Counter-Pressure Maneuvers

In order to decrease orthostatic symptoms due to low blood pressure, positions to increase or maintain blood pressure, otherwise called counter-pressure maneuvers, may be helpful. ¹ ² ³ ⁴.

Below are examples and descriptions of the three types of counter-pressure maneuvers.

Isometric counter-pressure maneuvers ⁵ (holding a position by tensing large muscles) Description
Leg crossing with muscle tensing Crossing of legs combined with tensing, or tightening, of the leg, abdominal, and buttock muscles
whole-body tensing Tensing, or tightening, of the arm, leg, abdominal, and buttock muscles
Buttocks clenching Tensing, or tightening, of the buttocks muscles
Positional counter-pressure maneuvers ⁶ Description
Bending over as if to tie shoelaces While sitting, bend over at the hips and reach for toes
Squatting Bending the knees and hips in a squatting position
Dynamic Muscle Pumping counter-pressure maneuvers ⁷ (moving the body in a way that uses muscles to pump the blood) Description
Heel raises/ toe extension While sitting or standing, lift up heels and/or toes
Marching in place While sitting or standing, march in place by lifting feet off the ground
Postural swaying While standing, shift weight back and forth from one leg to the other

While these maneuvers can be helpful in decreasing symptoms of orthostatic intolerance in some individuals, they might not be able to completely prevent a syncopal event, especially if not initiated early enough.

If symptoms persist and worsen to the point where you feel like you are going to faint, it is best to try and sit, lie down, or get into a safe position to prevent injury in the event of passing out.

Reviewed by Medical Content Experts, 2021


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