POTS Disease in Athletes: Navigating the Challenges of Competing with Chronic Illness
Imagine dedicating your life to reaching the pinnacle of your sport, only to find yourself struggling to stay upright after exiting the water. This is the reality faced by British professional triathlete Steph Clutterbuck at the 70.3 in Geelong in March 2026. Captured by TV cameras, the 31-year-old was seen staggering from the swim, clinging to course barriers for support before making her way into transition. This haunting image highlights a condition affecting more athletes than many realize.
Steph Clutterbuck is battling POTS disease—Postural Orthostatic Tachycardia Syndrome—a chronic disorder of the autonomic nervous system that is as brutal as it is invisible. Her story raises critical questions: How do elite athletes compete at the highest level while managing a chronic invisible illness? What strategies actually work? And how can the sports community better support those fighting unseen battles?
Understanding POTS: The Invisible Performance Killer
What Exactly Is POTS?
POTS is a chronic disorder affecting the autonomic nervous system, which controls involuntary functions like heart rate, blood pressure, digestion, and temperature regulation. In individuals with POTS, moving from lying or sitting to standing can trigger a rapid heart rate increase—typically by 30 beats per minute or more within ten minutes of standing. This can result in dizziness, fainting, extreme fatigue, brain fog, and a complete loss of physical function. While these episodes can be managed in everyday life through careful habit management, they can occur during a race for elite endurance athletes, with catastrophic consequences.
Currently, there is no cure for POTS. Management typically involves lifestyle modifications such as increased fluid and salt intake, compression garments, medication, and structured exercise protocols. The condition is often associated with related disorders like Hypermobile Ehlers-Danlos Syndrome (hEDS) and Mast Cell Activation Syndrome (MCAS), complicating diagnosis and treatment.
Why POTS Is Particularly Brutal for Endurance Athletes
The cruel paradox of POTS in sport is that the physical demands of endurance competition—heat, exertion, dehydration, and the transitions of swimming—are precisely the triggers that can send the autonomic nervous system into crisis. During an IRONMAN or 70.3, an athlete's body is under sustained physiological stress for hours. Blood pools in the lower extremities, the body sweats out essential fluids and salts, and core temperature rises, destabilizing an already compromised autonomic system. The sport becomes, in effect, one long POTS trigger.
Clutterbuck has described her dizzy spells during the swim at IRONMAN New Zealand as feeling "like being in a washing machine"—a visceral image conveying the disorienting nature of a POTS episode in a way clinical language cannot.
The Athlete's Dilemma: When Your Body Becomes the Enemy
From Symptoms to the Starting Line—and Back Again
Clutterbuck believes she has lived with POTS for some time, but her symptoms have worsened over the past year. The 2026 season brought matters to a head in the most public and painful way possible. Her opening race at IRONMAN New Zealand in Taupō ended in a DNF—Did Not Finish—after she fell ill during the swim and had to stop during the bike leg. It was a devastating blow for an athlete of her caliber, and she responded with a raw emotional video on Instagram that resonated deeply with athletes and fans alike.
Then came Geelong 70.3, where despite everything—the setback in New Zealand, the weight of an unresolved diagnosis—Clutterbuck lined up again. She finished in 17th place, but the television footage told a story the results sheet could not: a professional athlete fighting with every ounce of determination just to keep moving forward.
"I Can't Keep Going Like This"
"I can't really keep doing this. I can't keep not finishing races; it is not what I am here for. I don't know what is going to be next. I don't know what it is going to look like, but I have a lot of figuring out to do on how to be a professional athlete with POTS because it's not easy, and I don't want to give up. But I can't keep going like this."
These words carry enormous weight, speaking not just to the physical torment of POTS, but to the psychological toll of being a high-achieving athlete whose body is no longer behaving predictably. For someone whose identity, livelihood, and life's work are built around physical performance, the uncertainty is devastating.
The Isolation Factor—Invisible Illness in a Visual Sport
One of the most insidious aspects of a condition like POTS is its invisibility to the outside world. An athlete who looks fine at the start line—who may even post competitive times—can be experiencing internal chaos entirely hidden from spectators, commentators, and even fellow competitors.
Clutterbuck acknowledged this isolation directly, noting that if it were not for others reaching out with "exactly the same experiences," she would have worried it was all in her head.
"If it weren't for others reaching out with exactly the same experiences, I would be so worried it was all in my head," she wrote on Instagram after Geelong.
This sentence underscores why athlete visibility and community support matter profoundly when it comes to invisible chronic conditions.
Medical Management Strategies for Athletic Performance
Current Treatment Approaches for POTS
Managing POTS in a non-athletic population is complex enough. Managing it in a professional endurance athlete—where interventions like increased fluid intake, salt loading, and compression are constantly undermined by training and racing demands—requires a highly individualized approach.
The primary management strategies include:
- Increased fluid intake: Drinking significantly larger volumes of water to increase blood volume and reduce the pooling effect that triggers symptoms.
- Salt loading: Higher sodium intake helps the body retain fluid, supporting blood pressure stability. Athletes can benefit from electrolyte supplements to maintain proper hydration and mineral balance.
- Compression garments: Compression tights or abdominal binders help prevent blood from pooling in the lower body.
- Medication: Beta-blockers, fludrocortisone, and midodrine are among the pharmacological tools available, though their use in competition requires careful navigation of anti-doping regulations.
- Structured exercise protocols: Regular exercise, particularly recumbent exercise like rowing and cycling, is one of the most evidence-supported management strategies for POTS.
The Trial-and-Error Reality
Crucially, there is no universal protocol. What works for one POTS patient may be ineffective or counterproductive for another. For an athlete competing at the elite level, the margin for error is vanishingly small.
Clutterbuck has described her racing as a learning process—each event yielding new data about how her body responds, what triggers the worst episodes, and which management strategies offer even marginal improvements.
"Every race I'm learning. Every race, I'm growing and understanding my body a little better," she wrote after Geelong. "It might feel like I'm getting nowhere, but I know that's not true."
This iterative, race-by-race discovery is genuinely admirable and highlights the critical need for expert sports medicine support to help translate that experiential data into actionable clinical strategy.
The Support Network: Community Response and Professional Help
The Power of Peer Support
One of the most striking aspects of Clutterbuck's situation has been the response from the triathlon community. Far from suffering in isolation, she has been embraced by her fellow professionals—athletes who understand the physical demands of the sport and have responded with overwhelming warmth.
In her post-Geelong Instagram message, she offered an extensive and heartfelt list of acknowledgements:
"To the incredible women I have the fortune of racing with, thank you for all of the care and support you've shown me... @katr_matthews for the endless on-the-ground encouragement, grounding and joy. @gabi_lumkes for everything, honestly, just everything. @tamarajewett for the moments between the races and endless empathy. @dr_hannah_wells for being so welcoming at a particularly low point. @haleychura23 for being the biggest safety net on Ironman New Zealand day. @rhiannehughes for being a slice of home so far from home."
The specificity of that list reveals how carefully and gratefully Clutterbuck has catalogued the moments of human connection that have sustained her. It is a powerful demonstration of what genuine athlete community looks like.
Building the Right Professional Team
Peer support is essential, but it cannot substitute for expert medical care. Athletes managing POTS need a coordinated multi-disciplinary team that might include:
- A cardiologist or autonomic specialist experienced in POTS, ideally familiar with athletic populations.
- A sports medicine physician who can bridge the gap between POTS management protocols and the specific physiological demands of elite triathlon.
- A performance coach willing to adapt training loads and race preparation plans in response to an athlete's fluctuating condition.
- A sports psychologist to help navigate the psychological challenges of chronic illness, including the grief and frustration of DNFs and the anxiety around symptom onset.
Practical Strategies for Athletes Managing Chronic Conditions
Race Day Management
- Pre-hydrate aggressively in the days before racing to maximize blood volume. Consider magnesium complex supplements to support electrolyte balance.
- Salt loading in the 24-48 hours before a race can provide additional support.
- Plan transitions carefully: The shift from horizontal swimming to upright running is a known POTS trigger.
- Know your warning signs and have a pre-agreed plan with race medical staff about when and how to seek support.
Training Adaptations
- Prioritize recumbent exercise during periods of increased symptom severity.
- Build in additional recovery time, recognizing that POTS creates a physiological load above standard training fatigue.
- Monitor heart rate variability as an additional marker of autonomic function and recovery status. A heart rate monitor can be invaluable for tracking these metrics.
- Be willing to modify or abandon sessions when symptoms indicate stress—this is not weakness; it is intelligent management.
Communication and Advocacy
- Inform race medical teams in advance of your condition for appropriate support protocols.
- Keep a symptom and trigger log to identify patterns that can inform medical management and race planning.
- Connect with other athletes managing similar conditions—Clutterbuck's experience demonstrates the profound value of peer support.
The Broader Impact: Changing Sports Culture
Breaking the Stigma of Invisible Illness
Clutterbuck's willingness to speak openly about her POTS diagnosis carries significance far beyond her own career. In a sporting culture that often equates elite performance with physical invincibility, athletes who publicly acknowledge chronic health conditions are challenging a damaging myth.
Her Instagram posts—raw, honest, and refusing to sanitize the difficulty of her experience—have resonated with people far beyond the triathlon community. Athletes across all disciplines have reached out to share their own experiences of POTS and related conditions. That ripple effect is genuinely meaningful.
What Race Organizations Can Do
There is also a structural conversation to be had about how race organizations accommodate athletes with invisible chronic conditions. Current policies generally focus on visible or declared disabilities, but POTS and similar conditions can be both fluctuating and invisible, making fixed accommodation frameworks inadequate.
Greater flexibility in medical support protocols, better training for race medical teams on autonomic conditions, and clearer communication channels for athletes to disclose chronic health issues confidentially would represent meaningful progress.
The Mental Health Dimension
It would be a disservice to Clutterbuck's story—and to anyone else navigating chronic illness in sport—to discuss only the physical management of POTS without acknowledging the profound mental health dimensions involved.
The grief of a DNF, the uncertainty of not knowing whether the next race will bring the same crisis, the fear that your body—the tool you have spent a lifetime sharpening—can no longer be trusted. These are real, legitimate psychological burdens, and they deserve the same attention and care as the physiological symptoms of the condition itself.
Looking Forward: Clutterbuck's Determination and a Promise to Return
After Geelong, Clutterbuck announced she would be stepping back from competition to focus on finding solutions—a courageous and necessary decision.
"My season changes from here. I need to slow down, decompress and spend a bit more time digging into what else can be done. I'll be back on a start line before too long." 🫶
That final line—quiet, determined, undefeated—encapsulates everything remarkable about her approach to this challenge. She is not giving up. She is gathering information, building her team, learning her body, and preparing for the next chapter. And the entire triathlon community is behind her.
Key Takeaways
- POTS (Postural Orthostatic Tachycardia Syndrome) is a chronic disorder that causes rapid heart rate increase upon standing, leading to dizziness, fainting, and severe fatigue—symptoms that conflict with the demands of elite endurance sport.
- Management requires a highly individualized approach, typically combining increased fluid and salt intake, compression garments, medication, and structured exercise protocols.
- The psychological impact of chronic illness in sport is significant and deserves dedicated professional support alongside physical management.
- Community and peer support play a vital role in helping athletes navigate invisible conditions. Read more about inspiring triathlon stories that demonstrate resilience.
- POTS does not have to end an athletic career, but it demands honesty, expert support, adaptability, and the courage to prioritize long-term health over short-term competitive outcomes.
When to Seek Medical Evaluation
If you or an athlete you know experiences the following, a referral to a cardiologist or autonomic specialist is warranted:
- Persistent dizziness or light-headedness upon standing
- Heart rate spikes of 30+ BPM when moving from lying/sitting to standing
- Unexplained fainting or near-fainting episodes
- Chronic fatigue disproportionate to training load
- Brain fog and difficulty concentrating, particularly after standing
Early diagnosis and appropriate management can make a profound difference—both to quality of life and to long-term athletic potential. For athletes looking to optimize their training and recovery, consider exploring AI training apps that can help adapt workouts to your individual needs.
If Steph Clutterbuck's story resonates with you, consider sharing it within your own sporting community. Raising awareness of invisible conditions like POTS is one of the most powerful things we can do to support the athletes fighting battles that nobody else can see.
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