EPISODE · Jul 10, 2026 · 59 MIN
#38 Pacing is Power - POTS, PEM, EDS & MCAS Strategies with Dr Clayton Powers
from Make Visible: Chronic Illness Explored · host Visible with Emily Kate Stephens
STRATEGIES: Physical therapy tools to reduce crashes and improve quality of life for POTS, Post-Exertional Malaise (PEM), EDS, MCAS, and Infection-Associated Chronic Conditions like ME/CFS and Long Covid. Many patients are told that they have anxiety, depression, or just need to exercise, and that there is little that can be done for their symptoms. This week, Dr Clayton Powers, physical therapist and leading expert in complex chronic illness management, explains why patients should now be dismissed in this way, and what can be done to help. Dr Powers specializes in treating ME/CFS, Long Covid, EDS, Fibromyalgia, POTS, and MCAS, and trains other healthcare providers to do the same. While he doesn't promise a cure, his "pacing, not pushing" approach helps patients achieve measurably shorter, less intense, and less frequent crashes: outcomes his patients consistently report over months of care. In this episode, we discuss: Why pacing remains one of the hardest skills for chronic illness patients to learn, and how to start The key difference between POTS and POTS with post-exertional malaise (PEM), and how Dr Powers assesses it Why standard graded exercise programs (like the CHOP/Levine Protocol) can worsen PEM symptoms Dr Powers' nervous system toolbox: cold therapy, compression boots, vibration devices, and supplemental oxygen Managing mast cell activation syndrome (MCAS) with physical therapy How wearables like Visible, and trained service dogs, can flag an impending crash before it fully hits Why "permission to rest" needs to be built into clinical care, not treated as an afterthought Dr Clayton Powers works with the Bateman Horne Center, is a contributor to many of their free resources including the Clinical Care Guide, Therapy for Patients with PEM series and Coffee with a Clinician series. He has contributed extensively to education and research, including a feasibility studies on wearables for POTS management and a systematic review on the impact of exercise on POTS. Interested in taking part or sharing feedback on Make Visible? Please click here. Make Visible @visible.health [email protected]
What this episode covers
STRATEGIES: Physical therapy tools to reduce crashes and improve quality of life for POTS, Post-Exertional Malaise (PEM), EDS, MCAS, ME/CFS and Long Covid. Many patients are told they have anxiety, depression, or just need to exercise — and that nothing else can help. This week, Dr Clayton Powers, physical therapist and leading expert in complex chronic illness management, explains why that’s wrong, and what actually helps. Dr Powers specializes in treating ME/CFS, Long Covid, EDS, Fibromyalgia, POTS, and MCAS, and trains other healthcare providers to do the same. His ”pacing, not pushing” approach doesn’t promise a cure, but helps patients achieve measurably shorter, less intense, and less frequent crashes over months of care. In this episode, we discuss: - Why pacing is one of the hardest skills for chronic illness patients to learn - The key difference between POTS and POTS with PEM, and how it’s assessed - Why standard graded exercise programs can worsen PEM symptoms - A nervous system toolbox: cold therapy, compression boots, vibration devices, supplemental oxygen - Managing MCAS through physical therapy - How wearables like Visible and trained service dogs can flag a crash before it hits - Why ”permission to rest” needs to be built into clinical care Dr Powers works with the Bateman Horne Center as a contributor to their Clinical Care Guide and educational video series, and has contributed to research on wearables for POTS management and the impact of exercise on POTS. Share feedback on Make Visible: forms.gle/sE3Ed1zNMWEBrcSK9 makevisible.com | @visible.health | [email protected]
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#38 Pacing is Power - POTS, PEM, EDS & MCAS Strategies with Dr Clayton Powers
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