Stress impacts the body through both the sympathetic (fight-or-flight) and dorsal vagus (freeze) responses, leading to muscle tension, pain, fatigue, and disrupted sleep. The ventral branch of the vagus nerve supports social engagement and helps calm the nervous system. Massage can facilitate a return to ventral vagal control by releasing blocked energy, easing tension, and improving physical and mental well-being. Understanding these mechanisms allows therapists to better support clients in managing stress and restoring balance.
Key Takeaways
- Stress activates fight, flight, or freeze responses, leading to muscle tension, pain, and fatigue.
- The ventral vagus nerve plays a key role in calming the nervous system and restoring balance.
- Massage helps clients release trapped energy, reduce muscle tension, and improve physical comfort.
- Encouraging body awareness supports better relaxation, sleep, and emotional regulation.
- Therapists create a safe, focused environment to guide clients through stress recovery and enhance overall well-being.
Forty-seven percent of people who received a massage last year cited relaxation or stress reduction as the reason for their visit. Between 70-80% of all diseases and illnesses are stress-related1. Exploring stress and how the vagus nerve affects our stress response and its diverse symptoms of muscle tension, pain, fatigue, anxiety, and insomnia can help us better serve our massage clientele.2
What is Stress?
Stress is a physical response to a threat or stressor3. Threats can be real or imagined (e.g., fear of job loss), and the stressor can originate from an outside danger (e.g., a lunging animal) or from within (e.g., pain).
When threatened, the nervous system triggers one of two defense mechanisms: either SNS activation (fight-or-flight) or PNS shutdown (freeze-or-faint).
Although stress helps us adapt to meet a challenge, prolonged, unabated stress interferes with the natural healing process. Unchecked, stress will move through three stages – alarm, resistance, and exhaustion – and can lead to colds, migraines, insomnia, hypertension, and serious chronic disease.
Sympathetic nerve impulses (SNS – stemming from T1-L1 spinal segments) sound the alarm for the heart, lung, and musculoskeletal system to go on alert. During resistance, a stressed person tries to resist stress messages even though the threat still exists. In the exhaustion stage, one or more tissues affected by stress signals can no longer keep up and fail to function properly.
Unresolved stress undermines the ability to adapt. Bodies fall into a negative feedback loop of spasm – pain – spasm, where muscles contract and tighten to protect against stress. Tight muscles cannot absorb oxygen and nutrients, which weakens muscles and makes them prone to damage. Downward spirals of stress provoke anxiety, depression, and poor sleep, which further erode the ability to cope. Maladaptive behaviors such as eating disorders, substance abuse, and sleeping difficulties can result.
Fight or Flight Response (SNS Activation)
The SNS generates a huge amount of energy to fight or flee from danger through quick electrical impulses and slower hormonal (chemical) messages that remain longer in the body. Without a way to discharge amped-up energy, physiological stress responses will persist long after an immediate threat has passed or original injuries have resolved.
SNS Freeze Response
Wild animals that cannot safely fight or flee a predator demonstrate another survival response (Freeze). Prey animals become still and barely breathe while stress hormones race through their hearts and brains. When the predator leaves, prey tremble to discharge the trapped energy. Humans also deploy a freeze response, but unlike wild animals, rarely shake off stuck energy once the threat subsides.
The vagus nerve – mediator of the stress response
Stress has been presented as a binary process, either on (SNS) or off (PNS): there is not a lot of nuance, you are either stressed or not. A threat or demand, something happens to mobilize you into fight, flight, or freeze. When the threat passes or is taken care of, you can return to rest and restore (digest).
Recently, the Vagus nerve (Cranial Nerve X) has been identified as playing an important role in mediating 4 the off switch. CN X is a mixed sensory (mostly) and motor nerve. It has two branches: one slightly in front (ventral) of the other (dorsal).
“Vagus” comes from the Latin word “to wander”, and is aptly named as it wanders to and affects many parts of the body. The ventral branch wanders to the ears, tongue, voice box, and throat. CN X emerges from the skull, sending fibers to the heart, lung, esophagus, and through the respiratory diaphragm. The dorsal branch continues into the abdomen, from the solar plexus to the stomach, pancreas, liver, and spleen, and through the mesentery to the intestines. Ventral and dorsal branches bring the body to rest in different ways.
Dorsal Vagus Nerve – Shutdown
Dorsal vagal impulses shut down crucial autonomic functions such as breathing, heartbeat, and digestion. In this Freeze or Faint response, immobility or dissociation can result, or you could feel fatigued muscles or the lightheadedness of a bad flu.
Ventral Vagus Nerve – Social Engagement
Since the ventral vagus innervates sensory organs, it makes anatomical sense that this branch activates accurate reading of facial expressions and gestures, clear communication, playfulness, and connection. These Social Engagement skills are a way that we have evolved to adapt to stress.
Ventral vagus calms the system in the way that you slow a horse by pulling on the reins. It is a nuanced pulling then loosening on the reins to smoothly slow down the horse; ventral vagal calming occurs in that way.
Although not as immediate as Dorsal Shutdown, a Ventral Vagus response happens quickly (milliseconds), especially compared to SNS hormonal messages (seconds). As vagal impulses do not require chemical reactions or travel time through the bloodstream, a Ventral vagus activation can override the release of fight-or-flight chemicals (which, once started, would take 10–20 minutes to calm down).
Hierarchy of Stress Responses
- Social Engagement, described above, allows us to feel safe and secure and be present with ourselves, other people, and be in the now.
- When resources are spent, and we find ourselves unable to counter stress from the secure space of Social Engagement, the nervous system will mobilize in Sympathetic mode. You take action to dispatch the threat. You want to get up and run or fight. Sympathetic engagement spurs tension, anxiety, hypervigilance, and other hyperactive states. When the hyped-up energy is not discharged through action, it can lock up back muscles (the roots of the SNS are found in the thoracic and lumbar segments of the spinal cord). For clients with chronic back tension due to long-term stress, relaxation massage can move that stuck energy and powerfully affect previously intractable back muscles.
- The body cannot sustain excitement for prolonged periods. The overload of SNS hormones (adrenaline and cortisol) would wear out the heart and lungs and lead to system collapse. Dorsal vagus runs to the heart, lung, and organs below the diaphragm and locks those organs down. Shutdown is an act of self-preservation that can present in two ways – one is collapse, no muscle tone, flaccid, with no energy. The other is hard like a rock, frozen, unable to move. Clients in Shutdown may seem despondent, hopeless, and held down by the weight of the world.
Massage can Facilitate a Return to Ventral Vagal Control
Prolonged SNS activation and dorsal shutdown sap energy resources for physical recovery, mental acuity, and social relationships. These stress responses sensitize clients to perceived danger, and the world feels more threatening. Hearing and vision focus on detecting peril; facial expressions appear more menacing. Sensory stimulation that would not normally hurt is interpreted as pain.
Physical sensation and body awareness help restore the quiet restorative power of the parasympathetic nervous system. Relaxation massage can bring back ease to overly stressed clients and improve sleep, digestion, and mood. Massage can soothe shattered nerves, soften muscles, and bring clients back to the here and now.
When Clients Discharge Blocked Energy
There is no need to psychoanalyze or force clients to recall stressful events.
Clients do not have to consciously remember an event from the past to heal from it 5. As clients emerge from hyperarousal or shutdown, they begin to feel reconnected with their bodies, rather than constantly assaulted by them.
Bodyworkers play an important part in this recovery. Keeping focus on the physical body keeps you anchored in the scope of practice and creates a safe space. It is a bodyworker’s responsibility to be present, elicit feedback, and check in with their own gut.
Tense and relax techniques, where you provide resistance to push against, help discharge stuck tension. Discharge can be dramatic or subtle and quiet. You may observe violent shivering or feel your client trembling. You may feel a temperature change, or you may feel nothing during the session. Afterwards, your client may be a little calmer, more at ease, and a little less bothered by pain. It is important to NOT have an agenda, and to convey that open attitude.
Compression and tapping help clients kinesthetically feel their skin and muscles as boundaries that hold and contain sensations and feelings. Invite clients to feel their body weight supported by the table. Remind clients to sense breathing as air flows in and out of the nose. Since the ventral vagal nerve innervates the eyes, ears. and voice box, you may observe eye movements, ear twitching, or audible sighing.
Understanding the role of the vagus nerve in moderating the stress response can improve clinical practice and help clients navigate the complicated world of stress.
About the Author
Marian Wolfe Dixon is a licensed massage therapist, clinical hypnotist, and health educator in Portland, Oregon, with master’s degrees in psychology and health education. She helps adults with chronic pain, complex medical conditions, and injury recovery, while also offering pediatric sessions. Marian is the author of Body Mechanics and Self Care Manual and Body Lessons, and focuses on empowering clients through personalized, mindful care.
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- Massage Therapy Industry Fact Sheet – accessed November 1, 2023
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- Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W W Norton & Co. ↩︎