How Your Chiropractor Can Help With POTS

If you or someone you love has been diagnosed with POTS, you know just how debilitating it is. Moreover, you’ve likely been told, “We don’t know how you developed POTS. We don’t know if it will ever go away. There’s no cure, but we can try to manage the symptoms through lifestyle changes and medications.” Certainly not the words you were hoping to hear. Many POTS patients are left feeling discouraged, hopeless, and alone. 

Unfortunately, many doctors don’t fully understand this complex condition. As a result, they miss the opportunity to help heal the body by neglecting to address the root cause. Instead, they often make matters worse by prescribing unhelpful medication with dangerous side effects. 

While there are multiple causes and triggers for POTS, the underlying problem is often the same: a dysfunctional nervous system. Thankfully, chiropractors are highly trained and qualified brain, spine, and nervous systems experts. Ensuring you have an excellent chiropractor on your health care team will bring you one step closer to healing from POTS. 

What is POTS?  

POTS is a type of dysautonomia that impacts how blood flows through the body. Dysautonomia is a term used to describe a malfunction of the autonomic nervous system (ANS). Without thinking about it, this part of the nervous system regulates essential bodily functions such as breathing, digestion, heart rate, and blood pressure. 

POTS is short for Postural Orthostatic Tachycardia Syndrome. As the name suggests, POTS is not a disease but a collection of symptoms that frequently appear together. Syndromes are often challenging to treat because they don’t always have a clear cause, course, or underlying process. 

When an individual changes positions – either from lying down to sitting or sitting to standing – the force of gravity pulls blood down towards the lower body. The heart rate speeds up for about 10-15 seconds to keep the heart and brain adequately supplied with blood. Then, blood vessels constrict, and the heart rate returns to normal. 

For people with POTS, this mechanism is broken. Blood pools in the lower extremities and the heart races to move that blood to the brain and heart. An individual is diagnosed with POTS if, within 10 minutes of standing, their: 

  • Heart rate increases by at least 30 beats per minute
  • Heart rate is greater than 120 beats per minute
  • Blood pressure does not fall significantly when upright 

With this syndrome, a person will often experience dizziness, lightheadedness, and extreme fatigue. Individuals will sometimes faint due to the lack of blood in the brain and heart. Other commonly reported symptoms include: 

  • Heart palpitations 
  • Racing heart 
  • Chest pain 
  • Headache
  • Nervous, jittery, or anxious feeling 
  • Nausea
  • Abdominal pain or bloating 
  • Generalized chronic pain 
  • Temperature dysregulation (feeling hot or cold) 
  • Excessive or lack of sweating 
  • Shortness of breath
  • Insomnia
  • Brain fog
  • Weakness
  • Bladder dysfunction
  • Tremors
  • Exercise intolerance

POTS is often misdiagnosed as anxiety. After all, many of the symptoms overlap. Both conditions often lead to racing hearts, skipped beats, sweating, and a sense of fear or doom. Only when symptoms worsen and patients become more persistent are they properly diagnosed. 

Three types of POTS 

While POTS comes in many shapes and forms, there are three predominant ways POTS develops. Interestingly, all three have nervous system involvement. 

  • Neuropathic POTS 

Neuropathic POTS occurs due to a loss of nerve function in the body. Because the nerves are not working correctly, blood vessels don’t get the message to tighten when the body changes position. 

  • Hyperadrenergic POTS 

Hyperadrenergic POTS occurs as a result of an overactive sympathetic nervous system. Up to 60 percent of individuals with this type of POTS have high levels of the stress hormone norepinephrine circulating in their blood upon standing.  

  • Hypovolemic POTS

Hypovolemic POTS occurs due to low blood volume, which may result from bleeding, dehydration, or anemia. 

Understanding the nervous system 

When thinking about breathing, the lungs come to mind. When thinking about blood pressure, we think of the heart. And while those organs do indeed control those bodily functions, there’s a centralized command center telling our body what to do. The nervous system is, quite literally, the brain behind the machine. 

The nervous system includes the brain, the spinal cord, and an extensive network of nerves. The central nervous system (CNS) consists of the brain and spinal cord, whereas the peripheral nervous system (PNS) includes all the smaller nerves that branch out from the CNS. Much like your home’s electrical wires, these nerves send and receive electrical and chemical signals throughout the body.

The PNS can be divided further into the somatic nervous and autonomic nervous systems. The somatic nervous system is the voluntary nerve system under our control. For example, it tells us to pull our hands away from a hot stove. Conversely, the autonomic nervous system controls bodily functions without our thought. It’s the system that regulates heart rate, breathing, and digestion.

The autonomic nervous system is responsible for how the body handles stress. For example, if we encounter a scary situation, the sympathetic nervous system kicks in, alerting us to danger. As a result, pupils dilate, the heart rate accelerates, and blood shunts to the extremities, preparing us to run. If you’ve heard the heroic stories of a person lifting a heavy object, like a car, in an emergency, this is the sympathetic nervous system at work. 

On the other hand, the parasympathetic nervous system returns the body to a calm and composed state when the danger has passed. Subsequently, the heart rate and breathing slow, blood returns to the stomach, and pupils normalize. 

The relationship between POTS and the nervous system

When people have problems that cause cardiac intolerance with standing up, there is often a problem somewhere in their autonomic nervous system. With POTS, the autonomic nervous system is not controlling heart rate as it usually does. 

Because the autonomic nervous system helps circulate blood through the body, any dysfunction can cause various symptoms. Without properly circulating blood, tissues and organs are starved of life-giving oxygen and nutrients. 

Spinal misalignment as a source of nervous system dysfunction

The nerves flow from the brain down the back, enclosed in the spinal cord and protected by the hard bones of the spinal column, also called vertebrae. Pairs of nerves exit the vertebrae at each level of the spine. The nerves must have sufficient room between each spinal bone to exit appropriately. 

When the vertebrae are not lined up perfectly, it stresses the spinal nerves, surrounding blood vessels, and muscles. Various factors can cause vertebrae to move out of alignment, which a chiropractor refers to as a subluxation.

Compression of these nerve roots can cause interference in how the body functions. For example, compression of the nerves in the neck can cause problems with the heart, especially if the vagus nerve is impacted. 

Interestingly, studies have found a link between common spinal problems and POTS. For example, POTS commonly appears after a concussion or whiplash injury. Additionally, it’s not uncommon for POTS symptoms to develop after a trauma such as a car accident or a fall.  

The vagus nerve and POTS

Latin for “wandering,” the vagus nerve is the longest in the autonomic nervous system. As the main component of the parasympathetic nervous system, the vagus nerve is responsible for keeping heart rate, blood pressure, breathing, digestion, and relaxation in check. A vital vagus nerve naturally slows the heart rate and blood pressure. 

Wrapped in the carotid sheath, the vagus nerve runs down the neck right in front of the cervical vertebrae. Individuals with cervical instability or a forward head posture may compress the vagus nerve. 

Blocked vagus nerve impulses may be a contributing factor in POTS. When the vagus nerve is compressed, the messages from the nerve misfire, causing the sympathetic nervous system to step into action. Suddenly the classic POTS symptoms of tachycardia, dizziness, and fatigue appear.  

A chronically activated sympathetic nervous system results in inflammation in the body. Perhaps that is why it has been implicated in developing dysautonomic conditions such as POTS. 

Studies have found that POTS patients often have vagus nerve abnormalities. Moreover, studies have found that vagus nerve stimulation improves symptoms for individuals with POTS.  

How do I know if my vagus nerve is working properly?

If you care about fitness, you know that having “toned” muscles means you are strong. The same is true for your vagus nerve — strong vagal tone equates to a healthier body.

Vagal tone is measured by a heart-rate variability (HRV) test. This non-invasive test examines the variation of time that occurs between each heartbeat. Those with a robust vagal tone have high HRV. 

Studies have found that individuals with POTS often have poor vagal tone compared to healthy individuals. 

How can a chiropractor help heal my POTS?

By now, it should be evident that POTS is a neurologic condition that often results from nerve dysfunction or an agitated sympathetic response. Chiropractic adjustments are known to positively impact the nervous system, helping bring the body back into balance. 

Chiropractic care can reduce or alleviate POTS symptoms by: 

  • Removing upper cervical subluxations
  • Restoring proper structural and neurological function in the spine
  • Strengthening vagal tone 
  • Balancing the parasympathetic and sympathetic nervous systems

By removing subluxations in the spine, the autonomic nervous system can regulate itself, thus healing the body. A balanced nervous system helps improve nerve function, reduce inflammation, and naturally lower the elevated heart rate in POTS patients. 

Next steps

If you or someone you love suffers from POTS, you’ve likely seen many doctors. You may have a cardiologist, a neurologist, and a general practitioner on your healthcare team. But, do you have a chiropractor? If not, find one today and get on their schedule.

Healing from a complicated syndrome such as POTS requires a holistic approach. Optimizing your nervous system gives you the best chance of recovering from POTS for good. Schedule a free call with an NHD health coach for further lifestyle strategies that work alongside chiropractic care to enable your body to heal from POTS.

Eat well, Live well, Think well


Medical Review: Dr. Lauren Lattanza 2022

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