Understanding the Neurology of POTS and the Hope Applied Neurology Offers

A New Way Forward for POTS Clients

A New Lens for an Overlooked Condition

Postural Orthostatic Tachycardia Syndrome (POTS) is one of those diagnoses that tends to leave both patients and clinicians frustrated. Therapists often encounter clients with debilitating fatigue, dizziness, cognitive fog, and anxiety, yet nothing seems to fully explain or resolve their symptoms.

POTS presents with heart palpitations and faintness upon standing, but beneath the surface, it is deeply connected to the interaction between the autonomic nervous system and the brain.

In this post, we offer a hopeful reframe.

Rather than treating POTS as purely a cardiovascular issue or a list of symptoms to medicate away, applied neurology invites us to see POTS through a neurological lens. It gives therapists powerful tools to regulate the nervous system, shift dysautonomia, and help clients reclaim agency over their healing.

What Is POTS? A Quick Overview

POTS, or Postural Orthostatic Tachycardia Syndrome, is a form of dysautonomia. That means the body's automatic processes, such as blood pressure regulation, heart rate, digestion, and temperature control, are not functioning properly.

The hallmark feature of POTS is a rapid increase in heart rate (30 beats per minute or more) within 10 minutes of standing, without a significant drop in blood pressure.

Clients with POTS often experience:

• Lightheadedness or dizziness

• Fatigue and brain fog

• Nausea and digestive complaints

• Anxiety or panic sensations

• Exercise intolerance

While traditionally labeled as a circulatory disorder, a growing body of evidence supports that POTS is fundamentally rooted in nervous system dysregulation.

Traditional Approaches to Treating POTS

Most conventional treatments for POTS aim to manage symptoms:

• Beta blockers to slow heart rate

• Fludrocortisone or midodrine to support blood volume or vessel tone

• High salt and fluid intake

• Compression garments

• IV saline infusions for severe cases

These may offer temporary relief, but they don't address why the nervous system is misfiring in the first place. Moreover, patients are often told to "just exercise more" or manage stress better, advice that can be unhelpful or even damaging when their nervous system is overwhelmed.

Therapists working with POTS clients may find themselves at a loss.

Traditional modalities, manual therapy, cognitive work, or basic regulation skills may not fully touch the deeper dysfunction at play.

This is where applied neurology enters as a game-changer.

What Is Applied Neurology?

Applied neurology is a brain-based approach that uses the principles of neuroplasticity to improve how the nervous system functions. Rather than focusing solely on symptoms, it asks:

• Which inputs (sensory, visual, vestibular, proprioceptive) are overwhelming the brain?

• Where is the nervous system under-stimulated or misinterpreting safety signals?

• How can we engage the brain’s natural wiring to restore balance?

Applied neurology treats the nervous system like a trainable organ. Using simple, targeted drills gives therapists a framework to assess and improve function across visual, vestibular, and sensory systems.

By addressing these root dysfunctions, we can help calm the sympathetic nervous system and support autonomic regulation, the very heart of what’s malfunctioning in POTS.

How the Nervous System Gets Dysregulated in POTS

The autonomic nervous system (ANS) has two main branches:

• The sympathetic nervous system (fight-or-flight)

• The parasympathetic nervous system (rest-and-digest)

In POTS, the ANS often leans heavily toward sympathetic overdrive. The brain perceives normal stimuli, like standing up or walking into a store, as threats. This leads to an excessive heart rate, shallow breathing, dizziness, and overwhelm.

Over time, this hypervigilance becomes a feedback loop that keeps clients stuck in a dysregulated state.

From a neurological perspective, this dysregulation is trainable. By helping the brain reinterpret safety cues and increase its tolerance to inputs, therapists can make real changes in how the ANS functions.

Applied Neurology Techniques That Help POTS

Below are several core techniques used in applied neurology to regulate the nervous system and support POTS recovery.

These are tools you can explore with training through platforms that we have here at Next Level Neuro.

1. Vagus Nerve Stimulation

The vagus nerve is the main highway of the parasympathetic nervous system.

Stimulating it helps calm the heart, reduce inflammation, and shift the body into rest-and-digest mode.

Simple methods include:

• Auricular stimulation via the ear

• Humming or singing

• Cold exposure

• Diaphragmatic breathing

In applied neurology, clinicians are trained to assess which vagal techniques are most effective for each individual, avoiding one-size-fits-all interventions.

2. Visual and Vestibular Drills

The visual and vestibular systems play a massive role in autonomic regulation.

When the brain misinterprets head movement or visual input, it often triggers a sympathetic response.

Therapists can use drills that include:

• Gaze stabilization

• Saccadic eye movements

• Balance retraining

• Head movement while focusing on a target

These drills help recalibrate how the brain integrates movement and balance signals, critical for clients who feel lightheaded or "off" when they stand, turn their head, or walk in a busy environment.

3. Somatosensory and Proprioceptive Work

In POTS, the brain often lacks accurate body awareness, especially in the lower limbs, where blood pools. Stimulating the feet, ankles, and hips through touch, movement, or joint compression can strengthen the brain’s connection to those regions.

This improves posture, stability, and autonomic control.

Therapists might use:

• Vibration tools

• Sensory mapping

• Movement drills that integrate joint awareness

This work helps anchor the client’s sense of self in their body, an essential first step in resolving disassociation and autonomic chaos.

4. Respiratory Retraining

Many POTS clients are chronic over-breathers.

Shallow, fast breathing can increase sympathetic tone and reduce carbon dioxide, leading to dizziness and poor cerebral blood flow.

Retraining breath includes:

• Slow nasal breathing

• Diaphragmatic activation

• CO2 tolerance training

• Heart rate variability biofeedback

Breath is one of the most accessible levers for nervous system change.

With the right pacing and coaching, clients often feel immediate relief and long-term gains.

5. Brain-Based Stress and Limbic System Work

For clients whose brains have learned to expect danger from every standing posture or social situation, limbic retraining and cognitive tools can help rewire that pattern.

Applied neurology doesn’t just target reflexes; it also supports a shift in perception.

This might include:

• Mental rehearsal

• Positive neuroplasticity

• Visualizations paired with movement drills

• Exposure techniques paired with safety anchoring

This isn’t traditional therapy; it’s rewiring the fear response at the neurological level.

The Therapist’s Role: Guiding Safety, Curiosity, and Capacity

Applied neurology gives therapists a powerful message to deliver to clients with POTS:

Your body is not broken. Your nervous system is doing its best to protect you. And we can train it to feel safe again.

This message lands differently than “try another pill” or “push through the fatigue.” It restores agency, dignity, and hope.

As therapists, our role becomes about guiding exploration and self-awareness.

We use drills not to push but to test and teach the brain how to interpret input more accurately.

And we help clients build capacity, not tolerance, meaning they grow stronger from the inside out, not just gritting through the symptoms.

Next Level Neuro: Training for Clinicians

For therapists and medical professionals who want to incorporate these techniques into practice, Next Level Neuro offers education and mentorship in applied neurology.

Their frameworks are designed to help clinicians confidently assess neurological function, select drills, and track progress without guessing.

Whether you’re a physical therapist, mental health provider, or coach, this work integrates beautifully into your existing approach. You don’t need to become a neurologist; you need to understand how the nervous system works and how to speak its language.

Next Level Neuro helps you do just that.

A New Way Forward for POTS Clients

POTS is a difficult condition, but not an impossible one. Through the lens of applied neurology, we see clients not as fragile but as full of potential. We see their symptoms not as random but as intelligent signals from a brain doing its best.

When we meet the nervous system where it is, gently, strategically, and with deep respect, we unlock new paths to healing.

As a therapist, your understanding of the brain may be the very key a client has been waiting for. Let’s keep learning.

Let’s keep rewiring.

And let’s never stop believing in the capacity of the nervous system to change.

 If you would like to contact us with questions and/or help, email us here. [email protected]