There’s an ongoing debate about polyvagal theory (PVT), and because I talk about the vagus nerve a lot, people understandably ask where I stand. So here it is. (spoiler...I don't care!)
First: I’m a massage therapist. I’m not a neuroscientist. I’m not a psychologist. I don’t teach polyvagal theory, largely because the level of complexity to the neuro-physiology isn't helpful for most practitioners, it's always been murky and because I’ve always considered it outside my scope. This also isn’t new. Questions about the dorsal vagus have existed since the beginning of polyvagal theory.
From what I understand, the current debate centres around whether the dorsal branch of the vagus nerve does what PVT proposes it does — particularly in relation to shutdown states.
And I’m going to say something that might surprise you: It doesn’t change my clinical practice at all.
Whether the dorsal vagus controls heart rate in the specific way PVT suggests isn’t what determines whether an intervention is helpful in the room with a patient.
I care far more about whether a tool works than about defending a specific theoretical explanation for how it works. I think it's usually more complex than any one mechanism anyway.
Now, don’t misunderstand me — I love neuroscience. I read it for fun. (Because I'm a dork) I try to stay current. But when I teach, I anchor my content in well-established anatomy and physiology. Fundamentals based on evidence that has stood up over time.
Polyvagal theory is only one theoretical lens. It is not the entirety of vagal science. (Brief aside, there are many things about PVT I find personally helpful!)
Medical research has been studying and using vagus nerve stimulation for decades. There is strong, robust research around vagal tone, heart rate variability, inflammation, epilepsy, depression, and more — all of which exists completely outside of polyvagal theory.
So when I talk about the vagus nerve, I’m not referencing PVT as doctrine. I’m referencing anatomy and physiology and the effect on the safety of the nervous system.
Let’s not throw out decades of solid vagal research because part of one theory is being debated.
I build a toolbox.
No one nervous system responds the same way. No intervention works 100% of the time. So instead of anchoring to a theory, I anchor to outcomes.
I use what I call the 4 Rs:
If something meets that framework, isn’t invasive, and has no contraindications, I’ll try it.
I always have a rationale grounded in accepted physiology. But I’m honest when the mechanism isn’t fully known. Sometimes we’re working through multiple pathways. Sometimes we don’t fully understand the pathway yet.
What matters most? Does the person feel better?
I ask:
- Was that soothing, annoying or neutral?
- Does this feel better, worse or the same?
If their nervous system likes it, we keep it. If it doesn’t help, we drop it. I’m not attached to being right about a theory. I’m attached to helping the person on my table feel less pain, move better, and experience less unnecessary stress.
Everything else, honestly I don't have time for.
