11/22/2025
When “it’s just your heart” isn’t the whole story — understanding how the neck can influence Postural Orthostatic Tachycardia Syndrome (POTS)
In working with veterans, trauma survivors, and patients living with complex pain and dysfunction, one of the most under-recognized connections I encounter is the one between the upper cervical spine and autonomic dysfunction — including POTS.
Traditionally, POTS is viewed as a dysautonomia: excessive heart-rate rise upon standing, dizziness, fatigue, brain-fog, palpitations. But emerging structural models are offering additional insight. For example:
Research from Caring Medical & Rehabilitation Services describes how instability of the cervical spine can alter signals in the vagus nerve and baroreceptors — contributing to the classic POTS pattern of orthostatic intolerance.
A recent case report detailed a patient with POTS, dizziness and upper cervical instability who improved when the cervical spine was managed conservatively (manual therapy + stabilization) rather than exclusively via cardiovascular meds.
Upper cervical misalignment (especially at C1-C2) lies very close to the brainstem and autonomic centers, meaning that structural dysfunction may contribute to impaired autonomic regulation.
Why this matters for chiropractic care:
As a chiropractor with advanced training in spinal biomechanics, trauma, MRI interpretation and crash dynamics, I’ve found the following key clinical insights:
1. Screen for neck instability in POTS patients.
If a patient presents with tachycardia on standing, lightheadedness, fainting spells and a history of neck trauma, whiplash, hypermobility or chronic neck pain — don’t assume “just dysautonomia.” Cervical structural integrity may need to be assessed.
2. Structural correction must precede functional recovery.
Realigning and stabilizing the upper cervical spine — especially restoring cervical curve, reducing ligamentous laxity and optimizing neural communication — helps restore the parasympathetic (“vagal”) tone and improve heart-rate variability (HRV).
3. Collaborative care.
POTS remains complex — hydration, salt loading, medications, compression garments and exercise.