Polyvagal Theory: Pelvic Health Physical Therapy Applications

Nervous System Care Comes First.

It is fair to assume that a majority of people are familiar with the concept that we are social creatures. If it was not clear before, the pandemic certainly has illuminated this idea that we are all connected. We all depend on each other and affect each other. This is an important concept when it comes to our health. You may have felt intuitively that being connected to others feels healing and meaningful. There is now a physiological framework to explain this concept and to help deepen our understanding of its importance. That framework is called Polyvagal Theory.

Developed by Dr. Stephen Porges, Polyvagal Theory started as an exploration of the evolution of our nervous system, particularly the vagus nerve. Starting from the ancient circuits seen in reptiles, there is the oldest unmyelinated dorsal vagal complex and this is involved in immobilization or shut down response. This response is associated with slowing our heart rate, stopping our breathing, and defecation. Next, there is the sympathetic circuit which inhibits that dorsal vagal circuit. This keeps you from shutting down and instead creates the fight or flight response. One important thing to note here is that none of these circuits, including fight or flight, is inherently bad or wrong. They all play a role in homeostasis. Fight or flight can actually create the engagement for play just as much as it can for defense or anger. All of these systems work together to choreograph your unique responses and experiences as a human with a nervous system. So how does the nervous system detect the difference between play and anger? The third and newest mammalian circuit: the ventral vagal system.

The ventral vagal system is a myelinated circuit that is involved with communication, cranial nerves of expression, vocalization, and even hand movements. This circuit allows you to convey the state of your nervous system to another. The ventral vagal system is a physiological explanation for why we feel better when our environment is calm and why certain people can help us feel more regulated than others. It demonstrates the mechanism for co-regulation, meaning we can help each other stay in this state of connection and social engagement depending on the cues we are giving with our faces, voices, and body movements.

Why is this important? More and more research is being done that suggests stress is the main culprit for many disease states, both with physical pain and mental health. When we are stressed, we produce more stress hormones including cortisol which generates more longstanding inflammation in the body. We can also have less blood flow going to our gastrointestinal system and more tension in our muscles. The list can go on and on for the detrimental effects of stress. So the question is- what can you do about it?

Understanding your nervous system through polyvagal theory is a great place to start. This theory helps us to acknowledge and place more weight on the ways we can regulate our nervous system, and the ways in which we can benefit from doing that together as a species.

One of the most important implications of this theory is that we co-regulate. This gives more physiologically backed reasoning as to why the interaction between people, particularly patient and provider, is vital to the healing process. In order for someone to enter into a physiological state shift of safety and regulation, the environment needs to support that. Practitioners who are informed in Polyvagal theory and are actively pursuing work to embody a deeper understanding and execution of this theory have the potential to create better outcomes for their patients.

Dr. Porges executed a study in which he had participants face each other while talking, and one group inhaled more slowly during the conversation while the other group exhaled more slowly. The group that inhaled more slowly perceived their talking partner as critical whereas the group that exhaled more slowly perceived their talking partner as more benevolent. Longer exhales shift you into ventral vagal dominance which allows for more safety to be perceived and more social engagement states to occur. Something as simple, and yet profound, as breath can change how we interact with someone through the vagal circuit.

Polyvagal theory has also shown in research that music, chanting, and movement particularly in larger groups with synchronicity, aid in regulation. So the next time you wonder why a yoga class feels better in person than it does online, this is your answer. We are meant to move, vocalize, and express ourselves in witness of each other.

We come into this world on a quest for safety, and as mammals our evolutionary biology now shows a major reason we have survived as a species is because of our strength in regulating together and taking care of each other. In a hyper-capitalistic society that is ego-centric and individualistic, this physiologic framework presents a radical idea. It suggests our power is in our ability to rely on each other.

So as a patient, this is something to consider in your care. You are allowed to interview your providers and understand what their philosophies are. You are entitled to feelings of safety and trust in your providers. This is, in fact, a vital component to your healing process according to Polyvagal theory.

In the words of Dr. Porges “Polyvagal theory shifts our own personal documentary from events to feelings. Our life and narrative and way we relate to the world is based on global physiological states.” Shifting the paradigm of medicine away from just an event that happened to someone, and instead allowing space for the story we tell ourselves in how we felt about that event can drastically change the approach towards treatment. Medicine all too often contributes healing to something outside of the patient. Polyvagal challenges practitioners to recruit the client as a collaborator on this journey, empowering them to create physiological changes within themselves.

Find yourself a provider who sees you as a collaborator, not just someone to be “fixed”. The more your story is heard and validated and moved through with support, the more you may find the solution has existed inside you all along.

Check out this blog to learn more about how we apply this theory to chronic pain with somatics!

Interested in working with a Polyvagal Informed Practitioner at Bodyful? Book a discovery call today!