What You Need to Know

If you’ve been diagnosed with Postural Orthostatic Tachycardia Syndrome, or POTS as it’s often called, you’ll know how confusing and exhausting it can be.

One moment you’re lying down feeling relatively okay, and the next you’re standing up and your heart is racing, your head is spinning, and you feel like you might collapse.

It’s frightening, and it can make even the simplest daily tasks feel overwhelming.

Many people with POTS spend months or even years searching for answers. You’ve probably seen multiple GPs and specialists, had countless tests, and tried various treatments with mixed results. It’s natural to feel frustrated when a condition affects so much of your life but doesn’t seem to have a straightforward solution.

This article explores an often-overlooked connection: the relationship between the upper part of your neck and your autonomic nervous system. That’s the part of your nervous system that controls automatic functions like heart rate and blood pressure.

If you’re living with POTS, you’ve likely encountered many claims of treatment and conflicting information.

To be clear from the outset, upper cervical chiropractic care is not a cure for POTS.

However, because POTS involves autonomic nervous system regulation, exploring how the upper neck relates to neurological communication may offer a new way to think about management.

What Is POTS?

POTS is a condition where your body struggles to adjust when you change position, particularly when you stand up. Normally, when you move from lying down to standing, your nervous system makes quick adjustments to keep blood flowing properly to your brain. Your blood vessels tighten slightly, and your heart rate increases a little bit. Usually this is around 10 to 15 beats per minute.

How POTS Affects Heart Rate When Standing

In people with POTS, this response goes haywire.

Your heart rate can jump by 30 beats per minute or more (or 40 beats per minute if you’re aged 12 to 19) within ten minutes of standing up, according to research by Lau and colleagues published in 2026.

This isn’t just an inconvenience. It comes with a range of symptoms that can seriously affect your quality of life.

Common Symptoms of POTS

You might experience a racing heartbeat, dizziness, shakiness, extreme tiredness, difficulty concentrating (often called “brain fog“), blurred vision, weakness, and sometimes fainting. Some people describe feeling like they’re about to collapse, or like their body is running a marathon whilst they’re simply standing in the kitchen making a cup of tea.

How Common Is POTS and Who It Affects

Research suggests that POTS affects a similar proportion of people in the UK as in other countries, with estimates of around 1 in 100 to 1 in 500 people living with the condition. It most commonly starts between the ages of 15 and 50, and affects women more often than men. Around 80% of those diagnosed are female (Raj et al., 2020).

For many people, POTS develops after a viral illness (like Long COVID), an injury, surgery, or pregnancy. For others, it seems to appear gradually without any obvious trigger.

Why POTS Looks Different for Everyone

What makes POTS particularly challenging is that it’s not the same for everyone. Some people have a form where their nervous system is overactive, producing too much adrenaline. Others have problems with blood pooling in their legs because their blood vessels don’t tighten properly. Some have both issues, and many have additional conditions alongside POTS, such as joint hypermobility syndrome or chronic fatigue (Fedorowski, 2019). This variety means that what helps one person might not help another.

Your Autonomic Nervous System: The Automatic Pilot

To understand POTS, it helps to know a bit about your autonomic nervous system. This is the part of your nervous system that works automatically, without you having to think about it. It controls your heart rate, blood pressure, digestion, breathing rate, body temperature, and much more.

The autonomic nervous system has two main parts that work together like a seesaw. The sympathetic nervous system is your “action” system. It speeds things up when you need to be alert or active. The parasympathetic nervous system is your “rest and digest” system. It slows things down when you need to relax and recover. In a healthy body, these two systems balance each other beautifully, adjusting constantly to whatever you’re doing.

When you stand up, special sensors in your blood vessels (called baroreceptors) detect the change in blood pressure. They send signals to your brainstem. That’s the lower part of your brain that controls many automatic functions.

Your brainstem processes this information and coordinates the right response: tightening blood vessels and adjusting your heart rate to keep blood flowing to your brain (Benarroch, 2012).

In POTS, this finely tuned system doesn’t work properly. Research has shown that many people with POTS have problems with their baroreflex. This is the feedback loop that should quickly adjust heart rate and blood vessel tone when blood pressure changes (Stewart et al., 2012).

Some studies have found that the sympathetic nervous system is either too active or not active enough in different parts of the body, creating an unbalanced response that leads to those horrible symptoms you experience when standing.

Why the Upper Neck Matters

You might be wondering what your neck has to do with your heart rate and blood pressure. It’s a fair question, and the answer lies in understanding just how important the upper part of your neck is for your nervous system.

What Is the Upper Cervical Spine

The upper cervical spine refers to the very top of your neck. It’s where your skull sits on your spine. This area includes three bones: the base of your skull (called the occiput), the first neck bone (called the atlas or C1), and the second neck bone (called the axis or C2).

These bones are different from the rest of your spine. They’re designed to allow your head to move in many directions. Nodding, turning, and tilting are essential for navigating the world around you.

Nerve Sensors and Brainstem Communication

But there’s something else that makes this region special: it’s incredibly rich in nerve sensors.

The joints, muscles, and ligaments in your upper neck contain thousands of tiny receptors that constantly send information to your brain about where your head is positioned, how it’s moving, and what the muscles around it are doing. In fact, this region has more of these sensors per square centimetre than almost anywhere else in your body (Kulkarni et al., 2001).

Why does this matter? Because all this information flows directly into your brainstem. That’s the part of your brain that sits just above your upper neck bones.

Your brainstem is like a control centre, processing incoming signals and coordinating responses. It’s where your breathing is controlled, where your heart rate is regulated, and where many of the automatic adjustments your body makes are organised (Dampney, 2016).

Blood Supply to the Brainstem

The major blood vessels that supply your brainstem and the back of your brain (called the vertebral arteries) actually pass through small tunnels in your upper neck bones before entering your skull. This means the mechanical environment of your upper neck and the blood supply to vital control centres in your brain are closely connected.

The Connection Between Neck Function and Balance

Research has shown that the upper neck plays an important role in helping you maintain balance and know where your body is in space.

Your brain constantly combines information from three sources: your eyes (what you see), your inner ears (your balance organs), and your neck (position sensors in the joints and muscles).

When all three sources provide clear, accurate information, your brain can coordinate smooth movements and keep you stable (Kristjansson & Treleaven, 2009).

Several studies have found that when the normal input from the upper neck is disrupted. Whether through injury, muscle tension, or joint restriction. People can experience dizziness, balance problems, and difficulty coordinating movements.

One study published in 2017 found that people with neck problems often have altered proprioception (position sense) from their upper cervical spine, which can affect their ability to maintain balance and can contribute to feelings of dizziness (de Vries et al., 2017).

This is particularly relevant for people with POTS, many of whom struggle with dizziness and balance issues even when their heart rate isn’t obviously elevated. If your upper neck isn’t sending clear signals to your brainstem, your brain has to work harder to figure out where you are in space and how to keep you stable. This extra “processing load” might make it even more difficult for an already struggling autonomic nervous system to coordinate the adjustments needed when you stand up.

Neurological Stress and System Overload

The Nervous System as a Limited Resource

Think of your nervous system like a mobile phone trying to run too many apps at once. Each app needs processing power and battery. If one app is glitching or using more resources than it should, the whole phone slows down. Other apps might freeze or crash because there isn’t enough processing power left to run them properly.

Why This Matters for People With POTS

Your nervous system works in a similar way. It’s constantly processing enormous amounts of information. Monitoring your heart rate, adjusting your blood pressure, coordinating your breathing, tracking your position in space, managing your digestion, and much more. When one area is sending confusing or distorted signals, your brain has to devote extra resources to interpreting that information. This can reduce its capacity to handle other tasks efficiently (Edwards et al., 2012).

For someone with POTS, whose autonomic nervous system is already struggling to maintain normal function, any additional source of neurological stress might tip the balance further.

If your upper neck is mechanically stressed. Perhaps due to old injuries, poor posture, or restricted joint movement. The unclear signals from this region might add to your nervous system’s workload, making it even harder for your body to coordinate the complex adjustments needed to keep you stable when you stand.

This doesn’t necessarily mean that neck problems cause POTS

POTS has many contributing factors that vary from person to person: immune system problems, blood volume issues, genetic factors, small nerve damage, and more (Deb et al., 2022). But in a system that’s already overwhelmed, reducing any source of mechanical or neurological stress might help create an environment where your nervous system can function a bit more efficiently.

What Upper Cervical Chiropractic Care Aims to Do

Upper cervical chiropractic care focuses on the alignment and movement of the top bones in your neck. The goal is to identify and correct misalignments in this area, with the aim of improving communication between your spine and your brain.

It’s crucial to understand what this type of care is and what it isn’t.

Upper cervical chiropractic is not a treatment or cure for POTS. The condition is complex, and most people need a range of approaches to manage it effectively. These might include:

• Medications to help control heart rate or blood volume
• Lower limb exercises to improve strength and stamina
• Increasing salt and fluid intake
• Wearing compression stockings
• Making changes to daily activities.

What upper cervical care may offer is a form of nervous system support. By addressing mechanical dysfunction in a region that’s so closely connected to your brainstem and autonomic control centres, the aim is to reduce one potential source of confusing signals. This will allow your nervous system to use its limited resources more effectively, though this doesn’t guarantee symptom improvement.

People with POTS who have received upper cervical care have reported improvements in symptoms such as:

• Dizziness
• Brain fog
• Heart rate variability
• Overall quality of life

Because POTS is so different from person to person, what helps one individual might not help another. Some people may notice positive changes, whilst others may experience little or no benefit.

What the Research Shows (and Doesn’t Show)

It’s important to be honest about what we know and what we don’t know.

Whilst there is growing interest in the relationship between spinal mechanics and autonomic function, high-quality research specifically examining upper cervical care for POTS is limited.

Research has, however, established some relevant connections. Studies have shown that the upper cervical spine is richly innervated with proprioceptive nerves that influence postural control and that disruption of this input can affect balance and spatial orientation (Kulkarni et al., 2001).

Other research has demonstrated connections between cervical spine function and sympathetic nervous system activity, though the clinical implications remain under investigation (Passatore & Roatta, 2006).

What we can say is that the upper cervical region is neurologically significant, that it influences multiple systems involved in postural control and autonomic regulation, and that addressing mechanical dysfunction in this area is biologically plausible as a supportive approach for some individuals with POTS.

What we cannot say is that it will cure it, that it addresses the root cause of POTS, or that it should replace other forms of concurrent care.

Final Thoughts: Hope, Patience, and Self-Compassion

POTS as a Disorder of Regulation

POTS is a disorder of regulation. A breakdown in your body’s ability to coordinate the automatic changes that most people never have to think about. It affects not just your cardiovascular system, but your energy levels, your ability to think clearly, your capacity to exercise, and your overall quality of life.

Understanding that your body functions as an interconnected whole, where the mechanical environment of your neck might influence the neurological environment that controls your autonomic responses can open up new avenues for support. The upper cervical spine, with its unique position and rich connections to your brainstem, represents one piece of a much larger puzzle.

A Whole-Person Approach to Care

This isn’t about finding a magic cure or a single solution that fixes everything. It’s about building a foundation of care that addresses your condition from multiple angles:

• Medical management to stabilise your symptoms
• Physical reconditioning to rebuild your stamina
• Nutritional support to optimise your body’s resources
• Stress management to reduce additional strain on your nervous system
• Hands-on care aimed at supporting the neurological environment in which your autonomic system operates.

Progress may be gradual. Some days will be better than others. But with patience, realistic expectations, and a comprehensive approach to care, many people with POTS do find ways to manage their condition more effectively and reclaim activities that matter to them.

Living With POTS

Living with POTS can feel lonely and overwhelming.

You might have days when you feel relatively well, followed by days when simply getting out of bed feels impossible. You might have encountered doctors who didn’t understand your condition or who suggested it was “all in your head.” You might feel frustrated by the trial-and-error nature of finding what helps you.

You deserve care that acknowledges the real impact POTS has on your life, that treats you as a whole person rather than a collection of symptoms, and that supports your journey towards better health with honesty, expertise, and compassion.

If you wanted a free 15-min call to speak to our chiropractors for more information, feel free to do so here: https://calendly.com/d/3zy-hx2-xby/discovery-call-london.

References:

Benarroch, E. E. (2012). Postural tachycardia syndrome: A heterogeneous and multifactorial disorder. Mayo Clinic Proceedings, 87(12), 1214–1225.

Dampney, R. A. (2016). Central mechanisms regulating coordinated cardiovascular and respiratory function during stress and arousal. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 309(5), R429–R443.

Deb, A., Morgenshtern, K., Culbertson, C. J., Wang, L. B., & Hohler, A. D. (2022). A survey-based analysis of symptoms in patients with postural orthostatic tachycardia syndrome. Proceedings (Baylor University Medical Center), 35(4), 407–411.

de Vries, J., Ischebeck, B. K., Voogt, L. P., van der Geest, J. N., Janssen, M., Frens, M. A., & Kleinrensink, G. J. (2017). Joint position sense error in people with neck pain: A systematic review. Manual Therapy, 33, 77–82.

Edwards, M. J., Adams, R. A., Brown, H., Parees, I., & Friston, K. J. (2012). A Bayesian account of ‘hysteria’. Brain, 135(11), 3495–3512.

Fedorowski, A. (2019). Postural orthostatic tachycardia syndrome: Clinical presentation, aetiology and management. Journal of Internal Medicine, 285(4), 352–366.

Hendriks, E., Dijkstra, P. U., Hoving, J., & Pool-Goudzwaard, A. L. (2019). Manual therapy and dysautonomia in whiplash associated disorder: A systematic review. Chiropractic & Manual Therapies, 27, 15.

Kristjansson, E., & Treleaven, J. (2009). Sensorimotor function and dizziness in neck pain: Implications for assessment and management. Journal of Orthopaedic & Sports Physical Therapy, 39(5), 364–377.

Kulkarni, V., Chandy, M. J., & Babu, K. S. (2001). Quantitative study of muscle spindles in suboccipital muscles of human foetuses. Neurology India, 49(4), 355–359.

Lau, C., Kohn, T., Alshak, M. N., Chinthakanan, O., & Bokhari, S. R. A. (2026). Postural orthostatic tachycardia syndrome: A state-of-the-art review. Journal of Clinical Neuroscience, 132, 110961.

Passatore, M., & Roatta, S. (2006). Influence of sympathetic nervous system on sensorimotor function: Whiplash associated disorders (WAD) as a model. European Journal of Applied Physiology, 98(5), 423–449.

Raj, S. R., Guzman, J. C., Harvey, P., Richer, L., Schondorf, R., Seifer, C., … & Sheldon, R. S. (2020). Canadian Cardiovascular Society position statement on postural orthostatic tachycardia syndrome (POTS) and related disorders of chronic orthostatic intolerance. Canadian Journal of Cardiology, 36(3), 357–372.

Stewart, J. M., Medow, M. S., Cherniack, N. S., & Natelson, B. H. (2012). Postural hypocapnic hyperventilation is associated with enhanced peripheral vasoconstriction in postural tachycardia syndrome with normal supine blood flow. American Journal of Physiology-Heart and Circulatory Physiology, 291(2), H904–H913.