POTS Treatment in San Diego - Real Autonomic Care
Told your labs are normal, but you still can't stand up without your heart racing?
Our team evaluates autonomic function directly as part of the broader clinical picture.
Integrative rehabilitation intended to support steadier heart rate responses, reduce lightheaded episodes, and rebuild upright tolerance. Our non-pharmacologic approach may complement medical management when appropriate.
Real patient story
"I finally found a team that took my POTS seriously and actually helped me get my life back."
Charlie · POTS patient
Disclaimer: Individual results vary. Testimonials and patient stories reflect personal experience and are not a guarantee, promise, or prediction of outcome. Results depend on each patient's condition, adherence to care, and other factors.
Quick Answer
What is POTS?
POTS (Postural Orthostatic Tachycardia Syndrome) is a form of dysautonomia, a disorder of the autonomic nervous system. If you have POTS, you might feel dizzy or even faint when you stand up, experience a racing heartbeat, fatigue, brain fog, and other symptoms when changing position.
POTS affects an estimated 1-3 million Americans, predominantly women between the ages of 15 and 50. Despite its prevalence, the average POTS patient sees 7 doctors over 4 years before receiving a correct diagnosis. Many are told their symptoms are "just anxiety" or are dismissed entirely. This diagnostic delay is frustrating and harmful—but it also means that many patients have never received targeted autonomic rehabilitation.
At our San Diego chiropractic clinic, we offer non-pharmacologic rehabilitation intended to support people with POTS symptoms and complement medical management when appropriate. We take your symptoms seriously, and our chiropractors are Functional Neurology Trained. If you are still searching for answers, our clinical team evaluates autonomic function as one part of the broader clinical picture.
Common POTS Symptoms
If you're experiencing any of these, our integrative approach may help.
- Dizziness or lightheadedness when standing up
- Racing heartbeat (tachycardia) upon standing
- Fatigue that doesn't improve with rest
- Brain fog and difficulty concentrating
- Nausea or digestive issues
- Exercise intolerance
- Fainting or near-fainting episodes
- Anxiety or feeling of impending doom
POTS-like symptoms can have other causes. Seek urgent medical care for chest pain, severe shortness of breath, new focal neurologic symptoms, or severe or unexplained fainting.
Understanding Your Autonomic Nervous System
How POTS may affect autonomic regulation
The Autonomic Balancing Act
Your autonomic nervous system (ANS) operates like a seesaw between two branches: the sympathetic ("fight or flight") and parasympathetic ("rest and digest") systems. In a healthy person, when you stand up, the sympathetic system quickly constricts blood vessels in your legs and abdomen to push blood back up to your brain, while slightly increasing heart rate—a seamless adjustment you never notice.
In POTS, this automatic adjustment can be impaired. Blood may pool in the lower body, and heart rate can rise substantially as the body attempts to maintain circulation. These physiologic patterns may contribute to dizziness, brain fog, palpitations, and fatigue, but autonomic regulation can differ among individuals.
Commonly Described Physiologic Patterns in POTS
Neuropathic POTS
The most common type. Small nerve fiber damage impairs blood vessel constriction in the legs and abdomen.
Key features: Blood pooling in legs, purplish discoloration of feet/legs upon standing, reduced sweating in feet.
Hyperadrenergic POTS
Excessive norepinephrine release causes an amplified sympathetic response upon standing.
Key features: Significant blood pressure increase with standing, tremor, anxiety, pale appearance, sometimes elevated BP.
Hypovolemic POTS
Abnormally low blood volume means insufficient circulation when upright.
Key features: Low blood pressure tendency, significant benefit from fluid/salt loading, often worsened by dehydration or heat.
These patterns can overlap, and classification may vary based on the clinical history and appropriate medical evaluation.
Why Vagal Tone Matters in POTS
In some POTS patients, measures related to vagal tone, the parasympathetic influence on the heart, may differ. This is one potential contributor to an elevated heart-rate response during standing.
A pattern of greater sympathetic activity or reduced parasympathetic influence may be associated with elevated heart rate, lower heart rate variability, post-exertional symptoms, brain fog on standing, and slower recovery after activities such as a shower or grocery run. These patterns are not universal.
Our Functional Neurology Trained chiropractors in San Diego may incorporate non-invasive vagus nerve stimulation, breathing protocols, and graded autonomic rehabilitation when clinically appropriate. We follow orthostatic vitals while monitoring standing tolerance and individual response.
How We Evaluate Your POTS
A structured autonomic and neurologic assessment
Orthostatic Vital Signs & Active Standing Test
We measure heart rate and blood pressure while lying, sitting, and standing at 1, 3, 5, and 10 minute intervals. This may identify a physiologic pattern consistent with POTS or another form of orthostatic intolerance and provides a baseline for monitoring. Results are interpreted with the history, examination, and appropriate medical evaluation.
Autonomic Reflex Testing
Deep breathing ratio, Valsalva maneuver response, and sustained handgrip assessments may provide additional physiologic information about cardiovascular and autonomic responses. Findings are interpreted in context, are not independently diagnostic of POTS, and do not by themselves prove a single autonomic mechanism. They may help guide an individualized rehabilitation plan.
Neurological & Vestibular Examination
Because POTS can coexist with vestibular dysfunction, visual processing problems, and cervical complaints, our clinical assessment may include cranial nerve testing, oculomotor assessment, vestibular screening, and a cervical spine examination.
Comorbidity Screening
We review the history for commonly associated conditions, including Ehlers-Danlos Syndrome or joint hypermobility, mast cell activation syndrome, autoimmune conditions, and thyroid dysfunction. When appropriate, we recommend medical evaluation or coordinate with other healthcare providers.
Our Integrative Approach to POTS
Because POTS is complex, we approach rehabilitation from multiple angles. Our chiropractic clinic focuses on supporting autonomic regulation and function while also considering relevant musculoskeletal or cervical complaints.
Autonomic Conditioning Therapy
Gentle neural exercises intended to support how your body regulates blood pressure and heart rate. Think of it as guided autonomic conditioning and rehabilitation.
Vagus Nerve Therapy for POTS
Non-invasive vagus nerve stimulation is an emerging area of research in autonomic disorders. When clinically appropriate, it may be incorporated as one component of an individualized rehabilitation plan.
Vestibular & Balance Rehab
Vestibular rehabilitation to help your body handle position changes better and reduce lightheadedness.
Chiropractic Adjustments
Chiropractic care may be incorporated when a patient also has relevant musculoskeletal or cervical complaints. It is not presented as a stand-alone treatment for the underlying causes of POTS.
Lifestyle Guidance
Advice on fluid and salt intake, compression garments, and safe exercise as part of a holistic plan.
This comprehensive approach is intended to support symptom management and quality of life. We monitor changes in dizzy spells, standing tolerance, energy, and participation in daily activities. Individual response varies.
Self-Management Strategies for POTS
Evidence-based techniques to manage symptoms between clinic visits.
Counter-Maneuvers for Symptom Relief
Physical counter-maneuvers may help reduce blood pooling and support blood return when symptoms begin.
- Calf pumping: Rise up on your toes repeatedly while standing—the calf muscles squeeze blood back toward your heart
- Leg crossing & tensing: Cross your legs at the ankles while standing and tense your thigh and buttock muscles for 30 seconds
- Squatting: If you feel lightheaded, squatting immediately increases blood return to the heart
- Abdominal compression: Tighten your abdominal muscles while standing—this prevents blood pooling in the splanchnic (gut) circulation
- Practice these maneuvers regularly so they become automatic when symptoms begin
Breathing Technique for POTS Symptom Control
Extended-exhale breathing may influence autonomic regulation and may help some people manage symptoms associated with an elevated heart-rate response during standing.
- Sit or lie comfortably with one hand on your belly
- Inhale slowly through your nose for 4 seconds, expanding your belly
- Hold gently for 2 seconds
- Exhale slowly through pursed lips for 6-8 seconds—the long exhale is the key to vagal activation
- Practice for 5 minutes twice daily; also use before standing up from seated or lying positions
Recumbent Exercise Protocol
The modified Dallas/Levine protocol is one commonly used structured approach for POTS exercise rehabilitation.
- Many programs begin with recumbent or semi-recumbent activity, such as a recumbent bike, rowing machine, or swimming
- Begin with 15-20 minutes at a comfortable pace (you can talk during exercise)
- Exercise 3-4 times per week, increasing duration by 5 minutes every 1-2 weeks
- After 4-6 weeks of consistent recumbent exercise, gradually add semi-upright activities
- Add lower body strength training 2x per week—strong legs help pump blood back to your brain
Important: Many structured POTS exercise programs begin with recumbent or semi-recumbent activity and progress based on individual tolerance. Pushing too hard too fast may worsen symptoms. These strategies are general educational information and are not appropriate for every patient. People with heart, kidney, blood-pressure, or other medical conditions should discuss individualized fluid, salt, compression, and exercise recommendations with their treating healthcare provider.
Why Choose Our Chiropractic Clinic for POTS Care?
Functional Neurology Trained
Our chiropractors have training in neurologic rehabilitation
Collaborative Care
Works with your other providers
Compassionate Support
We listen and believe you
Progress Monitoring
We monitor individual response
High-Trust Environment
Never dismissive
I felt hopeless, but now I can do so much more without getting dizzy. This team understood POTS like no one else and helped me feel human again!
Individual results vary. Testimonials reflect personal experience and are not a guarantee of outcome.
Rowena V.
POTS Patient, San Diego
Our clinical team includes professional members of the Vestibular Disorders Association.
Not sure if what you have is really POTS?
POTS-like symptoms can have several causes and may warrant medical evaluation. Our free 15-minute consultation can help determine whether a full autonomic assessment may be an appropriate next step.
- No referral needed
- No obligation, no pressure
- Speak directly with a clinician
Frequently Asked Questions
Common questions about POTS, dysautonomia, and autonomic nervous system rehabilitation.
Treatments That May Help
Take the First Step
Living with POTS can feel overwhelming, but you're not alone. Rehabilitation goals may include improving standing tolerance, supporting participation in daily activities, and helping you manage symptoms with greater confidence. Individual response varies.
Schedule a consultation with our POTS team today. It's a free 15-minute call to answer your questions and explain our approach. Or call (619) 344-0111
More questions? Visit our FAQs page
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