The vagus nerve is an extremely interesting structure. Much more than just a passive wire or cable, its afferent (sensory) and efferent (motor) neurons work together to actively regulate a long list of processes that span the boundary between the brain and body, biology and psychology, and health and dysfunction. And, since we can stimulate the vagus nerve with the right kinds of touch, could hands-on work beneficially affect the vagus’s function?
The Influential Vagus Nerve
Some of the many ways the vagus (or cranial nerve X) actively influences our well-being include:
Stress Resilience and Recovery
When your vagus nerve senses stress hormones like cortisol and adrenaline, the motor neurons in its wide-reaching branches (Image 1) release neurotransmitters like acetylcholine (which was originally called “Vagusstoff,” or vagus-substance) and hormones like oxytocin, which dampen the sympathetic activation and help you recover more quickly from stress.
Inflammatory and Immune Control
The vagus inhibits inflammation by releasing anti-inflammatory neurotransmitters when it detects inflammatory markers like cytokines or tumor necrosis factor (TNF).1 When unchecked, these are involved in autoimmune conditions (such as rheumatoid arthritis), chronic pain, and more.
Mood Regulation
The vagus is the major communicator between the brain and the enteric nervous system—the rich neurology of your viscera. Your guts, with more than 100 million neurons, 30 neurotransmitters, and 95 percent of your body’s serotonin, send large quantities of information to the brain via the vagus nerve’s afferent fibers; this sets the mood or emotional backdrop for our brain’s mental processes.2 Vagal tone (a measure of the vagus’s responsiveness and its effects on the heart) has been correlated with organ-based conditions like heart disease and diabetes, as well as better emotional regulation and less anxiousness.
Vagal Stimulation
Vagal nerve stimulation (VNS) involves implanting a pacemaker-like device to excite the vagus via an electrode wrapped around it in the neck. Though somewhat drastic-sounding, VNS has long been approved for treating a list of conditions including epilepsy, headaches, and treatment-resistant depression, and is being studied for use in an even broader range of complaints, including anxiety disorders, Alzheimer’s, migraines, fibromyalgia, obesity, and tinnitus. VNS might offer welcome options, especially in difficult cases. However, not everyone responds to VNS; there are clear risks (including infection); and the long-term side effects of VNS are unknown.3
Of course, there are other, less invasive and less risky ways to elicit the vagus nerve’s beneficial effects. These include controlled breathing (especially longer exhalation); meditation; moving and relaxing the tongue, as well as singing, humming, and speaking (since the tongue and larynx are innervated by the vagus); animated conversation (since facial expression has a two-way relationship to vagal function)4; improving gut health; exercise and rest; and, especially, reducing sources of physical, mental, and social stress.
But as hands-on practitioners, with our pragmatic perspective, our question is often, “So how can I touch it, and in what way, that might help?”
The Vagus in Your Ear
The ear is the only place where the vagus nerve reaches the surface of the body (via its auricular branch, Image 2). In fact, transcutaneous (skin) stimulation of this particular branch of the vagus is being studied as a treatment for numerous vagal-modulated conditions, and already has European clearance for treating epilepsy, depression, migraines, and chronic pain.5
In our Advanced Myofascial Techniques series at Advanced-Trainings.com, we use several different ear techniques for working with conditions like temporomandibular joint (TMJ) pain (since the vagus nerve can be a powerful pain modulator, via its calming and neuroimmune effects), as well as for migraines and headaches.
The Vagus Nerve Technique
The vagus’s auricular branch is made up of afferent neurons, which means that stimulating sensation in the vagal-innervated parts of the ear (Image 3) excites greater vagal nerve activity. Since in most cases our aim is also to calm and reassure the client’s nervous system, a gentle, confident, and sensitive touch (Image 4) is usually most effective, with one study (of infants’ vagal reactions to massage) showing that moderate pressure yielded greater vagal effects than light touch.6 Since some clients may not be accustomed to having their ears included in bodywork, be sure to ask permission first, and explain your purpose for proposing this technique.
Could manual therapy with the ears be used to evoke some of the vagus’s many beneficial effects? Clearly, touch wouldn’t be expected to have the same effects as direct, longer-duration electrical stimulation; and though a few small studies have shown that hands-on work can measurably affect vagus tone,7 other results have been limited or mixed, and so a definitive answer would require more investigation. But, understanding more about the vagus nerve can certainly stimulate our therapeutic imagination and creativity. Practitioners have long known that careful work with the ears, as well as relieving specific complaints like headaches and TMJ pain, can be extremely calming, perhaps because of the vagus nerve’s power to soothe and relax both our body and mind.
An extended version of this article, including full references, links, and a bibliography, is available at www.a-t.tv/workingwiththevagusnerve.
The Vagus Nerve Technique
Purpose
• Increase vagal nerve activity through gentle stimulation of sensation.
Indications
• Migraines and other headaches
• Temporomandibular joint (TMJ) pain and temporomandibular joint dysfunction
• Stress, anxiousness, or sympathetic autonomic nervous system arousal
• Perhaps palliative in a wide array of conditions mediated by the vagus nerve, such as tinnitus, mood issues, digestive issues, immune function and autoimmune conditions, pain, and others
Instructions
• Use gentle touch, pressure, or light traction on the ear’s concha (deepest bowl), ear canal, and the scalp just behind the ears, to gently stimulate sensation in the ear’s vagus-innervated areas.
• For migraine or TMJ pain, look for areas of sensitivity, and for active movements of the jaw, eyes, and face that evoke, relieve, or relate to the pain felt.
Movement Cues
• “Let your exhale be even slower, fuller, and longer.”
• “Let your tongue rest in your mouth.”
• “Let’s hum a little tune … and meanwhile, let your neck and jaw stay relaxed.”
• For migraines: “Look left and right with your eyes.”
• For TMJ pain: “Gently, slide your jaw away from your ear.”
For More Learning
• “TMJ” and “Migraines” in the Advanced Myofascial Techniques series of workshops and video courses.
• Advanced Myofascial Techniques (Handspring Publishing, 2016), Vol. 2, Chapters 15, 18.
Notes
1. S. L. Oke and K. J. Tracey, “From CNI-1493 to the Immunological Homunculus: Physiology of the Inflammatory Reflex,” Journal of Leukocyte Biology 83, no. 3 (March 2008): 512–17.
2. Adam Hadhazy, “Think Twice: How the Gut’s ‘Second Brain’ Influences Mood and Well-Being,” Scientific American, February 12, 2010, accessed September 2017, www.scientificamerican.com/article/gut-second-brain.
3. National Institute of Mental Health, “Brain Stimulation Therapies,” 2016, accessed September 2017,
www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml.
4. K. M. Gothard, “The Amygdalo-Motor Pathways and the Control of Facial Expressions,” Frontiers in Neuroscience 8, no. 43 (2014).
5. R. H. Howland, “Vagus Nerve Stimulation,” Current Behavioral Neuroscience Reports 1, no. 2 (2014): 64–73.
6. Tiffany Field et al., “Moderate Versus Light Pressure Massage Therapy Leads to Greater Weight Gain in Preterm Infants,” Infant Behavior and Development 29, no. 4 (2006): 574–78.
7. J. Cottingham, S. Porges, and K. Richmond, “Shifts in Pelvic Inclination Angle and Parasympathetic Tone Produced by Rolfing Soft Tissue Manipulation,” Physical Therapy 68, no. 9 (September 1988): 1364–70; J. Cottingham and J. Maitland, “A Three Paradigm Treatment Model Using Soft Tissue Mobilization and Guided Movement-Awareness Techniques for a Patient with Chronic Low Back Pain: A Case Study,” Journal of Orthopedic Sports Physical Therapy 26, no. 3 (1997): 154–67.
Til Luchau is the author of Advanced Myofascial Techniques (Handspring Publishing, 2016), a Certified Advanced Rolfer, and a member of the Advanced-Trainings.com faculty, which offers online learning and in-person seminars throughout the USA and abroad. He invites questions or comments via info@advanced-trainings.com and Advanced-Trainings.com’s Facebook page.