Originally published on the tuneupfitness.com blog. Republished with permission.
The vagus nerve is involved in nearly every physiological action in the human body and harnessing its power can have an immediate and dramatic impact on your well-being.
Metaphors abound for the vagus nerve:
• The superhighway of your body, transporting vital information between your brain and the rest of your internal organs;
• A symphony conductor, directing how fast or slow, loud or quiet your nervous system will be at any given time;
• Air traffic control, monitoring a multitude of moving parts to make sure all of the physiological airplanes fly safely and efficiently to their destination.
In a time when we all speak the universal language of hyperbole, it would be easy to dismiss this vagus talk as just another passing trend from a wellness culture that promotes and discards the next! big! thing! for sport. (Literally.)
But, here’s the deal. Physicians as far back as the Roman Empire(1) have been grappling with how the vagus nerve impacts bodily function. We’ve now learned that simple movement and breath exercises can be done at home to manually stimulate the vagus nerve in times of stress to trigger the body’s natural relaxation response. And for patients with conditions ranging from epilepsy to rheumatoid arthritis to Crohn’s disease, electronic vagus nerve stimulation is offering hope and showing long-term results. The power of the vagus nerve lies in its ability to impact physical and emotional conditions that have proven to be difficult to treat with traditional drug and medical interventions. When people run out of options—for medical disorders or stress management—they find their way to the vagus and realize the power this one part of our anatomy has over the entire system.
The hype is now consensus; the future of medicine and self-care will be interwoven with our understanding of the vagus nerve and how it works.
The vagus is the tenth cranial nerve, originating in the brain stem and traveling through the face, neck, lungs, heart, diaphragm, and abdomen, including the stomach, spleen, intestines, colon, liver, and kidneys.(2) Vagus is Latin for “wanderer,” an appropriate name for the longest cranial nerve in the body. The vagus nerve is intricately connected to mood, immune response, digestion, and heart rate.(3)
Maybe you know a little bit about the vagus already, or perhaps you’re reading about it for the first time. Now that it’s on your radar, you’ll start to notice it everywhere, from podcasts to Facebook groups to mainstream news articles. Marriage and Family Therapist Justin Sunseri launched The Polyvagal Podcast, a show about all things vagus nerve, in February of 2019, and quickly built an audience of thousands each month alongside his co-host Mercedes Corona. “I felt a compulsion to do it,” says Sunseri. “I literally woke up one night at four in the morning and the words “Polyvagal Podcast” were pounding in my head. I knew the information would be really good, but I had no idea what the bigger picture would be.”
Lisa Elliott is an aerial acrobat in Seattle who discovered the vagus nerve after a near-death experience from an aortic dissection. She started the Vagus Nerve Study Group in her living room with six friends in 2015, and it’s morphed into a thriving Facebook community with almost nine thousand members studying the vagus together. “When I first started studying it, I was interested in the vagus nerve as a discrete anatomical structure,” says Elliott. “What is this thing that can make a big difference in chronic illnesses? But over the years, I came to see it as an anatomical map that can lead us to a new way of thinking about our bodies and beings, our emotions, and our interaction with the environment.”
On the medical front, Dr. Kevin Tracey is a neurosurgeon who has done groundbreaking work in the field of bioelectrics, where a small electronic device is implanted under the skin of a patient’s chest to send electrical impulses to the vagus. He published a study in 2002(4) about mice with strokes, revealing that vagus nerve stimulation turned off the body’s production of tumor necrosis factor (TNF), a molecule produced by the immune system during an inflammatory response that, when regulated, is good for the body, but in excess can damage organs, cause blood pressure to drop, and lead to septic shock.(5) This prompted a clinical trial using VNS on rheumatoid arthritis patients (6)with high levels of TNF that caused debilitating pain. At the end of the forty-two day study, the TNF levels of study participants were nearly the same as non-arthritic patients. Their pain was almost gone, joint swelling was reduced, and mobility had returned. Dr. Tracey has also had success with Crohn’s disease patients, and sees a future when diseases like Alzheimer’s, cancer, diabetes, and hypertension can be treated with bioelectronics. VNS has been approved by the FDA to treat epilepsy since 1997, and depression since 2005, but everything else right now is in the clinical trial stages. In addition to Dr. Tracey’s work, there are studies being done on the impact of VNS on diabetes, stroke recovery, glucose metabolism, and many others around the world.
While researchers and the medical establishment wade through lengthy clinical trials and FDA approval processes, the good news is that it doesn’t require a surgical implant to impact your vagus nerve.
Physical therapist and functional manual therapist Gregg Johnson uses his hands to do manual work on the vagus, and trains other practitioners to do the same at his Institute of Physical Art in Colorado. He’s been a physical therapist for fifty years, but stumbled into an interest in the vagus nerve five years ago when he had a student who had high blood pressure and an elevated heart rate, and was looking for a way to avoid going on long-term medication. Johnson palpated (examined with his hands) the student's neck, and could feel that the vagus nerve was in tension. “This was the first time I had selectively, consciously palpated the vagus nerve,” says Johnson. “All of a sudden, as everything started enhancing in mobility, his heart rate normalized and he started feeling like he hadn’t for months. And that night when he tested his blood pressure it had returned to normal.” Since then, Johnson has used manual vagus nerve stimulation to help patients with irritable bowel syndrome, kidney problems, and fertility issues, just to name a few.
Palpate: to examine a part of the body by touch for medical purposes
There are a number of things you can do with breath and movement on your own at home to manually stimulate the vagus nerve. But to understand how, first it helps to understand a little bit more about the anatomy and function of the vagus nerve itself.
The vagus nerve is part of the autonomic nervous system, the body’s unconscious control system that helps regulate our internal organs to optimize health, growth, and restoration, a concept known as homeostasis.(7) The autonomic nervous system is divided into two branches—the sympathetic branch, which mobilizes you for action (the “on” switch); and the parasympathetic branch, often referred to as the rest-and-digest state (the “off” switch). The vagus nerve resides in the parasympathetic branch of the autonomic nervous system. Much of our understanding of how the vagus functions within the parasympathetic branch, and our ability to impact it through breath and movement, can be traced to Dr. Stephen Porges and the introduction of his Polyvagal Theory in 1994.
Autonomic Nervous System: the part of the nervous system that unconsciously controls bodily function, including things like heart rate, breathing, and digestion. There are two branches of the Autonomic Nervous System:
1. Sympathetic: your body’s ON switch, supporting mobilization for action
2. Parasympathetic: your body’s OFF switch, supporting relaxation
The Dorsal Complex and Shutdown
Dr. Porges identified two pathways of the vagus nerve. The first pathway, the dorsal complex, is left over from our pre-mammalian, ancient vertebrate ancestors. It’s often called the sub-diaphragmatic branch of the vagus, because it originates in the brain stem and supplies nerves to the visceral organs below the diaphragm, including the stomach, liver, spleen, kidneys, gallbladder, urinary bladder, small intestine, pancreas, and ascending and transverse parts of the colon. (8) It’s unmyelinated, which means it lacks a myelin (fatty) sheath, and consequently transmits information slower than a nerve that’s myelinated. When humans or other mammals sense they are in grave danger, a surge in dorsal activity can result in system shutdown, including a drop in blood pressure, with a potential for fainting or state of shock.(9) The dorsal vagal response is referred to in shorthand as .
The Ventral Complex and Safety
The second pathway of the vagus nerve is the ventral complex. It formed as we evolved from ancient reptiles to mammals, and originates in the brain stem in the nucleus ambiguus, a group of motor neurons connected to the muscles integral to speech and swallowing, such as the soft palate, pharynx, and larynx. (10) The ventral vagus is the primary regulator of the heart rate, and muscles in the face and head. This newer ventral vagal path is myelinated and transmits information much faster than the dorsal vagal path. It’s what’s commonly referred to as our state, and evolved to provide a social engagement system, which was necessary in order for mammals to coexist, work in community, and reproduce. People in a ventral vagal state are generally engaged in the world, and open to connecting and cooperating with others.
Between the development of the dorsal vagal path and ventral vagal path, the sympathetic branch of the nervous system formed, allowing for mobilization in times of stress. This is most often referred to as the fight-or-flight reaction.
Dorsal Vagus: The oldest part of the vagal complex, left over from our pre-mammalian ancient vertebrate ancestors. A dominant dorsal vagus results in a shutdown state.
Ventral Vagus: The newest part of the vagal complex, developed during our evolution from reptiles to mammals. A dominant ventral vagus presents as a feeling of safety and social engagement.
Sympathetic: This part of the nervous system developed between the Dorsal and Ventral vagal complexes; supports mobilization by increasing blood flow throughout the body.
Polyvagal Theory identifies how these three neural (of or relating to nerves or the nervous system) circuits—the dorsal vagal, sympathetic, and ventral vagal—are involved in evaluating our environment and reacting to cues of safety or threat. There are three organizing principles of the polyvagal theory:(11)
The autonomic nervous system responds to cues in the environment in a specified and predictable way. Either in order from the oldest to newest neural circuits (dorsal, sympathetic, ventral), or the newest to oldest (ventral, sympathetic, dorsal).
This is a concept coined by Dr. Porges, and describes how our autonomic nervous system subconsciously evaluates and responds to cues of safety or danger in our environment. “Detection without awareness,” Dr. Porges says. The vagus has more than 100,000 nerve fibers, and communicates bidirectionally between the brain and the body, with 80% of the fibers communicating from the body to the brain, and the other 20% communicating from the brain to the body.(12) So, that “gut feeling” you’ve felt before—that’s neuroception. It’s your body having what amounts to a “sixth sense” moment, and communicating that information to your brain.
This is the mutual regulation of physiological state between individuals.(13) One example Dr. Porges uses for co-regulation is the relationship between a mother and her baby. If a mother is calming her child and the child responds by relaxing and vocalizing sounds of contentment, this has a reciprocal effect of calming the mother. If the infant continues to be upset and doesn’t respond to the mother’s attempt to settle her, the mother will also get upset. Dr. Porges calls this our “biological need to connect.”
Deb Dana, author of the book The Polyvagal Theory in Therapy, created the concept of the polyvagal ladder as a visual metaphor for how we experience physiological change as we move through the three neural circuits of the autonomic nervous system.
At the top of the ladder is the ventral vagus, where the feelings are likely to be safety, comfort, and engagement in the world around you. You’re generally feeling content, generally lacking in acute worry about anything.
Just below the ventral vagus on the ladder is the sympathetic state, the place you move to for mobilization if you detect risk. This could be something relatively small, like receiving a vague email request for a meeting from your boss that causes you to wonder if you’ve done something wrong, or something as frightening as hearing a window break in your house in the middle of the night and worrying that you are about to become a victim of a home invasion. In both cases, your heart may start beating faster, your palms might sweat, and your mind may race as you worry about what could happen next.
At the bottom of the ladder is the dorsal vagus, where shutdown occurs. In the example of the email from your boss, if it turns out you were called into the office and fired, you’d likely move down the ladder from sympathetic to dorsal state, and shutdown might look like extreme sadness or a bout of depression. In the broken window example, if it became clear quickly that you are about to be a victim of a home invasion, shutdown could involve fainting or going into shock as a way for your body to protect you from a potentially catastrophic physical confrontation.
In both instances, it’s possible to move up the polyvagal ladder instead of down, depending on the circumstance. In the example of the email, if you went to the meeting with your boss in a sympathetic state, heart racing and palms sweating, and it turns out it was a minor request about a project, you could quickly move back up the ladder into the safe and social ventral state, relieved that your fears about being fired were misplaced. And the same is true in the broken window example. If you discover it wasn’t a broken window after all, but instead a television that was left on with the volume up very loud, you would likely bounce quickly up the ladder to ventral vagus, relieved that you and your family aren’t in danger after all.
Hybrid States of the Polyvagal Ladder
There are scenarios where two of the three neural states are combined. Stanley Rosenberg, author of Accessing the Healing Power of the Vagus Nerve, calls these “hybrid states.”(14) The fourth state combines the ventral vagal (safe and social) and sympathetic (mobilization) to create mobilization without fear. Examples of this might be going to a zumba class, playing tag with your kids, or engaging in a friendly competition on the basketball court with friends. The fifth state combines the ventral vagal (safe and social) with dorsal vagal (shutdown) to create immobilization without fear. This creates a feeling of calm and safety, and examples could include lying still with a trusted partner after intimacy, or cuddling with your sleepy child before bedtime.
How to Move Between States With Breath
Unless you’re in a hybrid state like the examples mentioned above, which includes the safe and social feelings of the ventral vagus complex, being stuck in a sympathetic (fight-or-flight) or dorsal (shutdown) state can be draining to maintain—mentally, emotionally, and physically. If you’re locked in a sympathetic state, you might feel like you’re constantly stressed, always waiting for another metaphorical shoe to drop. If you’re locked in a dorsal state, you may find yourself in a perpetual malaise, unable to meaningfully engage with the people in your life and the world around you.
Luckily, there’s a readily available way to move yourself up the polyvagal ladder to include the safe and social feelings of the ventral state, and it starts with your breath. “The simplest vagal stimulation that you can recruit is being able to exhale slowly,” says Dr. Stephen Porges. Stimulating the vagus nerve with slow exhales slows down the heart rate and gives your body cues of safety. “In the brain stem there’s actually kind of like a switch,” continues Porges. “It’s like a hot water/cold water option on the same knob. When you exhale, the vagal influences to your heart’s pacemaker get optimized. When you inhale, your heart rate goes up. And when you exhale, your heart rate goes down. If you spend more of your time exhaling, you calm your body down. If you shift rations so that most of the time you’re inhaling, you’re hyperventilating. You’re huffing and puffing. When you see anxious people, they’re inhaling on virtually every sentence or every word. They’re huffing and puffing.”
Tune Up Fitness founder Jill Miller designed an entire immersion program, Breath & Bliss, around the polyvagal theory, using breathwork, position, movement, community, and a soft, air-filled sponge ball to manually stimulate the vagus nerve, and give students tools to move out of a fight-or-flight or shutdown state. “I want people to feel like they have as many options as possible to be able to modulate their own state,” says Miller. “And to understand the ‘why’ really helps with the experience of it. My bias is that I believe once you know that you can shift your physiology and you train yourself to witness your physiological shifts, it becomes a richer experience and you don’t feel so victimized by your moods or reaction to things. I want empowered recovery to be in everyone’s toolkit.”
Breath & Bliss is a movement and breath-based approach that leans into Porges’s theory of how we respond to our environment, and uses that knowledge for guidance on getting ourselves to a state where we can feel safe with ourselves and in the company of others. “One attribute of being a human being is that our body reacts to threat,” says Porges. “But it doesn’t just react to threat, it transforms how we interact with other people. So we have to understand that our body is shifting states to try and take good care of us, but in doing that, it distorts how we see the world. We know that our bodies change states and promote certain attributes to protect us. The issue is, can we create the structure and context for our bodies to feel welcoming enough to bring other people into our world? Can we give up our chronic need to be defensive, to take a chance to be accessible and live with our own vulnerability?”
Senior Tune Up Fitness® Instructor Lisa Hebert leads the Breath & Bliss Immersion internationally and has seen it transform students as they learn how to move between states. “I think the beauty of the polyvagal theory is that it brings us back to basics,” says Hebert. “Social interaction, human touch, human connection, a caring voice. All of these things we know so innately when we have a baby in our arms, but we grow up and push all that away so we can get tough and do everything ourselves. So we may lose it temporarily, but it’s this innate knowledge that we have in our gut somewhere.”
Hebert has also done Breath & Bliss work with first responders and former military members with PTSD. Jason Burd was a firefighter in Canada who almost died when a roof collapsed during a rescue operation in 2006. After the accident he went back to work, but suffered a back injury in 2010, followed by a lung injury in 2011. He ended his career as a firefighter because of physical pain, PTSD, and suicidal thoughts. He did Breath & Bliss with Hebert, where he learned breathing exercises and rolling techniques to stimulate the vagus nerve with the Coregeous ball. “There were so many lightbulb moments,” says Hurd. “I realized that my recovery is in my hands. When I came home after the first day of the course I told my wife that I felt like the inside of my neck was bigger. My ability to breathe felt completely different. Now I use the Coregeous ball a minimum of once a day, usually twice.” “There were so many lightbulb moments,” says Hurd. “I realized that my recovery is in my hands. When I came home after the first day of the course I told my wife that I felt like the inside of my neck was bigger. My ability to breathe felt completely different. Now I use the Coregeous ball a minimum of once a day, usually twice.”
Hurd’s experience is an example of how tuning in to breath, and manually stimulating your own vagus nerve, can result in a powerful shift from chronic pain and fight-or-flight anxiety, to empowered recovery.
“That is what I call embodiment,” says Miller. “It’s when someone feels their way through their body, engaging in a conscious dialogue of their senses, feelings, urges, and needs. Be willing to respond and parent yourself with curiosity and support.”
According to Dr. Porges, understanding polyvagal theory can help us negotiate with our bodies to optimize our experiences. “Amazingly, when you become more aware of what your body’s trying to do, the body tries to work with you. We’ve treated our body as if it was something that we had to contain or control. But the message is that we live in our body. Treat your body with honor and respect, and your body will serve you well.”
Of all the good news science is telling us about the vagus, perhaps the most important is that we have the ability to befriend this wandering nerve right this very minute. While researchers all over the world continue to explore ways modern medicine can use the vagus nerve to heal chronic disease, you can start breathing now. You can start listening to the cues your body is giving you now. You can begin taking your recovery into your own hands now.
At-a-Glance: How to Stimulate Your Vagus Nerve to Turn ON Your OFF Switch
To help your body “turn on” the vagus to improve its function, there are several social, physiological, and physical “tricks” that your body can employ.
1. The easiest way to stimulate the vagus nerve is through slow, deep, diaphragmatic breathing that emphasizes elongation of exhales.
2. Singing, humming, or playing a wind instrument also excite this downregulation nerve. (As demonstrated below.)
3. Massaging areas of the body which are innervated by the vagus alters vagal tone and provides a relaxation response. These include tolerable pressure to: A. Muscles of face, side, and front of neck and head B. Rib cage C. Abdomen
4. Positioning the body in ways that compress and decompress areas where the vagus nerve innervates: A. Rocking, which gently oscillates the head B. Neck stretches C. Abdominal and torso rotations that compress and decompress the viscera D. Gently flexing and extending the spine to affect pressure and/or stretch in the visceral area
5. Chewing food, sucking on food/objects and gargling
6. Safely rubbing the inside of your ear (the bowl shaped bits, not your ear canal)
7. Positive social interactions
8. “Feeling safe in the arms of another” or “feeling safe in the arms of another appropriate mammal, like a dog,” Dr. Stephen Porges
9. Meditation and yoga
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1. Stanley Rosenberg, Accessing the Healing Power of the Vagus Nerve, (California: North Atlantic Books, 2017), 37.
2. Vince, Gaia. “Hacking the Nervous System to Heal the Body.” Discover Magazine, May 2015
3. Breit, Sigrid, et al. ‘Vagus Nerve as Modulator of the Brain-Gut Axis in Psychiatric and Inflammatory Disorders’, Frontiers in Psychiatry, 13 March 2018.
4. Tracey, Kevin J., “The Inflammatory Reflex,” Nature, 19 December 2002.
5. “How Electricity Could Replace Your Medications.” YouTube, uploaded by TEDMED, 26 May 2016.
6. Koopman, Frieda A., et al. ‘Vagus Nerve Stimulates Cytokine Production and Attenuates Disease Severity in Rheumatoid Arthritis’, Proceedings of the National Academy of Sciences of the United States of America, 19 July 2016.
7. Porges, Stephen, “The Pocket Guide to the Polyvagal Theory,” (New York: W. W. Norton & Company, Inc., 2017), 15.
8. Stanley Rosenberg, Accessing the Healing Power of the Vagus Nerve, (California: North Atlantic Books, 2017), 19.
9. Stanley Rosenberg, Accessing the Healing Power of the Vagus Nerve, (California: North Atlantic Books, 2017), 32.
10. IMAIOS e-Anatomy online,
11. Dana, Deb, “The Polyvagal Theory in Therapy,” (New York: W.W. Norton & Company, Inc., 2018), 4.
12. Scudallari, Megan, “Scientists Discover How Vagus Nerve Stimulation Treats Rheumatoid Arthritis,” IEEE Spectrum, 18 July 2016.
13. Porges, Stephen, “The Pocket Guide to the Polyvagal Theory,” (New York: W. W. Norton & Company, Inc., 2017), 9.
14. Stanley Rosenberg, Accessing the Healing Power of the Vagus Nerve, (California: North Atlantic Books, 2017), 33.