Polyvagal Manual Therapy

Polyvagal Manual Therapy What can manual therapy offer for restoring the function of the vagus nerve and why is it so important? Manual and osteopathic methods have long been successfully used to treat dysfunctions of many tissues, including peripheral nerves. The vagus, with its extensive branches and equally extensive functions, represents a fascinating link between body and mind, gut and brain, visceral functions and their autonomic regulation, voice, breathing, and emotions... By normalizing all parts of this complex system, we move towards its balanced and stable functioning, exerting not just a local but, in the full sense of the word, a holistic influence on the person.

Introduction to the Polyvagal Theory

The polyvagal theory, developed by Dr. Stephen Porges, presents a revolutionary model for understanding the autonomic nervous system and its impact on our physical and emotional well-being. The autonomic nervous system consists of three main branches, which developed at different stages of evolutionary history:

1. Ventral vagal system (social vagus). The youngest system in evolutionary terms, associated with social communication and self-regulation. It is activated in a state of safety and promotes social interaction, allowing us to rest, digest food, and maintain prosocial relationships.

2. Sympathetic nervous system. Responsible for mobilizing the body in stressful situations, activating "fight or flight" responses. It prepares the body for action when perceiving threat or danger.

3. Dorsal vagal system (primitive vagus). The most ancient system, associated with freeze and dissociation responses. In extreme stress, it slows metabolic processes and conserves vital resources through immobilization.

The key feature of the polyvagal theory lies in the hierarchy of these systems: when facing threat, the body first attempts to use social engagement (ventral vagus), then activates the sympathetic system, and only in extreme cases shifts to the dorsal vagal response.

Manifestations of Vagus Nerve Dysfunction

Systemic Disorders

Chronic inflammatory processes, since the vagus nerve helps control inflammation
Autoimmune diseases
Heart rate variability disorders
Problems with thermoregulation

Emotional and Psychological Manifestations

Low vagal tone is closely associated with psychological disorders:

Inability to cope with stressful situations
Poor sleep and fatigue – the vagus nerve is linked to restorative sleep
Depression and anxiety
Difficulties with emotional regulation
Problems with social interaction
Reduced ability to self-soothe

Physical Symptoms

Vagus nerve dysfunction manifests through a wide range of bodily symptoms:

Speech and swallowing disorders: difficulties speaking, loss of voice, trouble swallowing liquids
Loss of reflexes: reduced or absent gag reflex
Cardiovascular manifestations: abnormal heart rate, blood pressure disorders
Digestive disorders: reduced gastric juice production, nausea, vomiting, bloating, abdominal pain, unexplained weight loss
Ear symptoms: ear pain due to vagal auricular branch involvement

Key signs to pay attention to: digestive problems, issues with voice or swallowing, rapid heartbeat, and difficulties calming down. Tests such as heart rate variability can also measure vagus nerve dysfunction.

Manual and Osteopathic Methods of Influencing the Polyvagal System

Direct Work with Neural Structures

Work with cranial nerves. The osteopathic approach includes direct neural manipulations and neurodynamic techniques aimed at:

Vagus nerve (cranial nerve X) and its branches
Trigeminal nerve (cranial nerve V), innervating facial muscles
Facial nerve (cranial nerve VII), controlling facial expression muscles
Accessory nerve (cranial nerve XI), innervating sternocleidomastoid and trapezius muscles

Techniques for sympathetic structures. Work with the sympathetic trunk and spinal nerves through:

Direct neural techniques in the thoracic and lumbar spine
Fascial techniques for the paravertebral areas
Mobilization of costovertebral joints

Parasympathetic sacral plexuses. Specialized techniques for working with sacral parasympathetic fibers that innervate pelvic organs.

Restoring Social Vagus Functions through Work with Innervated Tissues

Facial muscles. Fascial techniques to restore tone and mobility of facial muscles:

Massage of facial muscles and acupressure points
Myofascial release techniques for the midface (between eyes and mouth)
Work with masticatory muscles and the temporomandibular joint

Oculomotor system. Osteopathic techniques to improve oculomotor nerve function and restore quality eye contact as an important component of social engagement.

Throat and ear structures

Work with muscles and fasciae of the larynx and pharynx
Techniques to stimulate vagal fibers in the external ear (especially the tragus)

Eliminating Visceral Organ Dysfunctions

It is important to remember that 75% of vagus nerve fibers carry signals from the organs to the center, so the condition of internal organs is critically important for the function of the entire polyvagal system.

Eliminating chronic irritating or suppressive influences:

Correction of dysfunctions that may send pathological signals through vagal afferent pathways
Normalization of viscero-somatic reflexes

Visceral osteopathy of the abdominal cavity:

Work with the mobility of digestive system organs
Techniques to normalize liver, stomach, and intestinal function
Work with mesentery and visceral fasciae
Normalization of internal organ nerve plexus function

Work with thoracic organs:

Special attention to the diaphragm and restoring respiratory mechanics of the chest
Techniques for the heart and pericardium
Work with lungs and pleura
Mediastinum mobilization

Correction of Musculoskeletal Dysfunctions

It is important not to forget about treating musculoskeletal dysfunctions that can negatively affect the activity of different parts of the autonomic system, such as the spine (especially the cervical region), ribs, fasciae, and muscles.

Work with the spine:

Special attention to the cervical spine, where important autonomic structures pass
Gentle techniques for atlas and axis dysfunctions
Elimination of thoracic and lumbar dysfunctions affecting sympathetic activity

Work with ribs and respiratory structures:

Correction of rib dysfunctions affecting breathing
Techniques for intercostal muscles and fasciae

Special work with muscles innervated by the accessory nerve:

Sternocleidomastoid muscle
Trapezius muscle
As well as release of suboccipital muscles

Fascial techniques:

Work with superficial and deep fascial layers
Myofascial release to reduce overall system tension

Polyvagal Manual Therapy as Part of an Integrative Approach

Polyvagal manual therapy and osteopathy represent a crucial component of a holistic approach to restoring balanced functioning of the autonomic nervous system. This method aims at restoring optimal functioning of the body's regulatory mechanisms, positively affecting:

Psycho-emotional sphere
Humoral regulation
Hormonal system
Immune function
Digestion and metabolism

Synergy with Other Therapeutic Approaches

For maximum therapeutic effect, manual polyvagal therapy is effectively combined with:

Somatic exercises: body awareness techniques, proprioception development, qigong
Breathing practices: diaphragmatic breathing, exhalation-slowing techniques, Wim Hof method, and others
Other vagus nerve activation methods, including cold exposure and laryngeal exercises
Autogenic training: a method of self-regulation and relaxation
Trauma work: integration of traumatic experiences through body-oriented approaches, including EMDR

It is important to note that the therapist themselves, in order to be able to help the patient, must also be in a balanced, resourceful state. This means being able to distinguish their current state well and largely regulate their own autonomic nervous system. Some of the recommended practices can be found in the methods section.

Manual therapy within the polyvagal approach not only eliminates symptoms but works on restoring the nervous system’s natural ability for self-regulation, social interaction, and adaptation to changing environments. Such an integrative perspective provides an answer to the question that arises for all advanced osteopaths and other doctors: "What can we do for the patient as a whole being and, at the same time, as a most complex system of self-regulation, possessing innate abilities not only to survive but to thrive in this ever-changing world?".