The Thinking Practitioner Podcast:

Episode 148: The Vagus Nerve: Buzzword or Biology? (with Til Luchau & Whitney Lowe)

Whitney Lowe  

Welcome to the Thinking Practitioner podcast,

Til Luchau  

A podcast where we dig into the fascinating issues, conditions and quandaries in the massage and manual therapy world today. 

Whitney Lowe  

I'm Whitney Lowe 

Til Luchau  

and I'm Til Luchau.

Whitney Lowe  

Welcome to the Thinking Practitioner. Books of Discovery has been a 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", and they see that same spirit here on the Thinking Practitioner podcast, and are proud to support our work, knowing that we share the mission to bring the massage and bodywork community thought-provoking and enlivening content that enhances our profession.

Til Luchau  

Instructors of manual therapy education programs can request complimentary copies of Books of Discovery's, textbooks for review and use in their programs. Listeners like you can explore their collection of learning resources for anatomy, pathology, kinesiology, physiology, ethics, and business mastery at booksofdiscovery.com where you as a thinking practitioner listener, can save 15% by entering "thinking" at checkout. Thanks for sponsoring us, Books of Discovery. You make all this possible. Whitney, how are you doing?

Whitney Lowe  

I'm doing well, sir. How are you doing today?

Til Luchau  

Also very good. I missed you last episode. I'm glad to be back with you.

Whitney Lowe  

Yes, indeed, good to be back on stage, and I'll had you all had a great discussion heard, and certainly look forward to hearing all that stuff that came out of it.

Til Luchau  

Yes. And then today, we have an interesting topic in many different ways, both because for his content and for it's context, it's position in our Zeitgeist. Yes, what are we talking about today Whitney?

Whitney Lowe  

Well, it's time to talk about vagus not the gambling Vegas, but the anatomical Vagus. 

Til Luchau  

I thought, like it was like, "What stays in Vegas"? Or, how's that go?

Whitney Lowe  

Oh, "What happens in Vegas? Stays in Vegas". You know, 

Til Luchau  

It's not one of those. 

Whitney Lowe  

Not one of those. 

Til Luchau  

We're talking about the vagus, the nerve fame,

Whitney Lowe  

Yes. Vagus nerve, yeah. 

Til Luchau  

Let's get a little timeline here. When did you first hear about it? 

Whitney Lowe  

I have to throw a bone out to my outstanding anatomy teacher in massage school, because I know that's the first time I heard about vagus nerve. Do you remember the mnemonic for all the cranial nerves, the one about on old Olympus tiny tops or something like that.  Vin and German viewed some hops or something like that. And the V is for the vagus nerve. So anyway, that's the first time I heard about it. I'm sure, in massage school. But I think one of the other times that I began hearing about it that made an impact on me was sometime in the 90s, when there was lot of popularity with chair massage and they were having a number of instances of people passing out in massage chairs, and there was a lot of thoughts like, "what's happening here" and the primary theory was that this is something that is inducing the vagal response from the increased significant degree of relaxation that people were having, and then that was dropping blood pressure and heart rate to the point that people were passing out. 

Til Luchau  

I first heard about it when I was training as an EMT about 20 years old, and there was one of our instructors would would have us take his pulse and then do a valsalva maneuver where you just basically blow really hard without letting the air out. Yeah? And we he would like amaze us all by his ability to slow his pulse down. Oh, wow, by doing that, and I was basically a vagal response,

Whitney Lowe  

How did I not know that you had trained as an EMT? I don't remember ever hearing that.

Til Luchau  

I did it for two weeks, and then I was like, This is not for me. This is not my field. I was so glad to have had that experience to know, and I was glad to be there for the patients, or, you know, people that needed me for those two weeks. But that was I needed a different direction at that point.  But then I also heard about it a lot at the Rolf Institute in the 90s, when actually Steven Porges was of the polyvagal fame, who's going to be our guest at some point here in the next few episodes. He was doing some of this initial research on heart rate variability with John Cunningham, who was a Rolfer. They were actually looking for places they could see differences in heart rate variability. The Rolfers were really interested to see if he could find it in Rolfing. Apparently, Steven Porges was interested to see what he could find at all, and they did a bunch of studies of heart rate variability and Rolfing, and found, like one particular technique that seemed to have a pretty measurable effect on vagal tone. That was our, pretty much, our one piece of hard science evidence for many years and even now turns out the hard science aspect of that is about everything in hard science is debatable. Yeah, maybe we'll touch on that as we go too.

Whitney Lowe  

Yeah. Well, let's kind of, let's start at the at the at the basics. So because this may be something that people need some familiarity, refresher on, or, you know, maybe not even really having touched on this a whole lot, because this, this is deep and out of sight to a lot of us. So can you give us, maybe, kind of like a sort of anatomical rundown of, well, I guess, where is it?

Til Luchau  

Yeah. How did I get that question? I should have been asking you this as Mr. Anatomy, but, yeah, I'll give my best shot at it. But I should say too, it's deep and out of sight in the body, but in popular culture, it's right out front. I mean, you can't turn on at least. Maybe this has me pegged as a vagal person the algorithms, because every I'm always getting, like, stimulate your vegus, turn off, turn on your Vagus, tone your vagul push ups today. Do you know about vagal push ups? 

Whitney Lowe  

I do not. I'm curious to hear about Vegas. 

Til Luchau  

People are doing this, apparently, gagging themselves with a stick or a pen or something like that, because that gag reflex does give a little spike in vagal activity. And there's the idea that that's good for it. I don't think, I'm not recommending that, and I don't even think it's probably good for, I don't know, but that idea in the popular culture that turning on or stimulating to vagus is a good thing. Yeah, there's something to it, but it deserves some nuance. 

Whitney Lowe  

I was doing some reading prior to our episode here. I did run across some things that we're talking about gargling as another means of doing that, and I'm thinking that's maybe a little safer.

Til Luchau  

All right, what is the vagus? The vagus is the primary pathway for parasympathetic signaling out of the brain into the body, and it runs from the brain stem down the neck, right alongside the carotid artery, jugular vein, and then innervates along the way, branches of it and cousins of it innovate the throat, the motions of the tongue, vocal production, and then very directly, it starts to innovate the heart and the viscera below the diaphragm. And I'm sure, probably forgetting something, you know, and along that pathway, but it's taking information from those structures and feeding them back to the brain. It's about 80% afferent, meaning 80% of the fibers are sending information from those structures to the brain. The 20% of motor or efferent signals are interesting, but again, they may be, you know, for the vocal production, things like that, or there are some visceral functions that it stimulates as well.

Whitney Lowe  

Also interesting too, that there's some branches, and I got thinking about this because this is something that piqued my curiosity a little bit. There are significant branches also to the ear, the various different portions of the ear. And I kind of feel like there's a lot of acupuncture points and things like that, and there's some like reflexology or some other kinds of methods that focus on treating the ears. And I got thinking like, oh man, if there's like, there's a vagal factor there that they're trying to address.

Til Luchau  

 You know, I actually feature the vagal portion of the ear in my headaches workshop. There's some good evidence of vagal stimulation helping with migraines. People are actually getting vagal stimulators implanted, electronic stimulators or transcutaneous ones, and so I've for years experimented with using touch as a way to try to get a similar effect. And the ear and little patch behind you are the only places on the surface of the body that are innervated by the vagus.

Whitney Lowe  

I heard a story of somebody talking on this was on a Reddit forum or something like that, of somebody saying they were having some kinds of things where they wanted to try to do something, trying to increase vagul tone, and somebody had told them to stick their finger in their ear and just kind of like, you know, scratch around, or something like that.

Til Luchau  

Well, we're putting the cart before the horse a little bit, because I want to talk about stimulating the vagus as a concept, I'm, I'm guilty of the same thing, like, Oh, this must be cool. The vagus is a cool nerve. It regulates a lot of things, and so if we could stimulate it, maybe we can have an effect on some things like migraines or other things like that. I think there's a limit to that, and there's some things to know about it. Which is interested in having this conversation. 

Whitney Lowe  

Well, we'll get to that a little bit more detail here before we leave our structure stuff, can you talk a little bit about these divisions between the dorsal and ventral vagus?

Til Luchau  

This was Steven Porges and his polyvagal theory, or in other words, he says there's more than one vagal branch, and he divided ventral and dorsal.  There's some controversy about the science. We're going to get him on the show and hear from him directly, but it's still a really useful, you could say, way of talking about it, or way of thinking about it. The ventral vagus is thought to be in his model, more recent evolutionarily, or that's where some of the arguments happen. But any case, it connects the face, the throat, the heart, and in his model, associate with safety and social engagement, like when we watch each other's facial expressions or say things, that's that ventral part of the vagus that's modulating that, and that's how it's the nerve of social interaction and connection in that way. The dorsal vagus is the one that goes sub diaphragmatic, and it's thought to be more simplistically associated with the freeze response or shutting down or that depression aspect. It's thought to be more reptilian, again, in that metaphorical evolutionary model. But I should say they're both parasympathetic. You know, if they are indeed anatomical, they're both they're both together. They make a huge part of the parasympathetic structure of the body. We're interested in the parasympathetic part of the nervous system for listeners, just to review, because that's the relaxation response. That's the counterpoint to the fight and flight stress response that so many of us live in, so many of our clients deal with, and that wears us out. Eventually, the parasympathetic branch of the autonomic nervous system is the one that's possible for rest and repair, healing, relaxation.

Whitney Lowe  

So maybe just briefly too, most people are familiar with this, but let's just real quickly go over again. Remember, we're talking here about the the role predominantly of the autonomic nervous system, and that has these two divisions of the sympathetic and parasympathetic branches. The sympathetic being the one that we most commonly associate with those fight or flight responses. And as you mentioned earlier, the parasympathetic associated with the rest and digest activities, so trying to settle down and just maintain homeostasis of the system, predominantly in the parasympathetic system, and the vagus seems to be the captain in charge of a whole lot of that stuff.

Til Luchau  

Captain in charge or maybe it's just a wire. Maybe it's a cable that connects things.So maybe it's the things that it's that are being transmitted, they're in charge. But I think that is actually one of the points of contention. Is the vagus in charge? Probably not. It's probably a wire, yeah? Because it's a nerve.  Yeah, makes sense, So that's a that's behind that. Let's stimulate the vagus narrative. Sometimes it's not in charge, it's a wire, yeah? And maybe we can have an impact on the wires function, maybe not, but it's helpful to remember that, yeah. And then here's another one that's a different episode, but the idea of sympathetic and parasympathetic is a theoretical construct that doesn't have really good correlates in neurology or in function. You start getting down to the details, and you realize, wait a minute, his was a theory that was applied to the nervous system in the 20s. And there's lots of exceptions about the ways we name things. Sometimes we can dig into that rabbit hole if you're interested,

Whitney Lowe  

This is always interesting. We love divisions and categories and putting things in in boxes and models to be able to help it make sense to us, and that's certainly helpful from a construct, a mental construct, point, but the systems are systems, and they are networked and engaged in and meshed in so many different ways.

Til Luchau  

But relaxing is good, and that's yes, our that's what our work does. And so we're interested in things that help people relax,and the social part of this is good too, because, again, polyvagal theory says that we relax together. We basically feed off of each other's signals, and that helps us calm and regulate our nervous system.

Whitney Lowe  

Let's talk just a little bit about vagal tone, because this is one of the things that I think is a little bit confusing sometimes, because the idea often is that we're trying to get people to relax and to settle down, and then when you see a lot of the stuff written about vagus, it's talking about ways to increase vagal tone, which might seem a little counterintuitive. So can you kind of pull that apart for us a little?

Til Luchau  

The vagus nerve slows the heart down. That's it's action on the heart. When it's when it has more signal on the vagus nerve, when it's being stimulated, the heart goes slower.

Whitney Lowe  

The heart increased vagal tone is a good thing to turn down activity. 

Til Luchau  

If turning down the heart is a good thing, then increased vagal tone is a good thing. Like you said in your chair massage, you can turn down the heart too much and someone can faint, right? And I saw that once in a training situation, it was a student in a class, and someone was working on the neck, both sides. And maybe it was blood flow, but probably it was more vagal response. The person sitting up just fell over, fainted at that point. And that's probably what Bruce Lee, or whoever did the martial arts movies, is doing with his fingers. When he does his things with the neck, he's probably like,  knocking out the bad guy with his uh, vagal poke or whatever he does. 

Whitney Lowe  

Well, that certainly probably wasn't the case in the in the old days, because they didn't have that degree of anatomical specificity but that certainly would make, it's an idea like I know have from having studied martial arts for so many years, It certainly would help if, if they studied anatomy in really great detail in martial arts, because I think it would make a lot of what they're doing a whole lot more effective.

Til Luchau  

 It could be. I have a lot of respect for the teachers I studied with and their anatomical knowledge, maybe not in the way we think about it in this context, but really amazing knowledge of the body. And yeah, touch or blows, or whatever, whatever locks could affect that. 

Whitney Lowe  

I do remember a certain number of training activities that I did with some of my teachers that once I learned some more about biomechanical kinesiology is like, Okay, that's a bad idea.

Til Luchau  

 I get you. Yeah, I hear you. We were talking about vagal tone, though, yeah? How the vagus nerve's activity slows down the heart. The heart has its own pacemaker of cells, their cells that actually keep the heart regulated and keep it beating. And if, if the vagus nerve wasn't slowing it down, the heart would beat it about 200 beats per minute. That's the rate of the pacemaker of cells within the heart.  So thethe vagus, is actually the break, that anytime your heart is less than about that rate is because the vagus is slowing it down. So that's the vagal tone idea. Vagal tone is the amount of activity in the vagus nerve, and then heart rate variability is is a proxy measure for how effective that is, how much the heart varies, is thought to be a sign of how active and effective the vagus is being and slowing the heart down.

Whitney Lowe  

If you do any kind of digging into discussions about the vagus nerve, you'll hear a lot about this, HRV, the heart rate variability, as one of the primary measures. But that also seems like it's not something that's really easy for us as manual therapy practitioners to evaluate, because you really have to be monitoring the heart under lots of circumstances for a longer period of time to see those degrees of variability, right?

Til Luchau  

Right. And I'm not alone, but I did a bunch of experimentation on myself and a few clients and friends with heart rate variability. We had some cool chest straps. There were some of the first ones that came out that I knew about that helped us measure and watch heart rate variability in real time. And there were so many variables that it's not like pulse. It's not like you can just watch the pulse go up and down and know what's causing it, but it's it's heart rate variability is affected by so many things that it wasn't always clear why I was going up and down and and when someone was really relaxed, it didn't always translate to a lower heart rate variability. So that's a complex averaging you need to do, and limiting a lot of other variables, including, like, what's in your stomach will change your heart rate variability, the way you're breathing, your overall fitness, your how much sleep you got, all that stuff will affect your in the moment Heart Rate Variability measure, yes, so it's a tricky one to try to actually use in real time. Although there's a bunch of research that says it, it does correlate with symptoms, especially heart related symptoms and a bunch of other symptoms.

Whitney Lowe  

You spoke about breathing. I want to talk about breathing for just a second, because that is another one that's highlighted as critically important or super valuable in trying to help encourage good vagal tone. And then people talk about some other things that might have to do with the exhalation process, humming, singing, chanting, those kinds of things tell us a little bit about how does that relate? 

Til Luchau  

Well, breathing does slow slowing down your breathing, especially lengthening the exhale, does slow your heart rate and increases vagal tone 

Whitney Lowe  

So that sensation like how. "Ah", it's really a good thing to be doing.

Til Luchau  

If we are to be turning down the higher rate, which is, you know, the first question we should ask, but in most cases, yeah, especially doing the stress. My dog gives a big vagal breath when he settles on his cushion and finally ready to sleep, he's just this big old sigh, this big old canine sigh. And that's vagal spike. That's him like, "okay, now I can slow my heart down". Yeah. And so being able to do that intentionally excites a lot of people, so to speak, you can really start to think about like, if I can slow my breathing down. And you know, this is taught to people dealing with PTSD. Is taught to first responders to control their own fight or flight responses, things like that, to actually just slow the exhale. And there's lots of systems for that, basically does slow your heart. The mechanism of that is really pretty interesting, that it's, how can I say it in a simple way? Basically, when you exhale, there's a slightly less pressure in your chest, and the heart has to work less hard. So basically exhaling more vagal tone, slower heartbeat, less work needed, yeah, when you inhale the heart has to really push hard to work against that pressure of the air in your chest cavity, too. The vagal at that point has less tone and lets the heart beat harder. Yeah, so basically exhaling more vagal tone, slower heartbeat, less work needed. So you can take advantage of that by just emphasizing the exhale and spending proportionately more time in the exhale phase means your vagus is active more of your breath cycle, and again that can may it can result in lower overall heart rate and probably better stress control.

Whitney Lowe  

I don't recall seeing this in any of this stuff that I was looking over with, talking about breathing and vagal tone and things like that. And I'm just curious. I just had this thought as you were talking about this, what about yawning?

Til Luchau  

Absolutely 

Whitney Lowe  

so also doing the same thing, 

Til Luchau  

Yeah, opening up the back of the throat. I mean, the vagus runs right next to the back of the soft palate, and that's what people are poking at when they try to give themselves a vagal push up. But, yeah, yawning, absolutely. And there's, there's, you know, yogic correlates of opening up the back of the throat, or finally, on the breathing, different practices similar to yawning, that probably do leverage a lot of vagal effects, but you asked about humming or chanting? You know, auricular branch, the one that goes to the ear. So when we're listening to someone to hum along with them, we're activating that. When we synchronize up our tone, we're using the laryngeal flaggal branches to modulate the tone, and doing that together, like humming or singing with someone, is a co regulating activity, and that we have to listen and make sound in harmony with somebody else. That sounds pretty cool to me, that sounds like pretty regulating right there. 

Whitney Lowe  

So there's a therapeutic correlate for karaoke, maybe,

Til Luchau  

ah, that's it. That's it. Especially like duet karaoke, yeah, did say that, or a sing along with the audience, 

Whitney Lowe  

But that might be one of those things that you know, why do we resonate so much with just like a powerful choral presentation, performance, or something like that, like, it's more than just the volume, but it's just like all of those voices, that whole idea of entrainment,

Til Luchau  

Harmony has lots of meeting meanings there, where we start to harmonize and regulate around, we start to tune to the sounds we're hearing and sing along with, you could say. There's a there was interesting study, 2011 in International Journal Yoga around ohm chanting was, you know, it definitely raised the parasympathetic markers and had increased emotional regulation there. 

Whitney Lowe  

I'm thinking too about the the multiple frequency harmonic chanting that the Tibetan monks do, the multi-vocal, polyphonic chanting like there may be some interesting things with the fact that two different frequencies are being produced there, overlapping with each other and really causing a greater maybe, you know, vibration through the whole channel of the throat that way, or something.

Til Luchau  

It requires a lot of nasal and back of throat control. And just, if you've ever heard someone in person doing that, it is a powerful nervous system response, just to listen to someone who's really good at that, really feel your own nervous system and training to that.

Whitney Lowe  

This was another interesting piece that talked about, again, things that have a tendency to sort of stimulate vagal tone. This one was curious to me the whole idea of cold exposure, because it seems counterintuitive. Kind of seems like that's not the way it would go, but

Til Luchau  

if you got cold exposure, you'd be like, fight or flightish.

Whitney Lowe  

Generate some heat, move around, do a lot of physical activity or something.

Til Luchau  

This is the diving reflex in particular, I think, is related to a vagal tone, where face or neck immersion or cold water stimulates a vagal response that slows the heart rate. And that's the idea that if you're fall in the frozen lake, you want to go into shutdown so that you can survive and maybe last longer underwater, I think that's the presumed mechanism behind it. And there's, it's much stronger in babies, oh, yeah, that's where it comes from. Birth, you get your face and head out into the cold world first, and the baby's heart slows way down til it can basically survive that passage process that could take some time. So everything slows down so it's not using so much oxygen, and I think that's still really strong in kids. I remember back to my EMT days. You know, rescue protocol was different for drowning victims, depending on their age, because kids had such a shutdown possibility, they could really just turn everything off from, especially a cold water drowning, and be resuscitated for much longer times than adults could be.

Whitney Lowe  

Why do you think that dissipates with age or what? Why is it that kids are more versatile in that capacity.

Til Luchau  

Yeah, that's sad to think about all the things we lose with age, but that's our ability to survive in a frozen pond.

Til Luchau  

Our memory of being born. Who knows what else we lose? I really don't

Whitney Lowe  

So well, now let's kind of shift gears a little bit and kind of get back to where our audience is.

Til Luchau  

Yeah, I'm sorry. One more thing about cold. I don't know how many people are using that in their massage and body or practices - cold water immersion, but I know people probably not a lot, a lot splash your client with cold water.

Whitney Lowe  

 But it could be something. It's like, "Oh, I heard this on this podcast. I want to try this. I'm going to dump an ice bucket on my clients"

Til Luchau  

 There's a lot of people doing cold water, cold immersion as a way to boost their immune system, or do the different things that that probably can help with. Yes, for sure. And you'll have clients coming in who say, we had one yesterday in our in house discussion group here, my client says they want me to treat their vagus nerve. Someone told their client that the vagus nerve be to treat it, and so she went to her massage therapist to treat it. And what that means is what you know, that was the topic of discussion, can we treat the vagus nerve? And let's we start to unpack that. 

Whitney Lowe  

I think that's a great question. I'm curious to hear kind of your take on that of can we treat the vagus nerve? So what do you think? 

Til Luchau  

Can we treat the vagus nerve? I did pose the question. It depends on what we mean by treat, yeah, if we think of it like a tight muscle, where we just massage it and the muscle is not tight anymore and feels better. It's probably not like that with the vagus nerve. Or again, it's limited by us forgetting that it's a cable and not a thing. It's not a cable, not a control center. It's a it's a wire, it's a transmission pathway, not a regulatory agent to the same extent other things are, yeah, and this idea of treating is complex, because that gets pretty quickly into fixing and then so you identify a problem, you identify the one solution, you apply it, and you expect things to be better. And that thinking itself is problematic, especially when it comes to something as complex as the vagus.  Is thinking about the vagus, knowing that the vagus important and an important lever in our work absolutely other like magic points you can poke and have your clients be all better? Probably not. 

Whitney Lowe  

I think one of the challenges that we have to grapple with here, like in so many other areas, is people have recognized something interesting from the science that is highly relevant to optimum body function, and that's just vagal tone. So now a number of therapeutic approaches spring up or sprout up in relation to this idea with some some individuals creative thought about, oh, I'm going to do this and therefore stimulate the vagus nerve. And then they'll put that out there and make a course about it, or whatever, and get a whole bunch of people following that concept or model before it's ever really been. And kind of validated that this is actually something that's happening. Because, one of the things that has been there have been some kind of systematic review studies to try to look at manual therapy, and not just in massage, but, you know, chiropractic and joint mobilizations and all different kinds of manual therapy professions. Is there some trigger target, technique, methodology, etc, that can make the vagus nerve work more effectively or efficiently, or whatever. And the one thing that's kind of come out of that is that all of these manual therapy systems have a whole lot of things in common with gentle, soothing touch, and, you know, trying to encourage relaxation and do all kinds of things that may be systematically working all together to help improve or increase vagal tone. But it's not like anyone like it's not the vagus technique, you know, it's not this one technique that does something specific to these tissues that make it work.

Til Luchau  

The interaction we have with our clients is a very powerful vagal stimulator.

Whitney Lowe  

Back to your discussion of the ventral branch.

Til Luchau  

Yeah, to a place or a branch or something anatomical. We're probably through the context, through the way we talk to our clients, their enjoyment of our company or the table quality, or the ways our sheets smell, or all those kind of things have a big influence on vagal tone. More than us trying to touch the vagus nerve. Think about it again. If we think about like a nerve, someone comes in with sciatic pain, there are some things that we could do directly by touching the sciatic nerve that might help, but that's really a skilled intervention. You have to be not only very specific, but have a very specific kind of touch, a very listening touch that helps with maybe some glide or mobilization calming down. You don't calm the sciatic nerve down by just poking it or even trying to stretch, yeah? So it's if we think, if we translate that to the vagus nerve, another nerve, it's like, yeah, there's, there's lots of techniques you'll see where people digging into the neck, trying to rub their vagus nerve, or they, or they look for ways to work deep in the belly, like some deep belly work is trying to stimulate vagal nerve. I don't know if that's the way we want to go about it, necessarily.

Whitney Lowe  

This is a really valid point when you you know, some of the discussions around various different approaches seem to be saying to you, there's a lot of indirect methods that are probably occurring. For example, things such as me mechanoreceptors and certain tissues or or tensions through many fascial networks, or things like that that might have an influence, like some of the excess afferent signaling from mechanoreceptors may be picked up by a lot of the sensory receptors, and through those very, very substantial sensory afferent fibers in the vagus nerve. That may be what's really making the difference, not that we're doing something to the vagus nerve, but like, it's got really good sensory apparatus that picks up on all kinds of things, and it's helping transmit a whole bunch of information. Then you can kind of go back to thinking, at least I do anyway, thinking like if what you're saying is true, which I really think the Vegas is really the wire. That means that all that stuff is going into somewhere, getting processed. And then there's a response after that point, not that vagus is making the response itself.

Til Luchau  

Let me say something about that, right? It's, it's the transmission mechanism. There is. There are things going on in the nerve that are interesting, but it's the transmission mechanism, and we want to influence what the source of that signal is and where that signal is processed more than we want to try to influence the wire that's transmitting the signal. The source being, say, the belly or the viscera or the throat, those are the sources of that afferent information that's going to the brain. And then there's the brain, and we have a lot of effects on the brain through, again, through context, through the ways that we're helping people think about things, experiences we have, those are really powerful levers toward the thing we're trying to get to with vagal response, yeah. I should just give a shout out to Fabiano Silva, who was our guest back in 142 who's talking about fascia and the vagus nerve. And she's saying, yeah, the the physical context of that wire of the vagus nerve is important too, and there, there may be properties of the fascia or pathways that could help that vagus work better or worse through different density, compression or sliding issues. That's not unreasonable. I don't think either. But I think that's a much more powerful lever, lever to think again. About what the ultimate goal we want is, which is relaxation, regulation, connection, and there are very powerful ways to do that. It doesnt' involve trying to poke the vagus nerve.

Whitney Lowe  

Let me just backtrack a little bit here, too, in terms of, kind of back to what you said of the person saying that a client came in and said that they needed to have some work on their vagus nerve, yeah. How would we as practitioners know, or what would, what would be the factors that would make us think we need to help encourage better, vagal tone with somebody? What are what is it that would make us think that? Is it maybe just somebody saying that they're wound up and stressed out? Or what kind of things that would lead us in that direction do you think?

Til Luchau  

I don't draw that conclusion, because it's just one measure. It's a complicated measure. I don't think, oh, this person needs better vagal tone. I think, "Ah, they're stressed out", or they're having autoimmune issues or systemic inflammatory issues, all those are affected by vagal tone, too. Or they're having migraines, or they have a seizure history, or there's, there's a lot of conditions that relate to immune or autoimmune or inflammatory reactions that the vagus does actually help modulate that we didn't even mention inflammation yet. 

Whitney Lowe  

I know you've done a lot of deep dive onto that. Can you expound on that a little bit, the whole relationship of vagus and inflammatory stuff.

Til Luchau  

Yeah, the vagus has direct effects on the tissues around the gut and an anti inflammatory way. It actually does release agents and anti inflammatory, inflammatory resolution agents that help calm down inflammation in the gut, and it's monitoring the inflammatory reactions of those tissues and telling the brain, listen, there's something in our my gut, that's actually inflammatory to a mild or great extent, and we need to be a little more vigilant, perhaps.  It basically helps the systemic immune system turn down overall systemic inflammation, but it helps monitor it, and control it. So it has a powerful effect there, which is another reason a lot of people are trying to stimulate it, but it's one lever to turn down inflammation. It's a little bit like you're driving your car and you're going too fast, and so you think the problem is your speedometer cable. The problem is you're going too fast. Yeah. It isn't the transmission route of that information to your brain. In this case, the speedometer cable, the vagus nerve, does actually help your brain monitor what's happening and turn it down but it's not the main lever, it's a hack that we don't even know the long term effects of. There's a lot of interesting vagal stimulation happening electrically or transcutaneously for these conditions, but they're 10 years old at the most, maybe 15 at the very, very most, in research settings, and we don't know what it's like to try to use the speedometer cable to turn down the car speed for that long. 

Whitney Lowe  

Interesting metaphor there. 

Til Luchau  

And hat's a good one, but that's the best way I have of trying to describe it. It's, it's important, but it's not the cause. It's more the signaler,

Whitney Lowe  

You know, we've spoken on the podcast a good bit of both you and I've changes in our own thought processes over the years around what is our manual therapy actually doing? And this is another one of those instances, I think, for me, it's thinking less about direct specific effects to a target tissue or target structure, and more about the overall, generalized approaches that may seem to be gaining potential benefits in the in the long term.

Til Luchau  

Fewer magic bullets, greater overall skill in the interaction and,  including our touch interactions. That's what is the context for the change we get. But I think I want to go back to your question, because it was a really good one. What would a client present with, who would make me think of the vagus. It is stress, and it is autoimmune things, and it is inflammatory reactions, and it is sometimes like local arthritis, all those things. The vagus can be a lever for helping with those things. But I affect the vagus again, through the context and through maybe some breathing. You know, maybe I talk to them differently, and maybe I get them to hum along with me. Maybe, if we're being playful and trying things out. So, yeah, the vagus is one pathway, but it's, it's one of the pathways, It's the means to the end, and the end is a happier client, getting more of what they want.

Whitney Lowe  

Right? And that kind of taps into also, something, I tell my students this a lot, is, I think it's important for us to remember that when you are in the treatment room with your clients, you are really doing two distinct things, and we focus predominantly on one of them, and that is being clinician, doing some specific work with them and treating their body with your manual therapy techniques. But the other thing that we do is we are an educator, and this is one of those places where what you might be able to share with them or teach them about various different things that will help outside the treatment room could be just as valuable and really important for them when they get home and are trying to find other ways to to settle down the detrimental effects of whatever it is that's going on in their life causing these these challenges. They don't have access to massage 24 hours a day, of course, but they do have access to breathing, and that is something that they could do. They do have access to humming in most places. If you can't, not in a library, probably.

Til Luchau  

Like joining a community choir, yeah, or whatever. There's lots of ways to leverage vagal effects and help, and certainly increasing awareness of that in the culture as a whole is a good thing. Yeah, it's, it's, you know, I the reason for me want to do this episode was to talk about the oversimplification potential there. Back to your question again, someone comes in with a migraine, I'll work inside their ear for goodness sake, but that's one of the places I work. There's some really interesting research around inflammatory markers and work inside the ear with a vibrator. This is people with MS that were in the study so they had elevated autoimmune activity and cytokines, markers of that activity, and they did a study where they put a little mini vibrator inside these people's ear for 10 minutes, and people had a reduction in the cytokine levels that lasted for a week. So that's the talk about magic bullets. That sounds Yeah, promising.  And it took 10 minutes, and it was one marker, and so yeah, sure, if you want to work inside someone's ear for 10 minutes, please. Someone with a migraine is going to love that, yeah. But no, that's just again, one specific intervention. What may be a bigger conversation, bigger process that someone needs to engage in. 

Whitney Lowe  

I know a little bit difficult for us to do on an audio podcast, but can you just give any kind of brief discussion of when you talk about working inside somebody's ear, that's an unusual thing for us, especially a body cavity. 

Til Luchau  

You're going to ask me to describe where and how. We are such practical people as bodyworkers, we want to know what to touch and how to touch it and and that's good. I want to answer that question, but I just want to point out that again, that's where we take every question. Okay, great. Now, how do I touch it? 

Whitney Lowe  

I want to also make sure we cover. How do you not do this? Like not taking that that pin and poking somebody's eardrum?

Til Luchau  

Trying to get a gag reflex in our ear? No, but I do want to bookmark that tendency we have, and I have it too to want to reduce things to their physical component that I can touch. That's really good, but it's not the whole story, and thinking bigger can help that. That said, yeah, just the deepest part of the ear, the concha, the deep, the concha the cymba, the deepest folds of the ear, not the hole, not the meatus, not that hole, but the little bowl right above that hole, that deepest fissure, or the deepest bowl of the ear, which has the most direct vagal innervation, that and a little pets of skin right behind the ear on the scalp. 

Whitney Lowe  

Ok, so you say the deepest bowl of the ear, just again clarifying for our listeners here, you're talking about the outer ear, deepest bowl. And you said, not in the meatus, it's not in the internal hole into your head, but you're on the outer portion

Til Luchau  

of the ear outside, sticking my finger inside their ear hole, like the ear, the external ear, yeah, the deepest part of the external ear. That's right, 

Whitney Lowe  

I remember when I was in massage school, and they were teaching us how to do a general relaxation massage, and they've seen, like, oh, a nice way to finish off your massage is grab somebody's ears and, you know, pull them up and, like, pull them in all different directions. I thought, like, the head is weird, you know, isn't it? But it feels good, awesome.

Til Luchau  

Yeah, amazing. Yeah, someone's can, like, make friends with me really quick, I guess, in the right context, on massage table,  working my ears. Yeah, yeah, I guess, you know, it's called, we call it the headmaster technique, because in the wrong context, it's also pretty alarming. Yeah, someone grab you by your ear and pull you around, all right? 

Whitney Lowe  

Because the somebody did that to you as a little kid or whatever, get over here, you little twerp. 

Til Luchau  

That's right, yeah? But no, it's the ears are profoundly relaxing, and probably the vagal connection is a big part of that. 

Whitney Lowe  

Now we were also going to talk a bit more about polyvagal theory. We did touch base on that earlier. Did we kind of get the main

Til Luchau  

I should just say, Yeah, I think we did. But I should just say it's widely used. It's had a big influence. On trauma therapy and trauma awareness and trauma informed work. And it's, it's we're going to talk to Steven Porges, just soon here, I hope. And so I'm going to let him do a better job of telling us about it. But it gave a lot of us some kind of scientific map for understanding the effects we were having with both our touch and our the importance of the interaction. So it gave us a map for that. It is criticized in some circles for a lack of research basis, maybe, or a special especially around the evolutionary model is probably it uses, is probably not agreed upon in all circles. Maybe it's more metaphorical than actual, and then some of the anatomy involved gets argued about, but basically, it's a really influential model that's really useful and has been a big influence on my thinking as well. Yeah, that's, that's the introduction, and I'm looking forward to hearing from Stephen Porges himself here.

Whitney Lowe  

Yeah, good. So one of the other things that we kind of talked about maybe we should touch base on, and you had alluded to this earlier too, some claims that we've heard or seen people make around vagus, stuff or anything in particular come come to mind for you, of things that you've heard around just vagus stuff,

Til Luchau  

Just turning on my vagus, yeah, stimulating my vagus, yeah, you don't say "I turn on my brake pedal". Yeah, back to the car analogy. The vagus is the brake pedal of the heart, yeah. And so it's, it's, it's the modulation, you could say, or is the control or the nuance, or a little bit of that, a little more, a little less of that, that's important, not just a big pump on the brake. That's maybe the nuance that's important to keep in mind that it's always working. Your heart would be beating at 200 beats a minute if it wasn't working. And we want it to be effective.  We want it to be not fighting too much other stressors, so that it doesn't have to be pumping the brake so hard. And we want your whole system to be healthy, not just to push harder on the brake. 

Whitney Lowe  

I want to hear a little bit more, just kind of, and I'm curious about this, at least, maybe you can sort of shed a little more light on you. Suddenly the heart would be beating so much faster if it wasn't for the vagus. What is it that makes the heart beat so much faster, ordinarily. Seems like at that rate, you would think that that muscle would tire out a whole lot faster, earlier in life. 

Til Luchau  

As I understand it, I and I owe you a thanks to Mary Francies O'Connor, in her book about this, she lays out in pretty clear details that only she can do, that the pacemaker cells that are within the heart, that tell the heart what be, what it should that it should be beating, they generate the impulses that the heart uses to beat from are firing at 200 beats a minute. And it's the vagus. The only reason it's slower is because the vagus is slowing that down. Yeah, the vagus nerve does,

Whitney Lowe  

Makes me curious and wonder about, you know, I'm doing this, all this stuff all the time with bird rehab, because of my wife being a wildlife rehabilitator. And one of the things that we were talking about a lot during the summertime, during season with hummingbirds, is their heart rate. It's incredibly fast. It's something like, I don't even remember, 800 beats a minute, or 1000 beats a minute, or something like that. It's incredibly fast. And just like, are they absent of vagus, or is it just like irrelevant for them, or something like that? You know, 

Til Luchau  

I don't know what the this is birds in general?

Whitney Lowe  

This is hummingbirds in particular. Hummingbirds, oh yeah, see, I can imagine that. Yeah, wow. And the wing, wing beat rate is extremely high, also for them. But sure, that's just remarkable to think about muscles getting us a stimulus to contract that fast, that many times, for so long, you know, particularly difficult,

Til Luchau  

That's great. That's really a fascinating fact. Somehow those little hummingbird hearts are beating so quickly. Yeah. So we shall we finish it up with some key points? 

Whitney Lowe  

Yeah, let's do, yeah. So what are some of those key things that we want to zero in

Til Luchau  

If we want to learn from the vagus we can really use its properties, or it's power by incorporating slow breathing, you know, we're slowing people's breath down, or having people exhale slowly. We can use our voice. We can understand that our voice is a tool. It's tone, it's pace, it's rhythm that helps someone's brain and nervous system Calm down, too, and a lot of it's the client safety and connection they have with us. That's what where the vagus really come. Is online, and that's the biggest influence we have on the vagus, the client safety.

Whitney Lowe  

Again, we've sort of talked about this on other episodes, the the context of what we created that in that environment of safety and trust and support and everything that we're doing with our clients is immeasurably important.

Til Luchau  

That's the context that it happens in. 

Whitney Lowe  

All right, thanks for the conversation today. Whitney, indeed, always fascinating to get into some of these kinds of things. And again, I think, looking into these things, we see there's still a lot left to learn here, a lot that we're exploring. And there's, as you noted, a number of theoretical models out there, and some theories around vagus stuff that may turn out to be not as accurate as we initially think with the things, but that's, that's science, and that's progress. Is it continuing to refine our understanding over time?

Til Luchau  

Yeah, right. Accuracy is important, and the exciting part of the metaphor is the real story here. Why do people get so excited by the vagus nerve, it has that promise of doing amazing things? Yeah, and amazing things are possible. I don't want to say that. I'd say, let's really get clear about what is causing those amazing things and what our levers are for amazing things to happen.

Whitney Lowe  

I was thinking about this a little bit. Do you think that there's any kind of similarity? We kind of touched base on this a little bit with that episode, I don't remember the number right off the top of my head, the episode that we did on the psoas, of it having this mystique around it, of mysteriousness, because, again, not so easily visible, deeper down in the abdomen, but significant, having to do with lots of different things. And maybe there's some correlation there with why they're such fascination in the vagus.

Til Luchau  

They occupy a similar slot in our collective psyche, don't they? These mysterious, powerful, hidden things that are the key to a lot of important things, and maybe that gets oversimplified or overblown, but still great to know about and incorporating our work. Well, should I thank our sponsors? Let's do it. The thinking practitioner podcast is proudly supported by ABMP, Associated Bodywork and Massage Professionals, the premier association for dedicated massage and body work practitioners like you, 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.

Whitney Lowe  

and ABMP is committed to elevating the profession with expert voices, fresh perspectives and invaluable insights through continuing education courses, the ABMP podcast and Massage and Bodywork Magazine, featuring industry, industry leaders like my partner, Til and myself, Whitney. Thinking Practitioner listeners like you can get exclusive savings on ABMP membership at abmp.com/thinking. So join the best and expect more from your professional association. We'd like to say thanks to all of our listeners and our sponsors. You can stop by our sites for the video, show notes, transcripts, and any extras. You can find that over on my site at academyofclinicalmassage.com, and Til, for you, where can people find you there? 

Til Luchau  

My site is advanced-trainings.com and we want to hear from you listeners with your ideas, your feedback, your input about the show. Just email us at info@thethinkingpractitioner.com.  Comment on a episode in your podcast player, or look for us on social media and YouTube. I am at Til Luchau, my name, that's how you find me, Whitney. Where can people find you?

Whitney Lowe  

Also on social under my name, Whitney Lowe, and we'd really appreciate it if you would rate us on Spotify or Apple podcasts, or wherever it is that you happen to listen. It really does help other people find the show and keeps us going here. So please take a few seconds to do that, and thanks, as always, for sharing the word and telling a friend to get it out there. And we'll look forward to seeing you again. And before we leave today, one deep, good exhalation.