Maybe it started with dizziness. Then your heart began racing every time you stood up. Showers became exhausting. Walking through Target felt like a workout. You started getting headaches, brain fog, nausea, shakiness, temperature changes, or that strange feeling that your body simply couldn’t handle things it used to handle without a second thought. Eventually, someone mentioned POTS. For some people, getting that diagnosis is a huge relief. There’s finally a name for what has been happening. But then comes the next question:
Now what?
Because knowing you have Postural Orthostatic Tachycardia Syndrome can explain the pattern you’re experiencing without necessarily explaining why your body developed that pattern in the first place. At Transform Chiropractic Wellness Center in Shoreview, Minnesota, that’s the part of the conversation we’re especially interested in. POTS is fundamentally connected to the autonomic nervous system. So while symptom management absolutely has its place, we also believe the nervous system itself deserves a much closer look.
What Is POTS?
POTS stands for Postural Orthostatic Tachycardia Syndrome. It is a form of dysautonomia, meaning there is dysfunction within the autonomic nervous system, the part of your nervous system responsible for automatically regulating functions you shouldn’t have to consciously think about. Heart rate. Blood pressure. Blood vessel constriction. Digestion. Sweating. Temperature regulation. Breathing patterns. And many of the physiological changes your body makes when you move from lying down to standing up. When you stand, gravity immediately pulls blood toward your lower body. Your nervous system has to recognize that change and coordinate a rapid response to maintain adequate circulation. With POTS, that response isn’t working normally. Clinically, POTS involves chronic symptoms of orthostatic intolerance along with an excessive increase in heart rate when upright, without the sustained drop in blood pressure that defines orthostatic hypotension. Other causes of tachycardia also need to be ruled out before POTS is diagnosed, but the racing heart is only one piece.
POTS Can Feel Like Your Whole Body Is Struggling
One reason POTS can be so confusing is that it doesn’t always feel like one condition.
Someone may experience:
- A racing or pounding heart after standing
- Dizziness or lightheadedness
- Near-fainting or fainting
- Extreme fatigue
- Exercise intolerance
- Brain fog and difficulty concentrating
- Headaches or migraines
- Shakiness or tremors
- Shortness of breath
- Chest discomfort or palpitations
- Nausea, abdominal discomfort, or digestive changes
- Abnormal sweating
- Difficulty regulating temperature
- Weakness
- Sleep disturbances
- Symptoms that worsen with heat, prolonged standing, illness, or physical exertion
And the severity varies tremendously. One person with POTS may still be working, exercising, and functioning fairly normally while constantly managing symptoms in the background. Another may struggle to attend school, work a full day, shower standing up, exercise, or participate in activities they used to love. That variability is important.
POTS isn’t one identical problem happening to every person who receives the diagnosis.
Current research describes POTS as a complex, multifactorial autonomic disorder. Different people may have neuropathic, hyperadrenergic, hypovolemic, or overlapping patterns, and POTS can occur alongside other health conditions. Which is exactly why we’re cautious when someone says they’ve found the single root cause of POTS. There usually isn’t one universal answer.
But There Is a Common Thread: The Autonomic Nervous System
This is where we want to connect some dots. Your autonomic nervous system has two major branches that constantly work together. The sympathetic nervous system helps mobilize the body. Think alertness, action, increased heart rate, increased blood flow to muscles, and the physiological response commonly called “fight or flight.” The parasympathetic nervous system supports regulation, digestion, recovery, and restoration. Neither side is bad. You need both. The goal isn’t to live permanently in a parasympathetic state. It’s to have a nervous system capable of moving appropriately between different states based on what your body needs. Standing up is a perfect example. Your body shouldn’t have to think: Okay, I’m standing now. Better change my vascular tone, adjust my heart rate, maintain blood flow to my brain, and keep my blood pressure where it needs to be. Your nervous system handles that automatically. When that regulatory system isn’t adapting appropriately, standing can suddenly become a major physiological event. That changes the question we ask about POTS.
Instead of looking only at:
How do we get the heart rate down?
We also want to ask:
Why is this person’s nervous system having such a difficult time adapting to something as ordinary as standing?
Managing POTS Symptoms and Looking Deeper Can Happen at the Same Time
People with POTS are often told to increase fluids and sodium, wear compression garments, avoid known triggers, gradually increase appropriate physical conditioning, or use medications to address specific physiological problems. Those recommendations aren’t meaningless. In fact, increased fluid and sodium intake, compression, and carefully structured physical reconditioning are among the established first-line management strategies for many people with POTS. Depending on the individual, medications may also be appropriate. But managing a symptom and investigating the larger dysfunction aren’t mutually exclusive. Medication that helps control tachycardia may allow someone to function better while their healthcare team continues investigating contributing factors. Electrolytes may help support blood volume. Compression garments can help reduce blood pooling. Appropriately prescribed movement may gradually improve cardiovascular conditioning. Those can all be valuable tools. But for someone who has spent months or years trying to manage symptoms and still feels like nobody has explained why their system became so dysregulated, there’s another conversation worth having. What happened to the body’s ability to adapt? That’s where our work at Transform begins.
POTS Usually Isn’t a One-Event Story
When someone comes into our Shoreview office with POTS or another form of dysautonomia, we don’t expect every history to look the same. Some people remember exactly when things changed.
They were sick.
They had surgery.
They experienced an injury.
They went through a particularly stressful season.
Symptoms appeared during adolescence or after another major physiological transition.
For others, there wasn’t one obvious starting point. Looking backward reveals a nervous system that may have been struggling with adaptability for years before the most recognizable POTS symptoms appeared. Research supports the idea that POTS can arise through multiple mechanisms and can occur after infections or alongside autoimmune, neurological, connective-tissue, and other conditions. Deconditioning can also contribute to the physiological picture, although it shouldn’t automatically be assumed to be the original cause of someone’s illness. At Transform, we sometimes use the term “Perfect Storm” to describe this broader history. It doesn’t mean one event caused POTS. It means we’re interested in the accumulation of stressors and the individual’s response to them. Genetics may matter. Illness may matter. Injury may matter. Sleep, inflammation, nutrition, emotional stress, physical stress, hormonal changes, neurodevelopment, conditioning, and other health conditions may all be pieces of an individual’s story. The combination can look completely different from one person to another. And that matters when we’re deciding what support should look like.
Why We Look at the Neurospinal System, Too
The autonomic nervous system doesn’t operate independently from the rest of the nervous system. Your brain is continuously receiving sensory information about what’s happening inside and outside your body. One important source of that information is proprioception—the sensory input that tells your brain where your body is in space and how it’s moving. Your joints, muscles, spine, vestibular system, visual system, and other sensory systems contribute information your brain uses to coordinate movement and physiological responses. This is one reason neurologically focused chiropractors pay close attention to the spine and the sensory information associated with movement. At Transform, we’re interested in areas of neurospinal stress and how effectively the nervous system appears to be adapting and regulating. That does not mean a spinal misalignment has been proven to cause POTS. And it doesn’t mean adjusting someone’s spine is a treatment or cure for POTS. The evidence for chiropractic care as a treatment for POTS specifically is limited, and we think patients deserve to know that. Our role is different. We use neurologically focused chiropractic care to address neurospinal function and support the nervous system’s ability to adapt and regulate. For someone whose primary diagnosis involves autonomic dysfunction, we believe evaluating that neurological foundation can be an important part of a broader care strategy.
With POTS, Sequence Matters
This may be one of the most overlooked parts of the conversation. When the body is struggling with regulation, it’s tempting to throw everything at it.
New supplements.
A new diet.
A new exercise program.
More electrolytes.
Functional medicine.
Physical therapy.
Another specialist.
Another protocol someone on the internet swears changed their life.
Some of those things may ultimately be incredibly helpful, but a dysregulated system doesn’t always respond well to more. Sometimes it needs the right support in the right order, and there isn’t one sequence that works for every person with POTS. For some patients, medical stabilization has to come first. Someone experiencing significant fainting, cardiac symptoms, dehydration, severe functional decline, or unexplained tachycardia needs appropriate medical evaluation. POTS can also overlap with other conditions that need to be identified rather than assuming every symptom is “just dysautonomia.” From there, foundational support may include adequate fluids and electrolytes, sleep, nutrition, compression, pacing, carefully progressed movement or rehabilitation, and appropriate medical management. For some patients, nervous-system regulation and neurospinal care may be another part of that foundation. As capacity improves, additional layers of support can be added based on what that particular person needs. That’s what we mean when we talk about a sequential approach to healing. We aren’t trying to make every person follow the same protocol. We’re trying to understand what their system can handle right now, what foundational pieces may be missing, and what should logically come next.
Why “Just Exercise More” Doesn’t Work for Everyone
Exercise deserves a special mention because people with POTS often receive wildly conflicting advice about it. Physical reconditioning is an important part of established POTS management and can improve orthostatic heart rate and quality of life for many patients. Programs often begin with recumbent or horizontal exercise before gradually progressing toward upright activity. But tolerance matters. A person who is significantly dysregulated may not be able to jump straight into a conventional exercise program. And some patients experience substantial post-exertional worsening, particularly when POTS overlaps with conditions characterized by post-exertional malaise. In those situations, individualized pacing and gentler movement may be more appropriate than simply pushing harder. This is another example of why the diagnosis alone can’t tell you exactly what your next step should be. The person matters.
What We Evaluate at Transform Chiropractic
When someone comes to Transform Chiropractic Wellness Center with POTS or dysautonomia, we want to understand much more than their heart rate. We start with their history. When did symptoms begin? Was there an obvious trigger? What was happening before that? How are they sleeping? What happens with exercise? How do they respond to physical, emotional, and environmental stress? Are there digestive, sensory, hormonal, immune, migraine, pain, or other neurological patterns occurring alongside the POTS symptoms? What has helped? What makes things worse? What other providers are involved? Then we evaluate the nervous system and neurospinal system. One of the tools we use is INSiGHT scanning technology, which can include heart rate variability (HRV), thermal scanning, and surface electromyography (sEMG). These scans don’t diagnose POTS. They also don’t tell us that chiropractic can cure it. They give us objective information about physiological patterns we can use alongside the patient’s history and examination to better understand nervous-system function and neurospinal stress. For us, that’s an important difference. We’re not simply asking, “Do you have POTS?” We’re asking: “What does your nervous system look like?”
Where Does Chiropractic Fit Into POTS Care?
Neurologically focused chiropractic care at Transform is directed toward neurospinal function, regulation, and adaptability. We do not treat or cure POTS. We also don’t ask patients to abandon their cardiologist, neurologist, primary care provider, physical therapist, functional medicine provider, medication, or other appropriate care. POTS is complex enough that collaborative care often makes sense. What we can bring to that team is a very specific lens. We look closely at how the nervous system is functioning, how much stress appears to be present within the neurospinal system, how the patient is adapting, and how those patterns change over time. Then we use gentle, specific chiropractic adjustments based on that individual’s findings. And we reassess. Because if we’re talking about restoration, we want more than assumptions. We want to see how the nervous system is changing as the person moves through care.
What Does Healing From Dysautonomia Actually Look Like?
This is where we have to be careful with the word healing. Healing doesn’t mean promising that POTS will disappear. It doesn’t mean every patient gets off medication. It doesn’t mean there’s a three-month protocol that works for everybody. And it certainly isn’t always linear. A better goal is to help the body build capacity. Capacity to stand longer. Capacity to tolerate movement. Capacity to recover after stress. Capacity to sleep and restore. Capacity to handle a busy day without paying for it for three days afterward. Capacity to move between activation and recovery more appropriately. For someone who has been living in an extremely narrow physiological window, increasing that capacity can matter tremendously. But how you get there will depend on why your system is struggling. That’s why we’re much more interested in individualized restoration than another one-size-fits-all POTS protocol.
Looking for POTS or Dysautonomia Support in Shoreview, Minnesota?
If you’ve been diagnosed with POTS, or you suspect dysautonomia may be part of what you’re experiencing, getting the diagnosis can be an important step. But it doesn’t have to be the last question you ask. There may still be value in understanding the broader pattern: your history, your triggers, your autonomic nervous system, your neurospinal function, your current capacity, and the other factors that may be contributing to what you’re experiencing. At Transform Chiropractic Wellness Center in Shoreview, Minnesota, we work with individuals and families throughout Shoreview, Arden Hills, North Oaks, Vadnais Heights, Roseville, New Brighton, St. Paul, and the greater Twin Cities who are looking for a nervous-system-focused perspective on their health. Our goal isn’t to replace the rest of your care team or promise that chiropractic will cure POTS. It’s to help you better understand the nervous system underneath the symptoms, objectively evaluate how it’s functioning, and determine whether neurologically focused chiropractic care makes sense as part of your bigger plan. Because with a condition as complex as dysautonomia, the question usually isn’t: “What’s the one thing that fixes this?” A better question is: “What does my nervous system need next?”