Frome Valley Osteopaths

Trigger warning for sexual violence.

Polyvagal theory has been developed by Stephen Porges, it is allowing a much deeper understanding of what happens to our bodies day to day, and how they get ‘stuck’ as a result of Trauma.

Polyvagal theory is important to me as an Osteopath as it helped me realise the importance of ‘felt safety’ in a patients nervous system, and helped me understand where some of the benefit of more cranial treatment might be coming from.

Polyvagal theory teaches us that there are 3 different nervous system states that are independent of each other, and other states that are a combination of these three states.

1. Sympathetic Activation/SNS/fight/flight/freeze/fawn.

This state is a response to stress or perceived threat to life, this could be the tiger jumping out in front of you, your child not listening again!, or an email from your boss. This state sends your heart rate, blood pressure and breathing rate up, it tenses muscles ready to run or fight or hide, it takes your pre frontal cortex offline and means that executive function can be diminished and communication is harder. Many of us live in a state of SNS activation, anxiety is a common symptom of a chronically activated SNS state. We are quick to react and not always in the ways we would like. In this state our nervous system is looking for threat, we feel unsafe.

2. Dorsal vagal activation/Collapsed state.

This state is a response to perceived significant threat to life, it can be a response to powerlessness, where being activated can’t help us or stops helping us. It leads to a shut down or collapsed state. This might be a response to a traumatic incident where you were powerless. In combat soldiers are more likely to be traumatised when they are being shelled than when they are fighting because when they are fighting they don’t feel powerless. It can be a response to chronic pain and can lead to chronic pain, chronic fatigue, gut issues, sleep difficulty, depression etc. This state pulls us out of connection and awareness and into a state of self protection. In this state our heart rate, blood pressure and breathing rate drop and we feel unsafe.

3. Ventral vagal state/social engagement system online.

This state is a much more comfortable state to be in, our pre frontal cortex is online, we have higher executive functioning, we can listen and communicate well. We are seeing the bigger picture and not just responding from our own ‘triggers’ or sensitivities. We are not responding to threat. We feel connected to each other and ‘plugged in’ to the world around us. We can sit in awareness and be present. This is where as Osteopaths we would aim to be during a treatment session, to help co regulate our patients who may not be in this state. It can be a state that some patients haven’t experienced much of, and helping them get there through treatment and co regulation is helping expand their nervous system flexibility.

Combined states… play and rest.

There are many combined states, I mention these two because they are probably the ones we see most in our own lives and those of our children. Play is the combined states of SNS and Social engagement, we need enough activation to get us off the sofa and excited about playing, often we are connected to someone else through social engagement and if not our social engagement system can help us be creative through play. Rest is the combined states of ventral vagal/social engagement and Dorsal vagal, we don’t want to completely collapse but we do want to be able to shut down enough to be able to be still and our mind to calm. Many children and adults who have experienced trauma are unable to play, they are looking for threat and can’t relax into play. Many children and adults find rest and sleep hard for similar reasons.

A healthy nervous system is able to shift through these states, up and down the ‘polyvagal ladder’ without getting stuck at any particular level. But we know people get stuck in hyperarousal (SNS) or hypoarousal (Dorsal vagal), symptoms of this can be huge and far reaching, one person in a hyperarousal state may be very angry and reactive (fight response) and another may be very sweet and accommodating (fawn response) but they both may be experiencing a SNS dominant state.

Trauma is a massive part of why people get stuck, now humans are hugely resilient and there are many difficult things we experience that may be very upsetting but are not traumatising. However, we also need to understand that a huge percentage of people have experienced significant trauma. Before adulthood 1in4 girls and 1in5 boys have experienced sexual violence and the statistics for sexual violence against women is shocking, the ACEs study is a little dated now but the impact of Adverse Childhood Experiences on adult health is also huge. As professionals working in the health industry we need to know this to be able to support our patients effectively.

We need to know that to help people move out of a dorsal vagal state, they may need movement and rhythm and human connection. We need to know that to help people move out of a sympathetic activated state, they may need help slowing down, human connection, support to meditate.

We need to know our patients deeply to be able to help deeply. We have to know ourselves deeply to be able to meet people deeply. We need to be doing our own work, always, to be comfortable in our skin, comfortable in our connection, and regulating for others. We need to know when we need a holiday 😁🧡

If we all knew this we could understand ourselves and each other better. There would be less us and them, we are all trying, we are driven by our nervous systems lack of, or sense of safety, we could have more compassion for ourselves and each other.

All my love,

Lauren Manning BSc Hons Ost