POTS: When Salt + Slow Standing Are Only Part of the Picture
Understanding POTS, the autonomic nervous system + why support can look different for everyone
If your teen or young adult has been diagnosed with POTS, you may already know just how quickly it can change the rhythm of everyday life. A young person who was managing school, sport, work and time with friends may suddenly find that standing in the shower leaves their heart racing, getting through a school day feels exhausting, or dizziness, headaches, fatigue and brain fog start shaping decisions that once felt simple.
For families, it can be a lot to make sense of. You may have been told to increase fluids and salt, stand up more slowly, avoid getting too hot or make changes to activity. These strategies can be important parts of POTS management, but when your child is missing school, stepping away from sport or struggling to keep up with everyday life, it’s understandable to wonder what else is happening beneath the symptoms.
One important piece of that conversation is the autonomic nervous system.
POTS is a form of dysautonomia, which means the systems responsible for automatically adapting things like heart rate and blood pressure aren't responding to being upright in the usual way. The reasons this happens can be complex and can differ between people, which is also why POTS rarely looks exactly the same from one person to the next.
This article is for parents of teens and young adults living with POTS, as well as families trying to make sense of ongoing dizziness, heart racing, fatigue or brain fog. We’ll explore what’s happening in the body, why the autonomic nervous system matters, why salt and hydration are recommended, and how different pieces of support may fit together.
What actually happens with POTS?
POTS stands for Postural Orthostatic Tachycardia Syndrome.
One of its defining features is an unusual increase in heart rate after moving into an upright position. In adolescents, this generally means a sustained increase of at least 40 beats per minute within 10 minutes of standing. In adults, it is at least 30 beats per minute. Diagnosis involves more than heart rate alone, including symptoms and ruling out other possible explanations.
But when you're living with POTS, the experience can be about much more than a number on a heart rate monitor.
Some people experience dizziness or light-headedness, while others notice a pounding heart, significant fatigue, headaches, nausea, difficulty concentrating or a reduced tolerance for exercise. Symptoms can also fluctuate from one day to the next, which can make it difficult for young people and their families to know what they'll be capable of on any given day.
Why can standing make such a difference?
This is where understanding the autonomic nervous system can help make a little more sense of what's happening.
Your autonomic nervous system helps manage many of the things your body does automatically, including heart rate, blood pressure, digestion, sweating and temperature regulation.
When you move from lying or sitting to standing, gravity naturally causes some blood to shift towards the lower part of your body. Normally, your body responds almost immediately, making adjustments that help maintain blood flow to your heart and brain. Most of us never even notice it happening.
With POTS, this response works differently. The heart rate increases significantly and symptoms of orthostatic intolerance can appear, helping to explain why everyday things such as standing in the shower, waiting in a queue or walking around school can sometimes feel much harder than they look from the outside.
POTS sits within a broader group of conditions known as dysautonomia, where aspects of autonomic function aren't working as expected.
So, where do salt + hydration fit?
Quite importantly, actually. For some people with POTS, increasing fluids and salt can help support circulating blood volume, which is why these strategies are commonly recommended as part of POTS management.
So when you're told to focus on hydration or increase salt, there is real physiology behind that advice. It's not something we need to dismiss simply because POTS is more complex. The important distinction is that these strategies may be one piece of a much bigger picture.
Depending on the individual, management may also include compression garments, identifying and reducing exposure to known triggers, nutrition support, sleep strategies and an appropriately tailored approach to movement or exercise. Some people may also require medication prescribed and monitored by their doctor or specialist.
Higher salt intake isn't appropriate for everyone either, so individual recommendations are best discussed with the healthcare professional managing your POTS care.
Why can POTS look so different from person to person?
This is one of the things that can make POTS particularly confusing for families.
Two young people can have the same diagnosis and experience it quite differently. One might be most affected by dizziness and heart racing, while another may find fatigue, headaches, digestive changes or exercise intolerance are the things that interfere most with everyday life.
Symptoms can also change depending on factors such as heat, illness, prolonged standing and other individual triggers.
Researchers recognise that POTS is a complex and heterogeneous condition, meaning different mechanisms and contributing factors may be involved in different people. Rather than assuming there is one universal explanation for every person with POTS, it can be more helpful to understand the individual in front of us and consider the different factors that may be relevant to their presentation.
And what about the vagus nerve?
If you've spent time reading about POTS, dysautonomia or nervous system regulation online, you've probably come across plenty of conversations about the vagus nerve.
The vagus nerve is an important part of the parasympathetic nervous system. It travels from the brainstem through the neck and into the chest and abdomen, communicating with structures including the heart, lungs and digestive system.
Because of these connections, the vagus nerve plays a role within the body's broader autonomic regulation.
But POTS is more complex than simply having a “weak vagus nerve” or “poor vagal tone”.
Dizziness, fatigue, digestive changes, sleep difficulties or heart racing don't tell us on their own how well the vagus nerve is functioning, and POTS can't be explained or diagnosed simply by assessing the vagus nerve.
It is an interesting and important part of the autonomic nervous system, but it is still only one part of a much bigger picture.
What does support actually look like?
For many people, it means having more than one tool available.
Hydration and salt may make a noticeable difference. Compression garments can be helpful for some people, while understanding personal triggers such as heat or prolonged standing can make everyday situations easier to navigate.
Movement can also form part of POTS management, but this is an area where individualisation really matters. For someone who is highly symptomatic, simply being told to “exercise more” may not be appropriate. Movement plans may need to begin gradually and be tailored to the individual, particularly for people who experience significant symptom flares or post-exertional symptoms. Support from a physiotherapist or exercise physiologist familiar with POTS may be helpful.
Depending on the person, their broader healthcare team might also include their GP, paediatrician, cardiologist or another medical specialist, dietitian and other appropriately qualified practitioners.
Sometimes the goal isn't finding one practitioner who holds every answer. It's building the right team around the person and understanding how the different pieces of care fit together.
Where might chiropractic fit?
At Restore Studio, our role is quite specific. We don't diagnose or treat POTS. For someone living with POTS, our chiropractors may assess relevant aspects of their neuro-musculoskeletal system, including joint movement, muscle function, physical tension and other individual clinical findings.
Where chiropractic care is appropriate, it may form one part of a broader healthcare plan alongside appropriate medical and allied health care.
What about INSiGHT Scans?
At Restore, INSiGHT scanning technology may be used as one part of a chiropractic assessment. Depending on the scan, we can collect information relating to muscle activity, skin temperature patterns and heart rate variability (HRV).
HRV refers to the natural variation in timing between consecutive heartbeats. Because this variation is influenced in part by the autonomic nervous system, HRV can provide information related to autonomic activity.
There are plenty of things that can influence HRV, including breathing, sleep, physical activity, illness, medications, age and fitness, so it always needs to be considered in context.
INSiGHT Scans don't diagnose POTS or dysautonomia. Instead, the information they provide can sit alongside a person's history and clinical examination as part of their chiropractic assessment.
What if there isn't a diagnosis yet?
Maybe you're reading this because some of these experiences sound familiar, but you or your child haven't been diagnosed with POTS.
Regular dizziness when standing, unexplained heart racing, fainting or near-fainting, significant fatigue or changes in exercise tolerance are worth discussing with your GP.
There are a number of conditions that can cause similar symptoms, which is why POTS isn't diagnosed from symptoms alone. Assessment can include measuring heart rate and blood pressure in different positions, alongside other investigations where needed to explore possible causes.
Getting the right assessment is an important first step in understanding what might be happening and what support may be appropriate.
Sometimes the bigger picture matters
POTS can have a very real impact on everyday life.
Something as ordinary as having a shower, walking around school, exercising or standing through a conversation can suddenly require more planning and energy than anyone else can see.
So while salt, hydration and standing slowly might be important parts of the conversation, they don't necessarily have to be the whole conversation.
There may be different strategies, different practitioners and different pieces of support that become useful along the way.
At Restore, we're interested in understanding the person in front of us, assessing what's relevant to chiropractic care and working alongside the broader healthcare team where appropriate.
Sometimes understanding which piece belongs where can make the path forward feel a little clearer.
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Important Disclaimer
This article is provided for educational purposes only and does not constitute medical advice, diagnosis, or treatment.
If you or your child is experiencing developmental, behavioural, or health concerns, please consult your GP, paediatrician, or appropriate healthcare professional.
Restore Studio provides supportive chiropractic care and does not treat or cure medical conditions.
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Healthdirect Australia. Postural orthostatic tachycardia syndrome (POTS).
Australian POTS Foundation. Diagnosing POTS.
Australian POTS Foundation. Treating POTS.
Australian POTS Foundation. Living with POTS.
Raj, S. R., Fedorowski, A. & Sheldon, R. S. (2022). Diagnosis and management of postural orthostatic tachycardia syndrome. CMAJ, 194(10), E378–E385.
Original Article
Adapted from Why “More Salt and Slow Standing” Isn’t Enough for POTS, originally published by PX Docs.
Important information: This article is for general education only and isn't intended to diagnose POTS or replace individual medical advice. If you or your child are experiencing symptoms of POTS or another form of orthostatic intolerance, speak with your GP or an appropriately qualified healthcare professional.