Postural Orthostatic Tachycardia Syndrome (POTS) is a rare disorder of the autonomic nervous system. The number of people afflicted with this
dysautonomia has increased dramatically in recent years due to the long-term effects of coronavirus disease (
COVID-19); however, it is largely underdiagnosed. This case report is about a patient with post-viral neuropathic POTS. Neuropathic POTS is believed to be due to the damage of small nerve fibers that regulate the constriction of the blood vessels in the limb and abdomen, which leads to interference with vasoconstriction, and therefore causes
tachycardia. Current literature emphasizes a treatment that is based on lifestyle modifications, such as increasing water and
salt intake, and symptomatic pharmacological treatment. In this case, the 39-year-old male ptient was treated with
osteopathic manipulative treatment (OMT), specifically the compression of the fourth ventricle (CV4), which has been associated with the production of hyperparasympathetic and anti-inflammatory effects and, hence, helps overcome the
small-fiber neuropathy caused by the viral illness. We found that the CV4 technique led to the successful remission of the patient's symptoms. Therefore, we propose craniosacral
therapy as a successful single management modality in patients with POTS.