By Millie Brecheisen, physiotherapist in Basel. Updated: 1 October 2026.
Your vision going dark when you stand up is different from the room spinning when you lie down. Yet both are often called dizziness. For symptoms on standing, the trigger, duration and associated signs are much more informative than that single label.
Not all dizziness comes from the inner ear
Someone may describe dizziness on standing when they actually mean light-headedness, darkening vision, palpitations or feeling close to fainting. This pattern points towards a circulatory or autonomic cause rather than typical BPPV. Distinguishing spinning, unsteadiness and presyncope is therefore essential.
Orthostatic hypotension
Classical orthostatic hypotension is a sustained fall in systolic blood pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg within three minutes of standing. A 2024 position statement notes that it is common, particularly in older people and certain neurological populations [1]. Medicines, dehydration, autonomic dysfunction and other causes may contribute.
What about POTS?
Postural orthostatic tachycardia syndrome, or POTS, is a form of dysautonomia in which heart rate rises excessively when standing without classical orthostatic hypotension. Symptoms can include palpitations, fatigue, brain fog, feeling faint and exercise intolerance. Medical diagnosis requires specific criteria; a pulse that rises after standing is not enough on its own.
Why does this matter in physiotherapy?
A simple orthostatic assessment or Schellong test can provide clues, but results need interpretation in their clinical context. Physiotherapy can contribute to gradual reconditioning and education about exercise once the diagnosis is established. Reviews from 2024 suggest that individualised exercise programmes may improve some measures and quality of life in POTS, while noting that many people do not tolerate overly rigid programmes [2].
Non-pharmacological measures are important in orthostatic hypotension, but the strategy depends on coexisting conditions and should be coordinated with the doctor [3].
When vestibular assessment is still useful
Dysautonomia does not rule out a vestibular disorder. Some people have several causes of dizziness. If symptoms also occur while sitting, during head movements or in busy visual environments, the assessment should be broadened.
Clinical clues that guide the assessment
When appropriate, blood pressure and heart rate are measured after resting and then on standing. A fall of at least 20 mmHg systolic or 10 mmHg diastolic within three minutes meets the classical orthostatic hypotension threshold. POTS requires different criteria and a medical diagnosis; a single episode of tachycardia is insufficient.
What makes an orthostatic measurement useful?
One measurement may not be enough. The doctor considers symptoms, medicines, the preceding rest period and changes in pulse and blood pressure after standing.
- Describe how soon you feel unwell after standing and what relieves it.
- Mention palpitations, loss of consciousness and recent changes in medication.
- Arrange a supervised measurement if the risk of falling or fainting makes testing difficult.
Salt intake, hydration and compression are not recommended in the same way for everyone. The plan depends particularly on cardiovascular health and medical advice.
An individual assessment in Basel
A physiotherapy assessment in Basel can identify a possible orthostatic contribution and direct you to a doctor when needed. Once the diagnosis is established, adapted reconditioning may have a role. Mention episodes of loss of consciousness or palpitations when booking your appointment.
Frequently asked questions
Why does my vision go dark when I stand up?
A temporary reduction in blood flow to the brain can cause grey or dark vision and a faint feeling. This warrants an orthostatic assessment.
Is POTS vestibular dizziness?
No. It is an autonomic disorder. However, someone with POTS may use the word dizziness to describe their symptoms.
Does exercise always help?
Exercise can be useful but needs to be individualised. Some people need a very gradual start, sometimes in a semi-reclined position or on a bicycle.
Related articles
- Dizziness and vestibular rehabilitation in Basel
- Dizziness during sport: understanding the causes and choosing an assessment
- Balance problems: feeling unsteady without spinning vertigo
- Dizziness after concussion: vestibular, visual, neck or exercise related?
Scientific references
[1] Vidal-Petiot E et al. Orthostatic hypotension: Review and expert position statement. Revue Neurologique, 2024 (published online in 2023). Read the reference on PubMed.
[2] The use and effectiveness of exercise for managing POTS in young adults: scoping review. 2024. Read the reference on PubMed.
[3] Kulkarni S et al. Treating Lows: Management of Orthostatic Hypotension. Journal of Cardiovascular Pharmacology, 2024. Read the reference on PubMed.
This information explains possible mechanisms and rehabilitation options. Diagnosis and treatment depend on an individual assessment.
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