The Experience Miracles Podcast

POTS Diagnosis: The Root Cause to Real Healing

Mar 25, 2025

POTS in Teenagers: The Neurological Root Cause Parents and Doctors Are Missing

Episode 89 — Experience Miracles Podcast | Host: Dr. Tony Ebel, DC, CACCP — Pediatric Chiropractor & Founder of PX Docs | Published: March 25, 2024 | Duration: ~29 min

Key Takeaways

  • POTS (Postural Orthostatic Tachycardia Syndrome) is not a mystery condition — it is a neurological disorder driven by vagus nerve dysfunction, dysautonomia, nervous system dysregulation, and subluxation in the cervical spine and brainstem.
  • The majority of POTS patients were born via C-section, vacuum extraction, or forceps delivery, with neck and vagus nerve injury originating at birth — often decades before POTS symptoms appear in the teenage years.
  • Conventional medicine treats POTS with salt loading, beta blockers, and lifestyle modification, and even functional medicine falls short — neither addresses the underlying neurological root cause: subluxation and vagus nerve dysfunction.
  • Forward head posture and “tech neck” physically compress the vagus nerve as it passes through the cervical and upper thoracic spine, increasing neuromuscular energy expenditure and accelerating nervous system exhaustion — a primary driver of POTS onset in adolescents.
  • Neurologically-Focused Chiropractic Care — including INSiGHT scans (thermal and EMG), HRV monitoring, specific chiropractic adjustments, and postural rehabilitation — addresses the root cause directly. Healing is possible without drugs, though full recovery often takes many months and follows a non-linear path.

What Actually Causes POTS — and Why Conventional Medicine Keeps Missing It

POTS (Postural Orthostatic Tachycardia Syndrome) is widely treated as a mysterious, poorly understood condition. According to Dr. Tony Ebel, DC, CACCP, it isn’t. POTS is a predictable neurological outcome of vagus nerve dysfunction, dysautonomia, and subluxation — primarily in the cervical spine and brainstem — that has typically been building since birth or early childhood before surfacing in the teenage years.

The condition predominantly affects teenage girls and young women. This is not coincidental: the same neurophysiological dysfunction that drives POTS also commonly disrupts menstrual cycles and is closely related to the root causes behind fertility challenges. When POTS strikes during adolescence, it represents a nervous system that has been accumulating neurological stress for years — often since a difficult birth — finally hitting a breaking point.

What medicine calls POTS is really an aggregate of symptoms: dizziness, rapid heartbeat, chronic fatigue, positional sensitivity, weather-triggered anxiety, and brain fog. Medicine correctly identifies some of what’s happening (orthostatic intolerance, tachycardia) but provides no explanation for why — and therefore no effective solution. A label isn’t the same as an answer. The answer lies in understanding how the autonomic nervous system, and specifically the vagus nerve, governs virtually every function these patients are struggling with.

Why the Vagus Nerve Is the Center of POTS [00:07:00 – 00:14:00]

Dr. Tony Ebel: The four terms every POTS patient needs to understand are nervous system dysregulation, vagus nerve dysfunction, dysautonomia, and subluxation. These aren’t four separate problems — they’re four ways of describing the same root cause.

The vagus nerve originates in the brainstem and travels through the cervical spine into the thoracic region. It is the primary nerve governing the autonomic nervous system — the system that regulates balance, posture, digestion, heart rate, immune response, and the brain’s emotional regulation centers.

When the vagus nerve is functioning properly, it acts as the great balancer: moderating the stress response, keeping the sympathetic (“fight or flight”) and parasympathetic (“rest and digest”) branches of the nervous system in equilibrium. When it’s dysfunctional — due to subluxation, misalignment, or tension in the cervical spine — the entire system tips into sympathetic dominance.

Sympathetic dominance then drives every symptom associated with POTS:

  • Dizziness and positional sensitivity — The vagus nerve controls vestibular function and position sense. When it’s compromised, standing up or moving quickly becomes destabilizing.
  • Tachycardia — Without adequate parasympathetic input from the vagus nerve, the heart rate accelerates unchecked.
  • Brain fog — Sympathetic dominance overstimulates the amygdala (the brain’s anxiety center) and simultaneously suppresses the hippocampus and prefrontal cortex — the areas responsible for cognition, decision-making, and emotional regulation.
  • Anxiety — The amygdala in overdrive creates near-constant, easily triggered anxiety, including responses to weather changes, illness, or positional shifts.
  • Digestive issues — The vagus nerve runs directly into the gut. When it’s dysfunctional, the gut-brain connection breaks down. This is why POTS so often comes paired with digestive complaints.

“POTS lives in the neck, POTS lives in the brainstem, the cervical spine, and then what’s called the cervical-thoracic junction. Because that’s the journey the vagus nerve takes — and vagus nerve stimulation and activation is the answer to getting to the other side of POTS.”

POTS isn’t a cardiac condition. It isn’t a blood disorder. It isn’t genetic. It’s a neurological condition — and the access point to correct it is the spine.

The Perfect Storm: How POTS Builds Over a Lifetime [00:01:00 – 00:07:00]

Dr. Tony Ebel: Stressful life events — a viral infection, a difficult exam, a bad breakup — often get blamed as the trigger for POTS. Those aren’t the cause; they’re just the straw that broke the camel’s back.

The Perfect Storm typically starts years before anyone recognizes POTS. For most patients, it begins at birth. The majority of POTS patients in Dr. Ebel’s practice were delivered via C-section, induction, vacuum extraction, or forceps. These birth interventions place direct mechanical stress on the infant’s neck — injuring the cervical spine and setting up the early conditions for vagus nerve dysfunction and subluxation.

The early childhood record of these patients is recognizable: colic, chronic ear infections, croup, RSV, asthma, allergies, persistent colds. These aren’t random — they reflect a nervous system that has been dysregulated since birth, struggling to regulate the immune system, digestion, and stress response.

By the teenage years, two converging forces push that nervous system past its limit:

  1. Neurological accumulation — Years of unaddressed subluxation and dysautonomia have been slowly depleting the nervous system’s adaptive capacity.
  2. Physical postural collapse — Adolescents today spend hours daily looking down at phones and screens. This creates forward head posture — what Dr. Ebel calls “tech neck” — which mechanically compresses the vagus nerve where it passes through the cervical and upper thoracic spine.

“These teenagers have old people’s posture at 17. And when you tell them to stand up straight, they try and can’t sustain it — because the problem isn’t willpower. It’s subluxation.”

The bowling ball analogy makes this tangible: a head in perfect alignment is like a bowling ball balanced on a vertical stick. Shift that bowling ball just one inch forward, and the muscular force required to hold it multiplies dramatically. Two inches forward, three inches — the energy demand grows exponentially. The cervical and thoracic spine have been doing this extra work, often for years. Exhaustion — neurological and physical — is the inevitable result.

Why Conventional and Functional Medicine Both Fall Short [00:14:00 – 00:17:00]

Dr. Tony Ebel: Mainstream medicine’s answer for POTS is to increase salt and fluid intake, slow down, and if that doesn’t work, prescribe beta blockers or steroids to manage blood pressure and heart rate. For a teenager trying to live a normal life — school, sports, friends — this approach is inadequate on every level.

Functional medicine goes deeper. It addresses diet, physical activity, gut health, microbiome disruption, heavy metals, nutritional imbalances, and stress management. Dr. Ebel has genuine respect for this approach and sees it as far superior to conventional medicine. But it still stops short.

Neither approach touches subluxation. Neither addresses vagus nerve dysfunction in the neck. Neither corrects the underlying neuro-mechanical problem that is actually driving every POTS symptom.

“I take care of a ton of POTS case histories where patients have done everything — every diet, supplement, detox. But nobody has addressed the subluxation, nervous system dysregulation, dysautonomia, and vagus nerve dysfunction. Yet those four terms are only fully and effectively corrected through Neurologically-Focused Chiropractic Care.”

POTS has two sides to its core problem: too much sympathetic activity (anxiety, tachycardia, heightened reactivity) and too little parasympathetic activity (poor recovery, poor digestion, poor sleep). The vagus nerve is the system that balances these two branches. Correcting vagus nerve function is not optional — it’s the entire job.

Physical Signs of POTS: What to Look For [00:18:00 – 00:22:00]

Dr. Tony Ebel: When a POTS patient walks into the office, there are consistent physical patterns that show up before a single scan is run.

The birth and early childhood history almost always includes: C-section or difficult vaginal delivery with instruments, followed by colic, chronic ear infections, or respiratory issues like croup or RSV. By the teen years: anxiety, sleep problems, and complaints of physical tension at the base of the skull (suboccipital tension), chronic cervical headaches, and visible tightness in the trapezius muscles.

Looking at a POTS patient from the side, the signature finding is forward head posture — the head and neck drifting forward relative to the shoulders. This isn’t a posture problem that can be corrected by trying harder. The subluxation is maintaining that posture. The nerves and muscles in the area — including the vagus nerve — are under constant compression and tension.

From the front or back, you’ll often see the trapezius muscles elevated and braced, shoulders riding up toward the ears. Shoulders should slope gently downward. When they don’t, it’s a visible sign of chronic sympathetic dominance — the body stuck in a perpetual bracing pattern.

These are not cosmetic observations. They are clinical signs pointing directly to the neurological dysfunction underlying every POTS symptom.

Assessment and Treatment: The PX Approach to POTS [00:22:00 – 00:27:00]

Dr. Tony Ebel: To get to the root cause of POTS, the assessment has to be neurological — not symptomatic.

INSiGHT Scans are the starting point. The thermal scan reveals the inflammation and dysregulation in the autonomic nervous system — in POTS patients, the thermal readings are typically “a mess,” showing chaotic patterns across the adrenals and cortex. The EMG scan measures neuromuscular distortion in the cervical and thoracic spine. A classic POTS EMG pattern is recognizable — Dr. Ebel notes he can identify it for a teenage or young adult female without looking at the case history first.

Heart rate variability (HRV) is the essential monitoring tool for managing care. POTS is a neurological disorder, not a cardiac one — and HRV is the closest objective window into vagal nerve tone and autonomic balance. It guides the pace of care and helps track recovery.

The treatment protocol has three components:

  1. Specific chiropractic adjustments — targeting the subluxation in the cervical spine and brainstem area, using what Dr. Ebel describes as “mirror image neuro-tonal adjustments.” These release the subluxated, sympathetically dominant tension and directly stimulate the vagus nerve. For patients who have been severely affected, intensive care (twice daily adjustments for a period) may be appropriate.
  2. Postural and neuromuscular rehabilitation — targeted exercises to restore proper cervical alignment and reduce the mechanical load on the vagus nerve. These can largely be done at home and don’t require extensive time commitments.
  3. Supportive nutrition and hydration — electrolytes, hydration, and nutritional support are genuinely helpful. However, most POTS patients have already tried these before arriving at a PX Docs office. They’re an adjunct, not the primary solution.

“The adjustments do the job. They restore, they release the subluxated sympathetic dominant tension, they stimulate the vagus nerve, and they get the nervous system moving in the right direction.”

One patient example: Tommy, a teenage horse rider and student whose nervous system had become overwhelmed by the combination of athletic demand, academic stress, and postural collapse. Her thermal scans were severely dysregulated. After an intensive care plan, twice-daily adjustments, and postural rehabilitation — with nutrition already addressed beforehand — she recovered fully and is now pursuing chiropractic school herself.

What to Expect: The Healing Timeline for POTS [00:25:00 – 00:29:00]

Dr. Tony Ebel: For families starting care, the most important thing to understand about POTS recovery is that it is real, it is possible without drugs — and it is not linear or fast.

For most POTS patients — teenagers and young adults — the condition has been building for two decades. The nervous system doesn’t reorganize in weeks. Significant quality of life improvements often come early in care, and that’s encouraging. But the full, complete recovery takes many months, and the path will have ups and downs.

What can look like a setback or plateau is often a normal part of neurological healing — what Dr. Ebel calls neurological detox. The nervous system is reorganizing. Families who understand this in advance are far better equipped to stay consistent through those stretches, rather than concluding that care isn’t working.

Consistency is the differentiating factor. The families who stay in care through the non-linear parts are the ones who get to the other side.

“Healing is entirely possible, neurologically, naturally, without drugs — and it’ll happen fast and slow at the same time.”

Frequently Asked Questions

What actually causes POTS in teenagers?

POTS is caused by vagus nerve dysfunction, dysautonomia, sympathetic dominance, and subluxation — primarily in the cervical spine and brainstem. These neurological imbalances are typically set in motion by difficult birth experiences (C-section, vacuum extraction, forceps) and compounded over years by postural collapse and tech neck. By the teen years, the cumulative neurological stress tips into the full POTS symptom picture: dizziness, tachycardia, fatigue, brain fog, and anxiety.

Why do teenage girls get POTS more than boys?

The same neurophysiological root cause — vagus nerve dysfunction and dysautonomia — that drives POTS also affects hormonal regulation and the menstrual cycle. According to Dr. Tony Ebel, nearly every female POTS patient he’s treated has experienced menstrual cycle disruption alongside their POTS symptoms. The condition is closely neurophysiologically related to hormonal dysregulation, which is why it shows up more frequently in females and often surfaces around the hormonal shifts of adolescence.

Can birth trauma cause POTS years later?

Yes, according to Dr. Tony Ebel’s clinical experience. The majority of POTS patients he sees were delivered via C-section, induction, vacuum extraction, or forceps. These birth interventions place mechanical stress on the infant’s cervical spine, setting up early subluxation and vagus nerve dysfunction. These patients often had colic, ear infections, and respiratory issues as infants — early signs of the same nervous system dysregulation that eventually surfaces as POTS in the teen years.

Why doesn’t salt loading or medication fix POTS?

Salt and fluid intake, beta blockers, and steroids address POTS symptoms, not the root cause. They don’t correct subluxation in the cervical spine, don’t restore vagus nerve function, and don’t resolve the underlying sympathetic dominance driving tachycardia and anxiety. Even functional medicine approaches — diet, gut health, stress management — fall short without addressing the neuro-mechanical dysfunction in the neck. Symptom management without root cause correction means the underlying neurological dysfunction continues.

How long does it take to heal from POTS with chiropractic care?

Recovery varies, but for most teenagers and young adults — where the condition has often been building for a decade or more — full recovery typically takes many months of consistent care. Significant improvements in quality of life often appear early. The recovery path is non-linear: there will be better periods and harder ones. What can look like regression is often part of the neurological healing process. Patients who stay consistent through those stretches are the ones who fully recover.

How do I find a chiropractor trained in the PX Docs approach for POTS?

Search the PX Docs Directory by zip code or city to find a neurologically-focused chiropractor near you. PX Docs practitioners are trained in INSiGHT scanning, HRV monitoring, and the specific adjustment and postural rehabilitation protocols used for POTS care.

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