POTS - Uncovering the Hidden Root Cause
Living with Postural Orthostatic Tachycardia Syndrome (POTS) can feel like an uphill battle—like riding a roller coaster you never signed up for. Even on good days, there’s often a lingering fear that one small change in movement, stress, or even the weather could trigger another episode.
Now imagine your teenage daughter struggling to get out of bed every morning. She feels dizzy and lightheaded every time she stands. School becomes overwhelming. Sports and social activities fall away. After countless doctor visits and tests, you’re left without clear answers—watching helplessly as your once vibrant child’s life is put on hold.
This is the daily reality for an estimated one to three million Americans living with POTS. It’s a complex condition involving the autonomic nervous system, characterized by an abnormally rapid heart rate when moving from sitting or lying down to standing. Symptoms can range from mild to completely debilitating, often disrupting daily life, education, work, and relationships.
Unfortunately, POTS is frequently misunderstood or misdiagnosed. While medications may help manage symptoms, they often fail to address the underlying cause, leaving patients and families frustrated and searching for answers.
But what if there’s a missing piece of the POTS puzzle?
Emerging research suggests that understanding POTS—especially in children—requires looking deeper at the relationship between the brain, nervous system, and body. By examining the neurophysiology behind POTS, we can uncover root-cause dysfunctions that are often overlooked in conventional healthcare.
In this article, we’ll explore how factors like nervous system dysregulation, neurological interference, and proprioception play a critical role in POTS—and why understanding these concepts may be key to achieving better, longer-lasting results.
Understanding POTS
Postural Orthostatic Tachycardia Syndrome (POTS) is a form of autonomic dysfunction marked by an abnormal increase in heart rate upon standing.
Diagnostic criteria include:
A heart rate increase of 30 beats per minute (bpm) or more within 10 minutes of standing (adults)
A 40 bpm or more increase in children and adolescents
No significant drop in blood pressure (orthostatic hypotension)
Common POTS Symptoms
People with POTS may experience a wide range of symptoms, including:
Dizziness or lightheadedness
Fatigue and weakness
Headaches
Brain fog and difficulty concentrating
Heart palpitations
Tremors or shaking
Nausea and digestive issues
Heat intolerance
Sleep disturbances
For many, these symptoms are life-altering. Simple tasks—getting out of bed, showering, or preparing a meal—can feel overwhelming. Students may miss school or fall behind academically. Adults may struggle to maintain employment or care for their families.
Beyond the physical symptoms, POTS often takes an emotional toll. Anxiety, depression, and social isolation are common, fueled by exhaustion and the unpredictable nature of flare-ups.
Historically, POTS has gone by several names, including DaCosta’s Syndrome, Soldier’s Heart, and Chronic Orthostatic Intolerance. In 1993, researchers at the Mayo Clinic formally coined the term Postural Orthostatic Tachycardia Syndrome.
Types of POTS
Researchers now recognize several POTS subtypes:
Neuropathic POTS – linked to peripheral nerve damage
Hyperadrenergic POTS – associated with elevated norepinephrine levels
Hypovolemic POTS – related to low blood volume
Autoimmune-associated POTS – commonly seen alongside conditions like Sjögren’s syndrome or lupus
While “autoimmune POTS” isn’t a formal subtype, studies show that roughly 20% of POTS patients have a diagnosed autoimmune condition.
Understanding these variations is essential for developing personalized care plans—rather than relying solely on medications or advice like “stand up more slowly.”
Common Misconceptions About POTS
“POTS Is Just Anxiety”
One of the most damaging myths about POTS is that it’s caused by anxiety. While symptoms like rapid heart rate and palpitations may resemble anxiety, research clearly shows that POTS is a physiological condition, not a psychological one.
In fact, POTS patients are no more likely to have anxiety than the general population. When anxiety does occur, it’s often a result of living with POTS, not the cause.
“Medication Alone Is Enough”
Medications such as beta-blockers or fludrocortisone can reduce symptoms, but they rarely address the underlying dysfunction. Over time, patients may find themselves stuck in a cycle of symptom management without true improvement.
This highlights the need for a broader, more integrative approach—one that views POTS as a sign of deeper imbalance within the body’s regulatory systems.
A more comprehensive perspective considers:
The interaction between the nervous system, cardiovascular system, and sensory input
The role of proprioception, spinal alignment, the brainstem, and cerebellum
Contributing factors like cervical instability, genetics, and environmental triggers
Neurologically-focused interventions aimed at restoring autonomic balance
The Autonomic Nervous System and POTS
The autonomic nervous system (ANS) controls involuntary functions like heart rate, blood pressure, digestion, and temperature regulation.
It has two primary branches:
Sympathetic Nervous System (SNS) – the “fight or flight” response
Parasympathetic Nervous System (PNS) – responsible for rest, regulation, and recovery
In a healthy system, these two branches work together seamlessly. In POTS, that balance breaks down—a condition known as dysautonomia.
Think of the SNS as the gas pedal and the PNS as the brake. In POTS, the gas pedal is stuck, while the brake is exhausted. This complicated interaction does not allow for proper vagus nerve activation. The result is excessive heart rate increases, poor blood vessel regulation, and inadequate blood flow to the brain when standing.
This dysfunction also affects:
Digestion
Temperature regulation
Sleep quality
Compounding this issue is neurological interference, which disrupts normal proprioceptive and sensory input to the spinal cord, brainstem, and cerebellum. Because neurological interference doesn’t appear on standard medical tests, it’s often overlooked—even in holistic care.
The “Perfect Storm” Behind POTS
POTS rarely develops from a single cause. Instead, it often arises from a combination of factors, including:
Genetic predisposition (about 14% have a family history)
Viral infections such as mono or influenza
Chronic physical or emotional stress
Hormonal changes, especially during adolescence
Autoimmune conditions
Physical deconditioning from prolonged illness or inactivity
Over time, these factors can compound, creating widespread autonomic dysfunction.
The Neurological Roots of POTS
Emerging research points to the central nervous system, particularly the brainstem and upper cervical spine, as a key driver of POTS.
Studies have identified:
Reduced gray matter in the medulla oblongata
Altered brainstem connectivity
Impaired communication between the brain and peripheral nerves
Cervical instability or misalignment can further disrupt nerve and blood vessel communication in this critical region, leading to cervical dysautonomia. Chronic tension in the neck, shoulders, and upper back is strongly correlated with these neurological triggers.
Neurologically-Focused Chiropractic Care for POTS
Neurologically-Focused Chiropractic Care is a gentle, all-natural approach designed to restore balance within the nervous system by addressing neurological interference and dysregulation.
Evaluation may include:
INSiGHT Scans to assess nervous system activity
Precision imaging to identify instability or misalignment
Autonomic response testing
By addressing the neurological root of POTS, many patients experience meaningful improvements in symptoms and daily function.
Lifestyle Support for POTS
Chiropractic care works best when paired with supportive lifestyle strategies, such as:
Adequate hydration and electrolytes
Increased salt and mineral intake (when appropriate)
Compression garments
Recumbent or low-impact exercise
Whole-food nutrition
Stress-reduction practices like breathing or meditation
Together, these strategies form a strong foundation for long-term improvement.
Hope, Healing, and Empowerment
While there is no single cure for POTS, many patients see significant improvement when care focuses on root-cause neurological regulation rather than symptom suppression.
Education, validation, and support are essential. Living with an invisible condition can be isolating—but patients don’t have to navigate it alone.
If you’re ready to explore this approach and receive help, contact us to learn how to get started. Our team is here to support you with compassion and expertise every step of the way.