The Thinking Practitioner Podcast:

Episode 142: Fascia and the Vagus Nerve (with Fabiana Silva)

Til Luchau  

Welcome to the Thinking Practitioner. Books of Discovery has been part of the massage therapy and bodywork world for over 25 years, nearly 3000 schools around the globe teach with their textbooks, e textbooks and digital resources, Books of Discovery likes to say, learning adventures start here.They find that same spirit here on the Thinking Practitioner podcast, and they're proud to support our work, knowing we share the mission to bring the massage and bodywork community thought provoking and enlivening content that advances our profession. Instructors of manual therapy programs can request complimentary copies from Books of Discovery, textbooks to review for their use in their programs and listeners like you can explore their collection of learning resources for anatomy, pathology, kinesiology, physiology, ethics and business mastery@booksoftiscovery.com where you as a listener can save 15% by entering "thinking" at checkout. And today, I'm very honored to be talking to Fabiana Silva. Welcome to the show, Fabiana, it's such a pleasure to have you here with us. 

 

Fabiana Silva  

Thank you Til for having me here.

 

Til Luchau  

I'll introduce you a bit, and then we can talk some more about our topic today. You're a physiotherapist with a master's in epidemiology, currently pursuing your PhD in Rehabilitation Sciences at UFC SBA andthe Devry University type in Brussels. You serve as President of the Fascia Research Society and direct the Fascia Research Center in Brazil. You're also CEO of Circle Health Education, and sit on the academic board of the ACS as Omi College of Sciences. You've contributed chapters to the book Fascia, the Tensional Network of the Human Body, which is was really helpful for my deepening understanding of fascia as I wrote my own books. And you served as a technical reviewer for The Portuguese edition of Travelle and Simon's Myofascia, Pain and Dysfunction, an old classic. You also teach extensively across Latin America on fascia sports and manual therapy. And I, if that's not enough, I want to hear about your presentations at the upcoming Fascia Research Congress, which is in just a few months in New Orleans, and the insights that you with your presentation and the Congress in general are going to bring to the field.

 

Fabiana Silva  

Thank you. At the conference, I will talk about the relationship between fascia and the vagus nerve. 

 

Til Luchau  

Tell us about how you got interested in that, or what drew your attention there as a topic.

 

Fabiana Silva  

I started working with fascia a long time ago as a practitioner, as a PT, my background is manual therapy, and after I started to read more about the autonomic nervous system, and started to be with patients with chronic issues like gut issues and etc, and the vagus nerves shows to me that this can be a pathway to explore. So I started to to study and work with the patients with a a regular transcutaneous vagus nerve stimulation that is like a way to treat the vagus nerve that is we have that we have a lot of research about it, and it's approved by the FDA for depression, for stroke rehab, and for some types of migraine So, and seizures too.

 

Til Luchau  

So just to clarify a little bit, transcutaneous stimulation of the vagus nerve. This is through the skin. This is not an implant. There's those are also sometimes used, no but you're, you're inspired, or you're, you're taking information or ideas from this fact that we can stimulate the vagus nerve through the skin, this is electrical stimulation in this case?

 

Fabiana Silva  

Yes, yes, it's electrical stimulation in physiotherapy, you already use a lot of transcutaneous electrical stimulation that is not invasive, and we can apply inclusive inpatient with cancer, for example, there is no adverse events. And this type of stimulation you can use to stimulate the vagus nerve and the ear is one local that the vague nerve is more superficial, so you can pass the electrical stimulus through the skin and fashion, etc, and stimulate the vagus nerve. And the other place that I use is to stimulate near to car rotated sheet here at the

 

Til Luchau  

neck rod and sheet,

 

Fabiana Silva  

yeah, and it's another place that you can do the transcutaneous stimulation that is non-invasive. There is a few contraindications, but with more indications and with good, good results. So I usually combine to manual therapy, the electrical, vagus nerve stimulation, the respiratory work and movement as well. For the patients.

 

Til Luchau  

Let's get into the specifics in a minute. But can you refresh us a little bit on why the vagus nerve would be a target. Why would it be so important?

 

Fabiana Silva  

Yeah, two principal points. The first one is the action of the vagues nerve to bring us the inflammatory process that is necessary for recover and so the vague nerves, it starts the inflammatory process, because here it has a relation with the immune system. So this is quite important for us, and because

 

Til Luchau  

the vagus nerve is a really key player in systemic inflammation, like you said, helps start that cycle, which is so important, also, as I understand it, helps modulate it, or time it, or help wind it down, those kinds of things. 

 

Fabiana Silva  

Yes, and with chronic issues, in acute but in chronic issues, we have like this, balance between the pro-inflammatory cytokines and the anti -inflammatory cytokines and the vagus nerve improve the anti- inflammatory with the path of the time and the other important thing is that vagus nerve is in relation with a psychological functioning of our body and in relation in chronic issues, we have a lot of patients with depression, anxiety and sleep problems and etc, and the vagus can help us to modulate these other things, not just the direct ones that are directly linked with inflammatory problems. And so vagus have a peripheral but a central influence that is really important for us, and it's the major nerve of the parasympathetic nervous system. And so this is why

 

Til Luchau  

the parasympathetic nervous system again being the one responsible for repair and rest and recovery, and often the thing we're thinking about when we're doing calming therapies, or relaxation based therapies, often thinking about an ongoing state. And like you said, the vagus nerve is the primary structures involved with that,

 

Fabiana Silva  

and is it's other way how you can, we can improve the vagal tonus is, for example, with respiration, with manual therapy, with exercise or body practical movements that when the person is engaged with their own body, they are taking attention. They are trying to calm down. So this is this can regulate the vagus tonus too.

 

Til Luchau  

Just being engaged with our bodies, just moving, just paying attention to our somatic experience that regulates the vagus nerve as well. You're saying,

 

Fabiana Silva  

Yeah, deep breath for five minutes. And because this the vagus have a afferent power so it's always giving notice for the central nervous system what's going on in our body. Is something like us in the fascia field we we call interception. And Professor Steven Porges, who will be at the FRC with us this year, he talks about neuroception. It's a different concept and then reception.

 

Til Luchau  

Stephen Porges, yeah, he's, by the way, it's gonna, I just heard this morning, he's gonna come join us on the podcast for an episode. We'll talk to him about that. I'm excited about that.

 

Fabiana Silva  

Amazing, yeah, I like his work. He's a like gives us the foundation of the vagus nervous stimulation for me, something that is really important from his work. It's about safety. And when we are with a patient that have chronic problems, that have fear of the movement, that have fear of a lot of things in their lives, we need to help them to go to a place that they can be more safe. And some, some people are not safe with their own bodies. And this can be really stressful in this can causes or having the feeling more pain and more stress and more in a sympathetic predominance. That is something that us as massage therapists, physiotherapists, yoga practitioners and so on, we can help this, these people with these issues.

 

Til Luchau  

Okay, so you're talking about the power of the vagus nerve in so many different areas of experience, including autonomic nervous system, psychological effects, inflammation, sleep, etc. How does that relate to fascia? Isn't fascia just tissue.

 

Fabiana Silva  

At the beginning, I it was for for a lot of people, but now we know that the fascia is the glue, but not just this and fascia.

 

Til Luchau  

Then again, I'm sorry, fascia is the glue. 

 

Fabiana Silva  

The glue that brings everything together? Okay? And thinking on vagus nerve perspective, fascia brings the the interface, the tissue that gives passage to the nerve. You know, because the vagus nerve needs to goes out of the jugular foramen and goes down through the body, passing for a lot of fascia sheets, a lot of fascia connections. And one of the problems it off the low vagal tones can be in this interface that the nerves need to go through if you have a scar tissue on fascia like at the neck, for example, or gut or uh other at cervical for example. Or if you have like a concussion, you can bring a dysfunction they see throughout this fusion that can cause a low functioning for the nerve, for all nerves, not just vagus, but we are talking about vagus right now. And this can give to the nerve less axial plasmatic fluids. This can bring to the nerves less mobility, and this can cause inclusive pain for some people, and so fascia have a mechanical protection for the nerves, including the vagus nerves. So it's why it's important to have a health fascia for the you for the good functioning of the vagus nerve, for example, and other nerves. But it's not just this, because fascia, like vagus nerve is a sensory organ, and always second by second, it's giving information for the central nervous system about what's going on at the periphery, and the vagus nerve, regulating the autonomic nervous system will bring us the, as we say, the not the afferent, but the afferent. Um, responses, including, for example, it's not just motor and sensory, but we have a vagus nerve, improving our stomach acids, for example, improving our gut movements, improving our liver work and etc. And so this communication occurs. It's it's not. It's something autonomous. It occurs every time, every second in our body, and if the fascia is this regulated, or in this function, or in with fibrosis, for example, this information can goes in a wrong way to the Superior central nervous system or etc, and the reference response of the Vegas can be this balance, for example. So this is, this is not a just a mechanical relationship between vagus and fascia, but as it's a relation about the information of the things that are going on in our body. So it's really important.

 

Til Luchau  

You're saying the vagus nerve has, let me see if I can summarize, vagus nerve has many functions. It is a mechanical structure. It is a nerve. It is surrounded and mechanically protected by fascia, and qualities of that fascia can influence its functioning, both mechanically, but you also talk about axial, plasmatic relationships, inflammatory processes, things like that, locally that can change the functioning of the nerve itself, perhaps density, you said, or certain places where scarring or tissue problems might change the functioning of the nerve, both in its role as an afferent signal for the central nervous system, but also you mentioned its role as an efferent pathway for the central nervous system's effect down into the body. I get that right.

 

Fabiana Silva  

Perfect. Yeah, and it's something so it's so good to study and to learn about it. And at the Congress, we will have a lot of opportunities, not just with Professor Porges, just that will be amazing. It's like something that a lot of people want to know him and stay with him, but other practitioners that we will present about vagus nerve, about the the inflammatory, chronic inflammatory issues that we have a lot, a lot, including post COVID, with The Long COVID situation that brings a lot of issues from patients like fatigue and chronic pain, inflammatory pain, etc. So we will talk about this at the Congress that is like reality for us right now. This

 

Til Luchau  

is all a topic that's dear to my heart, having been through chronic health conditions myself, but I'm also going to get a chance to do a short hands on workshop post Congress about inflammation and fascia. So I'm looking forward to bringing

 

Fabiana Silva  

that. I will be there,

 

Til Luchau  

and the vagus nerve has for a long time, then a place that I've focused my attentions, there was some really interesting research maybe 10 years ago, maybe a little more, with Kevin Tracy around using vibration to stimulate the vagus nerve in the ear. Of course, there's the transcutaneous electrical stimulation you talked about, which is pretty obvious and probably really great, effective and easy to research, but as manual therapists, my assumption is we're also having effects through our touch and through the mechanical and other kinds of stimulation we get by touching those same areas. So I leverage that ear a lot than the little area behind the ear where the vagus innovates for for our migraine approach, and I'll talk about that in our inflammation workshop as well. So it's, it's, uh, there's not that many people talking about it. I appreciate seeing the topic that you're speaking of, and then these things you've mentioned today, any other practical considerations we can brainstorm together here, before we turn our attentions to the Congress itself, what would you say to practitioners who are interested in starting to use these ideas in their hands on work?

 

Fabiana Silva  

I use the hands-on approach too on vagus, especially to the cranial, cranial myofascial release there, because this is when vagus goes out and we know when we work in this region, the region we have, as we know from now, from the research, we have a lower, lower salivary cortisol level and a improvement at the anti inflammatory cytokines. So

 

Til Luchau  

let's translate that a little bit for people that would imply that there's there's a bad there's a more robust response to stress, ability to recover from stress, more and lower activities of systemic inflammation, just as a result of working on the vagus nerve in those places, you're saying,

 

Fabiana Silva  

Yeah, and this is a technique that is common for those that work with craniosacral therapy or manual therapy. For PTs, for example, this suboccipital release, manual release, I use a lot, and we have some research showings, the work at the sternal colloidal mastoid muscle and area in the front of the neck there, yeah, yeah, in front of the neck that it's, it's quite interesting. And two years ago, I did a review about the fascia target approach at the goods and we found in at this review that we have good improvements for people that have like a problems like reflux and geo issues, yes, yes, yes, and for people that have low back pain and as the same time they have gut problems like constipation, for example, they improve when you use a fascia target manual therapy at the guts. So this is really interesting, and I use it a lot, but we don't have evidence for manual therapy in all the pathway of the vagus nerve. So it's something that we really need to work on it. Yeah,

 

Til Luchau  

and we don't have the studies you say. We haven't done the research there. We do have, you know, decades, centuries, maybe millennia of clinical experience. Like you said, there's so many people that work the sub occipitals in response to a headache. We do that for ourselves sometimes. So there's, you know, maybe we're finding some of the mechanisms that explain or can help us get even more specific about things we know already in the manual therapy traditions,

 

Fabiana Silva  

yes, yes. And of course, some things that we do we will never see in research.

 

What do you think

 

Fabiana Silva  

because to do a randomized control, control trial that simulates what what we do in a clinical moment. In a clinical practice, we can't have all the pieces of the puzzle in a randomized controller trial, because the result that we have. It depends of a lot of things, not just the technique, but depends about the connection between the practitioner and the patient or the client. It depends about the environment. It depends about the level of stress. It depends about a lot of things. It's not cause and consequence. It's like more an interaction. And we will have, we will give one input to one scenario, scenario, and we will have an output. Of course, we are hoping that the best output is less pain, more mobility and etc, but the interaction depends of a lot of things, the history of the person, their beliefs, their culture, and a lot of things, and so it's why, when you look to the randomized controller trial about manual therapy, the results are just low or moderate. You can choose each technique that you want to. A mobilization like trust or massage or facial target therapy or etc, the results are not outstanding. The results are not high as we with respect, because some pieces of the puzzle will never be there in a research environment.

 

Til Luchau  

That's maybe, yeah, that's a that's an interesting thing to keep in mind, that especially as we think about research it's designed for it was, you know, originally used around measuring pharmaceutical interventions, which are much easier to reduce to a single factor, even then, there's pretty strong arguments that the context is sometimes the most important part of The experiment. Yeah, and I just as a mental exercise, it's, there's, there's some really interesting research design that does include a lot of contextual factors that is, is is still interesting to compare one context to another, for example, that's something that I want to do more learning and thinking about myself, But your point is a good one, that there are some things that make manual therapy or massage therapy or body work effective that are really difficult and not suited for the randomized clinical control trial.

 

Fabiana Silva  

As a research society, we and in I wanna support this. I wanna see more context studies, more pragmatic studies, like, for example, you do treat everybody with low back pain in the same way, right? Yeah. And, but when you do a study, you treat everybody with the same techniques in the same repetition, with the same thing. And for doing pragmatic studies, we can keep in mind the context that but we will have something that we will lose, but at least the treatment can be more specific for that individual, and it's why I'm looking for this type of study. This the pragmatic studies that can bring us a little bit more things, more closer to the things that we do at our offices.

 

Til Luchau  

You're the president of the Fascia Research Society. How does this thinking affect your mission there, or the role of society in supporting our field?

 

Fabiana Silva  

I'm new on this task, like one month, but I have a lot of ideas together with the board, and for me, the first one is that thinking on the fascia, fascia field, the quality of the publications are not so good. We have a lot of studies about fascia published in predatory journals.

 

Til Luchau  

Predatory journals? Can you tell us something about what those are? Yeah,

 

Fabiana Silva  

predatory journals is that ones that don't have their first goal is not quality, their first goal is to publish, and the researchers need to pay to publish, so they are for a fee as

 

Til Luchau  

a researcher, or even not as a researcher, I could go to journal or a service and have a study designed and published and put out in my name, showing a particular result for a fee.

 

Fabiana Silva  

Yes, yeah, yes. Every week, every week I receive emails from the journal blah, blah, blah, oh, we are going out with our next edition, do you have some research to publish with us? Why are you inviting me so a lot, if you had a lot of people applying to produce you with you, you don't need to invite me, you know. And it's not just me Fabiana, it's they send it to a lot of people. And these predatory journals, they. The the quality is low because they don't have good reviews that will look at the they study and say, Please change this. Change that wrote in a different way. No, your study. Your study can't be published by us. And so it's not a critic and constructive work. And a lot of studies from fascia, fascia field, are published in this type of journal. And so it's something that we can really, really support the researchers to to do in a different way. And another thing that we, we are looking for doing is have FRS, have have our own journal with good reviewers, with an editor that can put the scale high, not low, because we deserve the best quality of research that We can have. And this is not not now. Are reality, and it's not a criticism for those that publish it there I already did, and after did the publication, the journal that I published, entered in that list, and that's it. I already published it, and okay, but we can help the researchers. We will have our own journal, and we are looking for more partnerships with other research associations, like International Association, Association for studies of pain, Yap speed, that is really good, the American Physical Therapy Association. We need to be together with other societies to show how we work, to show that we can put fascia on a lot of other fields, like yoga, international, Euro, Geneecology Association. And fascia can be in a lot of places. And Fascia Research Society can give the opportunity, or can put this people together, and for this Congress in NOLA this year, we are with, say, any am PT offering continuous education credits. So there is something that is amazing. And we are with a Australia Massage and Myotherapy Association too. And we are really how happy for having these, these people with us, supporting us. And we are supporting them too. So

 

Til Luchau  

they're the biggest massage therapy association in Australia. So it's great that you have them on board as well.

 

Fabiana Silva  

Yes, yes.

 

Til Luchau  

Let's let me go back for a second. You said the seventh International Fascia Research Congress is coming up in Nola you said, For listeners who don't know what that is, that's New New Orleans, Louisiana, yes, yes, new worries, yes, that that's coming up. Let's just name the date. When is that?

 

Fabiana Silva  

August? August, from 10th to 14, since the 14th, yeah, but we will art on late with anatomy, dissection workshop with a team of stars like Carly steco, you Hadley, John Sharkey and Gabriel van

 

Til Luchau  

and John have both been guests on the show. We hope to and Antonio stecco has been a guest on the show. So there's they're running a dissection workshop before the Congress that should be pretty exciting.

 

Fabiana Silva  

Yeah. And they will have astology and ultrasound image ultrasound together, and will be really, really interesting. And it's good, as I mentioned at the the interfaces, the fascia pathways for the the nerves and etc anatomy, and knows anatomy is really important for this and other things in our practice.

 

Til Luchau  

What makes the Congress unique compared to other scientific or academic conferences? What was that?

 

Fabiana Silva  

The first thing is that this is our Congress. This is the Congress from people that works with fascia day by day, like you and me, and this is the Congress for of our community. And we need to improve this sense of community in the fascia field, the sense of collaboration. And as Professor Carol Davis mentioned and to me, she says, I'm feeling this year with the program that you and the in the the Committee of the scientific committee of the Congress. I'm feeling the community sense together again. I'm feeling I'm feeling that I'm, I'm part of this again, because we will have at the Congress a lot of opportunities for change the experiences the special interest groups, and we will have one about manual therapy and fascia, one about movement and fascia, and one about bio tensegrity. And from these special interest groups, we will create task force, and there is the society will work after to write a clinical recommendation, including the clinical recommendation for the use of tools and rows and balls and etc. So we will have a lot of opportunity to really honor our mission that is bringing the gap between clinical the practitioners and the researchers, and we will put them in at least three round tables. So they will discuss from a research perspective and from a clinical perspective. And so this is the event. This is the Congress that someone who works, someone who likes someone who study fascia, needs to be there, not just because they're researchers, but because the practitioners that will be there too.

 

Til Luchau  

That's something I've always enjoyed. I've been to most of them, and I've always enjoyed the practical applications. And of course, that's my bias as a practitioner. I'm always looking for, how can we use this information like that? Many of us, many of us who are in the clinic want to know this is very interesting, but then, how do we use that? And I've always been really pleased at the conversations that happen there and at the high number of practitioners in attendance. It's not just academics and researchers. And I'm imagining this, but it looks like this year's roster presentations has an emphasis on practice and application too. There's quite a bit of that that I saw,

 

Fabiana Silva  

yeah, and it was something that people talked to to me after Montreal

 

Til Luchau  

was the last Congress people talk to you about that,

 

Fabiana Silva  

yeah, that it was amazing. And it was I enjoyed a lot, but some people were saying, oh, I need more practical things. I need to think about my work. I need to I need more application of this, and so it's, it's like, I put this as I mission for me, and this year, we are already doing doing this.

 

Til Luchau  

Well, you have me leading a round table discussion one evening on how do we put this into practice? So I'm looking forward to examining that question together very

 

Fabiana Silva  

specifically, yeah, and we will have morning movement sessions every day, and morning lectures about manual therapy, application, manual therapy and movement and etc. We will have a pre and post Congress, workshops and the network session, networking sessions. So a lot of opportunities for people and and the abstract presentations and postal presentations too that have, and we have a lot of practical works that will be show there.

 

Til Luchau  

I'll be talking to Dr. Robert Schleip, in a few weeks about the Congress talking, like I said to Dr Stephen Porges, about the Congress, and then I hope to have a couple conversations while I'm there with people and share them with our listeners afterwards as well. Are there, will the Congress be online, or are there recorded options for participating for people?

 

Fabiana Silva  

No, the Congress is in-person, yeah, and it's a not easy decision, but we decided to maintain person, and because it's in three years, is the opportunity to have everybody together and and we started playing in this Congress three years ago, of course, and we are ready plan it to be in person, so we will continue to see this come

 

Til Luchau  

in-person, come be part of it, or tune into the podcast, or do the research and read up on some of the things that are going to be happening there. I'm looking forward to it. Anything else you want to tell us about? What note Do you want to leave us on? God, thanks for your time today. What do you want to leave us with?

 

Fabiana Silva  

Just say that the plans for Fascia Research Society are really good about journal about more membership, opportunity to to work together with the society and we, we will, we will apply to a center Myofascial study, to a lot of things that the guidelines, the recommendations. So it's, for me, it's one duty of the society, try to guide the people that work in this field. And so we will do this, and we'll have the nomenclature work we have a lot of now we will start with fashion, cancer, cancer. We start at the Congress to work with Professor Werner Kingler and Stephanie Otto from university, and we will have good news, good things, and we just want to people together with us and enjoying the Congress and the society too, and feel and feeling that they are part of this,

 

Til Luchau  

the Fascia Research Congress in New Orleans, August, 10 through 14th, 2025 we'll put a link on the in the show notes, the Fascia Research Society will also link to there. Fabiana. Thanks for joining us today. Let me go ahead and thank our closing sponsor, also, which is ABMP. They are proudly supporting us. They are the premier association for dedicated massage and body work practitioners like you the associated bodywork and massage professionals. When you join ABMP, you're not just getting industry leading liability insurance, you're gaining practical resources designed to support your career, from free top tier continuing education and quick reference apps like pocket pathology and five minute muscles, ABMP equips you with the tools you need to succeed and grow your practice. ABMP is committed to elevating the profession with expert voices, fresh perspectives and invaluable insights through CE courses, the ABMP podcast, Massage and Bodywork magazine, which features industry leaders like Whitney Lowe, who wasn't able to be here today, and myself Til Luchau thinking practitioners like you can get exclusive savings on ABMP membership at abmp.com/thinking Join the best and expect more from your professional association. Thanks to you our listeners and to all of our sponsors. Stop by our websites for the video, show notes, transcripts and extras. Whitney's site is AcademyofClinicalMassage.com. My site advanced-trainings.com we want to hear from you with your ideas or input and feedback about the show. Just email us at info, at the thinking practitioner.com, or look for us on social media or YouTube under our names again. I'm Til Luchau, Whitney Lowe, my cohost, will be back. People can check out Whitney's channel, where he has a YouTube channel where has lots of resources for rehabilitative massage, and we would appreciate it if you would rate us on Apple podcasts. It really does help more people find the show. It helps our sponsors know that we're thinking of them and giving them value as well. So take a second. It takes about eight seconds to click your podcast. US link and go there and just rate us. Tell your friends, share the word come on back next time, we'll have even more guests. Fabiana Silva, thank you so much for joining us today, telling us about your research in the Congress. I appreciate you taking the time. Thank you too.