West Ham’s Sophie Hillyerd on POTS, the condition ‘nobody else can see’

West Ham United goalkeeper Sophie Hillyerd says the last 12 months have been nothing like she’s experienced before.

“Nobody can tell,” she told ESPN. “When you’re having a bad day, they think, ‘Why is she struggling today?’ People say, “Come on, Soph, run,” and I’m like, “I can’t.”

“You just won’t know. You’ll think, ‘She’s lazy, she’s not fit’, but no. I am dealing with something no one else can see.”

For physical injuries: “You know what it is, you have scans and you know what to do to fix it.

“But it was so different. It was unknown.”


In September 2021, Hillyerd began to embark on her professional career, signing for Manchester United’s Charlton Athletic in search of a senior first-team football streak. A COVID outbreak hit her and a large group of her teammates before the start of the season. When the goalkeeper returned to training, she realized something was wrong.

“I was out of breath, but it wasn’t until after three sessions that I realized it wasn’t normal,” Hillyer recalled.

“I had heard of people struggling to play again but there was nothing quite like how I felt with my heart beating so fast. My heart rate went up to 224 [beats per minute]which is ridiculous.”

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For comparison, Hillyerd’s maximum heart rate should have been 202 BPM at this point. Despite her symptoms, tests on her heart returned to normal. At first glance, there was no physical reason to stop training. However, she soon knew the situation was untenable.

“I did a session of crosses. That’s a pretty low intensity,” she explained. “I fell to the ground and I got up and I was like, ‘God, I’m going to faint, I’m going to fall down again.’

“It was more than just daze. The dizziness – I couldn’t get up without feeling faint. I knew something was wrong.

“When I sat in bed at night, all I had was this excruciating pain in my chest and there was no explanation for it. It was so hard not knowing what was going on and such a horrible thing to do with your heart. “

The lack of answers is a common theme among patients with Long COVID. In a Pultizer Prize-winning statement on Long COVID by Ed Yong, patients describe denial or disbelief of their symptoms from friends, family and even medical professionals. However, Hillyerd spoke enthusiastically about Charlton’s medical team, led by Dr. Chris Schoeb and the way they continued to search for answers in the face of inconclusive testing.

“He never gave up,” she said of Dr. Schoeb, and he helped her set up an appointment for the specialist to confirm his suspicion of a condition known as POTS.


Postural Orthostatic Tachycardia Syndrome – POTS – has some tell-tale signs. These include dizziness, brain fog, chest pain, fatigue, and a heart rate that spikes in excess of 30 when standing. It’s also a common diagnosis for people with Long COVID. Most people have never heard of the condition, let alone what the signs are, and it can take months or even years to diagnose.

Exercise physiologist Carlo Sibulo works at the Wellness Station in Melbourne, Australia. He specializes in Chronic Fatigue Syndrome and Myalgic Encephalomyelitis, collectively known as ME/CFS. POTS is known to be related to ME/CFS.

“POTS relates to intolerance to postural changes and an inability to regulate blood volume,” Sibulo told ESPN. “However, both POTS and CFS can stem from the same root cause and therefore share common risk factors.”

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ME/CFS and POTS affect a wide range of people. They’re far from exclusive to Long COVID — they’re also absent from other viral infections. However, in the last 12 months there has been a significant increase in Long-COVID cases at the Sibulo clinic. The most common symptoms that his patients show are fatigue, concentration, memory problems and an intolerance to movement. He explains that this results in “a significant impact on daily life and function.”

Risk factors for developing diseases like ME/CFS and POTS include exposure to a demanding or stressful environment, high activity levels, and certain personality types, including high achievers and caregivers. While everyone is at risk of developing post-viral syndrome, these risk factors will inevitably grip a large number of athletes – something sporting organizations are beginning to become more aware of as the effects of the COVID-19 pandemic continue to reverberate around the world.


Hillyerd’s definitive POTS diagnosis provided her with the answers she was so desperate for and a possible route back to soccer.

While the science remains unclear as to the exact prevalence of POTS in long-COVID patients, there appears to be a clear link. The severity of the symptoms can vary. Some POTS patients report that their condition has forced them to give up work or education. However, the vast majority report an improvement in symptoms with treatment. Many recover either completely or to the extent that their quality of life is no longer affected.

Treatment options include increasing salt intake, staying hydrated, and wearing compression clothing. They may also contain certain heart medications to help with low blood pressure. Hillyerd immediately noticed improvements after implementing the Specialist’s recommendations.

“It’s probably been two to three months before I’ve been able to get back into training since I had that appointment,” she said. “It sounds long, but after having the unknown, it was great for me.”

After re-entering the professional training environment, several changes were required.

“When I was training, I wore compression on my legs to get the blood back up and help the flow of oxygen,” she explained. “I wasn’t allowed to do isometric exercises that involve holding on either – so I can’t do a wall sit, for example, because that just triggers it.

“If my blood is in the wrong place, I get dizzy.”

With the help of these treatments and modifications, Hillyerd has recovered to the point where POTS no longer prevents her from competing daily as a top athlete. She is fit now and firing at West Ham ready for her chance in the FA Women’s Super League.


POTS, like many other ways Long COVID can present itself, is invisible. This means that someone with the syndrome can appear perfectly lucid to the world around them while having any number of symptoms at the same time. It can lead to misunderstandings about how serious an illness is.

While Hillyerd stressed the understanding of the coaching staff at both Charlton and West Ham, she admits it’s enormously difficult to explain.

“Several days after training really hard, I can’t move out of bed, I can’t get up without feeling bad. And there are other things that people don’t talk about – you get stomach pains, headaches, chest pains. The girls around me will have no idea,” she said.

“You just have to manage it yourself somehow and remind yourself that maybe today and tomorrow could be better.”

The unfortunate reality is that more stories like Hillyerd’s are likely to crop up in pro sports for years to come. However, Sibulo offers a hopeful prognosis.

“In my experience, the prognosis for POTS is mostly positive,” he explained. “The key is to receive an appropriate diagnosis, be evaluated and receive a tailored management plan.”

Post-viral conditions like ME/CFS and POTS can be treated and overcome like they were for Hillyerd – but they can’t be if clubs don’t know what to look out for.


It’s amazing to think that Hillyerd is only 19 years old. Although she is yet to play an official game for West Ham, she speaks as if she were already a seasoned professional and the club’s trust in her speaks for her ability between the sticks. Considering goalkeepers are given more years to mature than others, Hillyerd has a good chance of making a name for himself in English football.

“Obviously I want to go to World Cups and play for England in Euro finals and stuff like that,” she mused, “but right now I’m totally focused on the club and doing my best for West Ham, especially after the Rocky year I.”

It’s difficult to overstate the mental and physical challenge of a condition like POTS. Some days those with the syndrome feel like they’re on top of the world, that they can do the same things they could before the disease. Then there’s the crash – they do too much and have more severe symptoms as a result.

A big part of the struggle with recovering from POTS is learning to manage those symptoms. It’s about learning when to stop and having systems that allow you to rest and recover when you need to. Hillyerd emphasized this management throughout our conversation and how much that has improved for them over the past 12 months. Bad days today are a far cry from the bad days of the past.

However, recovery from such a complex illness will rarely be linear — and that’s okay. Doctors like Sibulo emphasize the importance of keeping hope.

“You are not alone. There are many others with POTS or ME/CFS who have been able to return to meaningful athletic participation,” he said. “Respect your symptoms and learn to listen to your body and your limits.”

Stories like Hillyerd’s serve as an example of what is possible. It’s tough and the journey may be long, but it’s possible that careers and lives will return to normal during and after the impact of Long COVID.

Most people suffering from post-viral diseases aim to return to basic activities – walking the dog or mowing the lawn. Knowing that there are examples of elite athletes like Hillyerd living relatively comfortably with the condition offers enormous optimism. She gives a clear message to others who are walking the same path as her – don’t give up.

“Don’t let those bad days get you down because I certainly did. I let them get me down — but I’ve learned not to,” she said. “You have your own techniques. They may take forever to find, but find what works for you because they won’t work for everyone.

“Take it day by day. Be resilient. You will make it.”

https://www.espn.com/soccer/english-womens-super-league/story/4775114/west-hams-sophie-hillyerd-on-potsthe-condition-nobody-else-can-see West Ham’s Sophie Hillyerd on POTS, the condition ‘nobody else can see’

Emma Bowman

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