response
- bladder and bowel function
When this system is not regulating well, symptoms can occur across many different body systems. One of the more commonly recognised forms of dysautonomia is Postural Orthostatic Tachycardia Syndrome, often called POTS.
Common symptoms
Symptoms vary from person to person and can change from day to day. They may also flare with illness, stress, poor sleep, hormonal changes, heat, dehydration, pain, overexertion or prolonged upright posture.
Common symptoms may include:
- dizziness or light-headedness
- fainting or near-fainting
- difficulty standing or staying upright
- rapid, slow or irregular heartbeat
- palpitations
- low blood pressure or fluctuating blood pressure
- chest discomfort
- shortness of breath or difficulty regulating breathing
- fatigue
- exercise intolerance
- weakness
- muscle aches or cramping
- headaches or migraines
- brain fog
- poor concentration
- memory issues
- nausea
- appetite changes
- diarrhoea or constipation
- temperature regulation problems
- tremors
- sleep disturbance
- anxiety-like symptoms or feeling “wired”
- difficulty relaxing after activity
Not everyone will experience all of these symptoms. Some people have only a few symptoms, while others experience a much broader pattern.
Conditions that may be associated with dysautonomia
Dysautonomia may occur on its own, but it can also be associated with other conditions or triggers, including:
- hypermobility spectrum disorders or Ehlers-Danlos syndromes
- mast cell activation disorders
- diabetes
- coeliac disease
- inflammatory bowel disease
- autoimmune conditions such as Sjögren’s disease
- Parkinson’s disease
- vitamin deficiencies
- mitochondrial or metabolic dysfunction
- concussion or head trauma
- physical trauma
- surgery
- pregnancy
- infections, including COVID-19 and long COVID
Because dysautonomia can involve multiple body systems, assessment and management often require a team approach. This may include your GP, cardiologist, neurologist, immunologist, dietitian, psychologist, exercise physiologist or other health professionals.
At Inline Physio, we also recognise that some patients present with signs of poor energy production, post-exertional crashes, inflammatory load, histamine-type responses or other metabolic stressors that may affect their ability to tolerate rehabilitation. Where appropriate, we work closely with your GP or medical team to help identify and support these underlying contributors, so that physical rehabilitation can be paced safely and effectively.
Is there a cure for dysautonomia?
There is currently no single cure for dysautonomia. Management usually focuses on improving regulation, reducing symptom flares, supporting blood flow and gradually improving the body’s tolerance to activity.
Many people benefit from a combination of medical care, lifestyle strategies and carefully guided physical rehabilitation.
Common management strategies may include:
- increasing fluid intake, where medically appropriate
- increasing salt intake, if recommended by your doctor
- compression garments to support venous return
- pacing and energy management
- heat management
- sleep support
- breathing regulation strategies
- carefully graded exercise or movement rehabilitation
- medication, when prescribed by a medical practitioner
It is important that these strategies are individualised. What helps one person may flare another, especially when symptoms are severe or unstable.
Physiotherapy treatment for dysautonomia at Inline Physio
At Inline Physio, we take a gentle, individualised approach to dysautonomia rehabilitation.
Our focus is not simply on “getting stronger”. Many patients with dysautonomia need their body to first feel safe enough to tolerate movement, upright posture, breathing demands and load.
Your physiotherapist will assess how your body responds to position changes, breathing, muscle activation, postural load and movement. We also consider whether symptoms such as post-exertional crashes, delayed recovery, histamine-type reactions, poor sleep, digestive disturbance or inflammatory load may be limiting your body’s capacity to adapt.
When these broader medical or metabolic contributors appear to be affecting progress, we may recommend review with your GP or relevant medical practitioner. With your consent, we can communicate with your healthcare team to support a coordinated plan.
From there, we develop a treatment plan that matches your current capacity.
Treatment may include:
- education about dysautonomia and symptom patterns
- pacing and flare management strategies
- breathing and rib cage mobility work
- gentle manual therapy where appropriate
- nervous system calming strategies
- postural and movement retraining
- carefully selected Clinical Pilates-based exercises
- gradual progression from supported positions toward more upright activity
- monitoring of symptom response during and after treatment
- communication with your GP or medical team where broader medical or metabolic contributors may need support
Many people begin with exercises in supported positions, such as lying down or semi-reclined, before gradually progressing as their system tolerates more load. Small changes in position, breathing, head placement, muscle activation or exercise range can make a significant difference for some patients.
The aim is to build capacity without repeatedly pushing the body into flare.
How long does treatment take?
Treatment timeframes vary depending on the severity of symptoms, other medical conditions, current activity tolerance and how reactive the nervous system is.
Some people notice changes within a session, such as easier breathing, less muscle guarding, improved clarity or feeling more settled. Longer-term changes in daily function usually take weeks to months and require careful progression.
Recovery is rarely a straight line. The goal is to help you understand your body, reduce boom-bust patterns, and gradually increase what you can tolerate in daily life.
Book a dysautonomia assessment
If you would like to explore whether physiotherapy may help your symptoms, please contact our friendly admin team and ask about booking a Dysautonomia Assessment with one of our experienced physiotherapists.
We look forward to supporting you on your journey toward improved function, confidence and capacity.
Tracey Lane (Moorooka Clinic)
Senior Physiotherapist and Dysautonomia Physio
FAQs
Do I need a GP referral to see a physio for dysautonomia?
No. A referral is not necessary to assess and treat you for private patients. If you are a DVA or WorkCover client, we do require a referral from your doctor outlining your presenting problem. If you want to claim treatment under a Medicare CDM Plan, a copy of the plan and a referral from your doctor is required.
How long does an appointment take?
Usually, initial appointments specifically for management of Dysautonomia/POT and Hypermobility take 45-60 minutes;
Can physiotherapy help with POTS and dysautonomia?
Yes. While physiotherapy cannot cure dysautonomia or POTS, it can help reduce symptom flares, improve tolerance for upright posture and daily activity, and support nervous system regulation. Treatment is highly individualised and paced carefully to avoid post-exertional crashes.
What does a dysautonomia physiotherapy assessment involve?
Your physiotherapist will assess how your body responds to position changes, breathing, muscle activation and postural load. They will also consider broader contributors such as post-exertional crashes, sleep disturbance, inflammatory load or histamine-type responses that may be affecting your capacity to tolerate rehabilitation.
Is dysautonomia related to hypermobility?
Yes, dysautonomia – particularly POTS – is commonly associated with hypermobility spectrum disorders and Ehlers-Danlos syndromes (hEDS). Many patients present with both conditions, and physiotherapy for these overlapping presentations requires a specialised approach.
What exercises are safe for someone with POTS?
Exercise for POTS must be individually prescribed and carefully graded. Many people begin in supported positions such as lying down or semi-reclined, progressing slowly as the nervous system tolerates more load. Pushing through symptoms can worsen the condition, so the pace of progression is guided by symptom response during and after each session.
Can long COVID cause dysautonomia or POTS?
Yes. Infection with COVID-19 is a recognised trigger for dysautonomia, including POTS. Long COVID presentations involving fatigue, brain fog, palpitations and exercise intolerance may include an autonomic component. Physiotherapy management in these cases requires careful pacing and attention to post-exertional symptom patterns.
What is post-exertional malaise and how does it affect dysautonomia treatment?
Post-exertional malaise (PEM) refers to a worsening of symptoms following physical, cognitive or emotional effort. It is common in people with dysautonomia and long COVID. Recognising PEM is essential in planning treatment — pushing too hard can set recovery back significantly. At Inline Physio, we pace treatment carefully to avoid triggering these crashes.
Where in Brisbane can I see a physiotherapist for dysautonomia?
Inline Physio offers dysautonomia and POTS physiotherapy at our Moorooka clinic, with Senior Physiotherapist Tracey Lane. We also have clinics in Ashgrove and Samford. Online physiotherapy appointments are available for patients who cannot travel or who are managing symptoms from home.
How is dysautonomia diagnosed?
Dysautonomia is diagnosed by a medical specialist, often a cardiologist or neurologist, using tests such as a tilt table test, heart rate monitoring or other autonomic function testing. Your Physiotherapist does not diagnose dysautonomia but will conduct some of the tests to assist in the diagnosis and support management once a diagnosis has been made or is being investigated.
What is the difference between dysautonomia and POTS?
Dysautonomia is a broad term for dysfunction of the autonomic nervous system. POTS (Postural Orthostatic Tachycardia Syndrome) is one specific type of dysautonomia, characterised by an abnormal increase in heart rate when moving from lying to standing. Not all people with dysautonomia have POTS, and not all people with POTS experience the same pattern of symptoms.
Can I specifically request a male or female Physiotherapist?
Yes. Just let one of our friendly Samford Physio reception staff know your preference when you are making an appointment and they will be happy to help you find an appropriate time with the Physiotherapist of your choice.
What do I need to bring to my appointment?
You should wear clothing that your feel comfortable in and allows your Physiotherapist to properly assess your injury (eg. if you have a knee injury, it is best to wear shorts or pants that roll up easily). If you have had any imaging done prior to your appointment (X-Rays, MRIs etc), it can help your Physiotherapist if you bring these reports along as well. If you have any other information that you think might help your Physiotherapist assess and treat your condition, feel free to bring it along also.
Is Physiotherapy treatment covered by my private health insurance?
Yes. If you have extras cover for Physiotherapy, each consultation is can be claimed immediately on site, so you will only be out of pocket the gap between the amount paid by the health fund and the total cost of the treatment. The gap payable will depend on your health fund and your level of cover.
We accept all health funds, for all types of treatment. Depending on your private health cover, gap payments will vary, as will what treatments you are covered for.
If you need clarification, just ask when you make your appointment.
If you have any other questions, please contact us!