Helpful Tricks To Cut Down Orthostatic Symptoms


There are some basic movements and ways you stand and sit that can help prevent orthostatic symptoms from developing or from getting worse.1-11

They can help when you are dealing with one of the orthostatic stressors, like having to stand in line at a store or a warm room or warm weather.

With time, doing these things will become more ordinary for you. You will probably have to pay attention to these things for a long time, maybe even the rest of your life.

  • Things to do Standing Up
  • Sitting-Tricks for Dizziness
  • Sitting-To Reduce Dizziness
  • Other tricks
  • Eating

There are some movements you can do that will help prevent getting dizzy or other orthostatic symptoms. You can do them when you start getting symptoms.1-4

Better yet - when you are standing, just start doing one of them, like cross your legs. Then you won't get the symptoms as easy.

In the medical literature and articles on orthostatic intolerance, OH, NMH and POTS, these are called "countermeasures – they help increase blood pressure when you stand up.  They decrease how much blood can pool in your legs. Most of these things are everyday kind of movements. Other people will probably not even notice you are doing them.

  • Cross your legs – cross them over, some call it "scissor legs". Cross them at your thighs, knees or below your knees. Experiment - find the level that works for you so you don't fall over. The higher you cross them, the more they prevent blood pooling.6
  • Stand up on your toes, go back down so your foot is flat, stand up on your toes, go back down.  When you go up on your toes, hold it for 15-30 seconds (count)6
  • Shift your weight from one leg to the other
  • Tighten your thigh muscles at the same time if you can6
  • Slow marking in place6
  • Lean against something
  • Bend forward from the waist – like leaning over a grocery cart3, 6
  • Tighten your abdominal muscles, or any muscles in your abdomen, buttocks, thighs, calf muscles.  Tighten them for 30 seconds, let them go, repeat it. 
  • Stand on one leg and put one foot on a ledge or chair and lean as far forward as possible.5, 6
  • Clench your fists.4  Do it like the other things where you tighten your muscles, then let go , then repeat.
  • Raise your arms up so they are at the level of your shoulders.  Curl your 4 fingers into a C for both hands.  Grip one hand with the other with your fingers.  Then pull so each arm is pulling in opposite directions.  Hold this for 2 minutes.

If none of this works and the orthostatic symptoms get worse, lie down!
If you can't do that, try these:

  • Sit down in a chair, bring your knees up as high as you can, hug them and give them a squeeze.
  • Squat down, put your head down between your knees if you have to.
  • Sit down on the floor and cross your legs.
Emergency Tricks
  • Sit with your knees up to your chest3
  • Sit in a low chair, like a camp chair 3 or a kid's stool
  • Lean forward with your hands on your knees when sitting.3
  • Sit down and raise your legs straight out so they are level with the bottom of your chair (like a recliner or put them on another chair or a foot stool.) 
  • Lean back so you are not sitting up straight.   
  • Sit down on the floor and cross your legs.

Sitting for long periods of time can be an "orthostatic stressor". There are 2 different things to address about sitting up.

1. If you sit up for periods of time for example, at a desk. It is important to not sit still. Blood can pool in your feet and lead to dizziness and orthostatic symptoms when you stand up.

Things to do to reduce the dizziness when you stand up: Wear an abdominal binder or corset and knee-hi support stockings. Move your feet around. Press your toes on the floor, then your heals, like you were rocking back and forth only you're sitting. This works the calf muscles and moves blood back up to your abdomen and chest. Use a footboard or stool under your feet. It will bring more blood back to your abdomen/chest. If you use an angled footboard, it gives you something to push your feet against. If you are not used to sitting up with your feet on the floor, it can stress your body just like standing up. Lean forward for 20 counts, lean back for 20. Do that a couple of times. It will move the blood around. Sit on an exercise ball. They come in sizes that would fit a desk. When you sit on the ball, you need to use more of your core (abdomen and back muscles) to keep your balance. Your body is "actively" sitting when you are on an exercise ball. You can also do little movements - that help move the blood around. You can move your bottom side to side, in small movements. You can move front and back and in circles. Before you stand up, move your feet, rock back and forth. Get the blood moving. You can also try drinking water 15 minutes before you plan to get up.

  • Lying down - hug your knees  - If you have been standing and are getting symptoms, when you lie down, if you bring your knees up to your chest and hug your knees, it will help settle things down faster. This works well after a shower!
  • When you drop something or want to pick something up from the floor, squat down.  Bending over from the waist - creates orthostatic symptoms (especially in the head).
  • Sitting in a high stool (bar stool) - Put your feet on a foot rest on the chair. (Dangling your legs will pool the blood in your feet and make things worse.)
  • While you get up to stand - Take a deep breath and tighten the abdominal muscles while getting up. This helps maintain blood and oxygen flow to the brain.
  • Low BP after eating - this is especially a problem for people with diabetes and autonomic neuropathy. Try eating smaller meals, Hot drinks, hot foods and meals rich in carbohydrates can be more troublesome.1
  • Going up in an elevator - Going up in an elevation, there is more gravity force pushing the blood down to your feet. Do the standing maneuvers to counter it and cut down the pooling in your legs.
  • Changing elevation, like in an airplane - Since you will probably be sitting down when this happens, start with the Water Trick and load up on water and salt before you take off. Then, see which of the sitting tricks you can manage in the airplane seat.

What happens when you eat: When you eat, the blood shifts to your GI system - the gastrointestinal system. The GI system includes the stomach, liver, intestines, pancreas. With this shift in blood, some people get orthostatic symptoms after they eat because the blood is in the abdomen digesting food. It is not all going back to the heart.

GI Symptoms: Many people with OH, NMH and POTS have GI symptoms. People can also get "post-prandial" angina - which is pain in the abdomen ('stomach') after eating. This is due to low blood oxygen getting to the GI system. It's not clear how much is due to autonomic nerve failure, to low blood flow, or both. Sullivan showed that people who have their orthostatic symptoms under better control had fewer GI symptoms.13

Let your gut digest food. It's important to pay attention to eating and activity so that your GI system gets the blood it needs to safely digest your food.

    •  Activity that requires standing and exercise should be done before eating.12

    •  After eating, rest. Do quiet things (e.g. watch TV, read) to your body time to digest food (about 1 hour),12

    •  Eat low cholesterol food and avoid large meals.14

    •  Decrease alcohol intake.12

To reduce night-time high blood pressure (Supine Nocturnal Hypertension) It might help night time blood pressure to eat a small meal high in carbohydrates (pasta, bread, potatoes, rice) before going to bed. 12  This takes advantage of the shift in blood to the gut and lowers the general blood pressure when you are in bed.

The Water Trick!

  1. Figueroa JJ, Basford JR, Low PA. Preventing and treating orthostatic hypotension: As easy as A, B, C. Cleve Clin J Med. 2010 May;77(5):298-306.  Abstract.  Article PDF.
  2. Low PA and Singer W.  Update on Management of Neurogenic Orthostatic Hypotension. Lancet Neurol. 2008 May; 7(5): 451–458. Abstract. Article PDF.
  3. Rowe, Peter.  General Information Brochure on Orthostatic Intolerance and Its Treatment. June 2010. Accessed from http://www.cfids.org/webinar/cfsinfo2010.pdf. Accessed May 28.2012.
  4. Rowe, Peter. Managing Orthostatic Intolerance. Webinar. September 1, 2010. Hosted by CFIDS Association of American. Accessed June 1, 2012.  Written material.  Slides PDF.   Video.
  5. Mayo Clinic Staff. Orthostatic hypotension (postural hypotension).  Lifestyle and Home Remedies. Web Article. Last accessed July 7, 2012
  6. Bouvette CM, McPhee BR, Opfer-Gehrking TL, Low PA.  Role of physical countermaneuvers in the management of orthostatic hypotension: efficacy and biofeedback augmentation. Mayo Clin Proc. 1996 Sep; 71(9):847-53.
  7. Claydon VE, Hainsworth R.   Increased postural sway in control subjects with poor orthostatic tolerance. J Am Coll Cardiol. 2005;46:1309– 1313.
  8. Krediet CT, Dijk N, Linzer M, et al.   Management of vasovagal syncope, controlling or aborting faints by leg crossing and muscle tensing. Circulation. 2002;106:1684 –1689.
  9. Ten Harkel AD, van Lieshout JJ, Wieling W.   Effects of leg muscle pumping and tensing on orthostatic arterial pressure: a study in normal subjects and patients with autonomic failure. Clin Sci (Lond)1994 Nov; 87(5):553-8.
  10. van Dijk N, Quartieri F, Blanc J-J, et al. Effectiveness of physical counterpressure maneuvers in preventing vasovagal syncope. The Physical Counterpressure Manoeuvres Trial (PC-Trial). J Am Coll Cardiol. 2006;48:1652–1657.
  11. van Lieshout JJ, ten Harkel AD, Wieling W. Physical manoeuvres for combating orthostatic dizziness in autonomic failure. Lancet. 1992; 339:897– 898.
  12. Medow MS, Stewart JM, Sanyal S, Mumtaz A, Stca D and Frishman WH. Pathophysiology, Diagnosis, and Treatment of Orthostatic Hypotension and Vasovagal Syncope. Cardiology in Review 2008;16(1):4-20. Abstract.
  13. Sullivan SD, Hanauer J, Rowe PC, Barron DF, Darbari A, Oliva-Hemker M. Gastrointestinal symptoms associated with orthostatic intolerance. J Pediatr Gastroenterol Nutr. 2005 Apr;40(4):425-8. Abstract.
  14. Freeman R, Miyawaki E. The treatment of autonomic dysfunction. J Clin Neurophysiol. 1993;10:61– 82.

Author: Kay E. Jewell, MD
Page Last Updated: May 31, 2012