The Thinking Practitioner

Rebroadcast: One of our most popular episodes (Ep 45), shared again in honor of the upcoming Fascia Research Congress.

🎙In this lively and far-reaching conversation, fascia researcher and manual therapy pioneer Robert Schleip returns to talk with Til Luchau and Whitney Lowe about the newly expanded second edition of Fascia in Sport and Movement. They explore what’s new in fascia science, how manual therapy and movement are evolving, and how fascia functions as a sensory and fluid-regulating organ. Along the way, Schleip shares stories, research, and a few surprises.

🔍 Key Topics:

📚 Resources Mentioned in This Episode 

• Book: Fascia in Sport & Movement at Handspring (Get 15% off with coupon code TTP) 
• fasciaresearch.de
• somatics.de
• Fascia Research Society 

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🎙In this episode, Til Luchau and Whitney Lowe speak with renowned neuroscientist Dr. Stephen Porges, originator of Polyvagal Theory. Together, they explore how our nervous systems respond to cues of safety, how touch can support regulation and connection, and what all this means for bodyworkers and manual therapists.

Dr. Porges shares the latest thinking on co-regulation, trauma, attunement, and the science of feeling safe—along with practical insights for practitioners working with the body.

🔍 Key Topics:

• 00:00 – 02:00 Intro, ABMP welcome & framing the Polyvagal lens for bodyworkers
• 02:00 – 07:00 Early research with Peter Levine and John Cottingham: how structural shifts (pelvic tilt, fascia work) alter autonomic regulation
• 07:00 – 12:00 Evolutionary foundations: fascia types, diaphragm function, and the hierarchy of autonomic response
• 12:00 – 17:00 Facial expressivity, voice prosody, and breathing as channels of co‑regulation
• 17:00 – 22:00 Identifying autonomic states (“tightly wrapped” bodies) and choosing when—not just where—to touch
• 22:00 – 27:00 The Body Perception Questionnaire: a tool for mapping clients’ interoceptive awareness
• 27:00 – 32:00 Trauma, autonomic reactivity, and parsing traumatic events vs. responses
• 32:00 – 37:00 The Safe and Sound Protocol: acoustic interventions for nervous system safety
• 37:00 – 42:00 Vagal “hacking” misconceptions: why rhythm and safety signals matter more than stimulation
• 42:00 – 47:00 Feedback loops: tissue ↔ nervous system ↔ fascia → chronic pain
• 47:00 – 52:00 Therapist intuition: physiological co‑regulation, broadcasting accessibility, therapist self‑state
• 52:00 – 57:00 Finding safety in a chaotic world: why therapists need safe colleagues and co‑regulation too
• 57:00 – 60:00+ New resources: Polyvagal Theory: A Science of Safety, the Norton-edited somatic therapies volume, Safe & Sound Protocol book, Our Polyvagal World

📚 Resources Mentioned in This Episode

 • Polyvagal Theory: A Science of Safety

Stephen W. Porges (2022)

A foundational, peer-reviewed article exploring how our nervous system detects safety and threat.

https://doi.org/10.3389/fnint.2022.871227

• Somatic-Oriented Therapies: Embodiment, Trauma, and Polyvagal Perspectives

Edited by H. Grassmann, M. Stupiggia & S. W. Porges (2025)

A rich collection on body-centered therapy approaches and trauma healing through a Polyvagal lens.

https://www.amazon.com/dp/1324052724

• Safe and Sound: A Polyvagal Approach for Connection, Change, and Healing

Stephen W. Porges & Karen Onderko (2025, Audiobook)

A warm, practical guide to healing and connection through nervous system regulation.

https://www.amazon.com.au/Safe-Sound-Polyvagal-Approach-Connection/dp/B0DGGZLJ3J

• Our Polyvagal World: How Safety and Trauma Change Us

Stephen W. Porges & Seth Porges (2023, Audiobook)

A father-son conversation exploring how trauma and safety shape our bodies, brains, and relationships.

https://www.amazon.co.jp/dp/B0CW5CPPFP

• Polyvagal Perspectives: Interventions, Practices, and Strategies

Stephen W. Porges (2024, Audiobook)

Hands-on insights for bringing Polyvagal ideas into therapy, education, and everyday life.

https://www.amazon.co.uk/dp/B0D9PJQC55

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🎙From “vagal push-ups” to inflammation to trauma healing, the vagus nerve is everywhere in bodywork and wellness talk—but what does the science actually say? And more importantly, what does this mean in actual practice?

In this episode, Til and Whitney take a grounded, myth-busting look at the vagus nerve’s role in health, relaxation, and hands-on practice. They explore what we can clearly influence through bodywork, what’s misunderstood, and how to work with and think about this vital nerve in our hands-on practices.

🔍 Key Topics:

0:01:50 Introduction to the vagus nerve
0:02:07 Early experiences learning about the vagus nerve
0:03:40 Chair massage and vagal responses
0:03:40 EMT training and vagal response demonstrations
0:04:03 Early research on heart rate variability
0:05:23 Steven Porges and polyvagal theory origins
0:05:46 Anatomical overview of the vagus nerve
0:06:15 Nerve pathways and innervation
0:08:44 Branches to the ear and other body parts
0:08:44 Ventral and dorsal vagus nerve divisions
0:10:01 Parasympathetic nervous system explanation
0:11:11 Evolutionary perspectives on vagal function
0:12:44 Vagal tone and heart rate variability
0:14:38 Mechanisms of heart rate regulation
0:15:04 Breathing and its impact on vagal tone
0:19:47 Breathing techniques for vagal stimulation
0:21:15 Humming, chanting, and vocal effects
0:23:15 Social regulation through sound
0:25:24 Cold exposure and vagal response
0:26:35 Diving reflex
0:27:00 Physiological changes in response to cold
0:28:07 Can we "treat" the vagus nerve?
0:32:27 Limitations of direct nerve manipulation
0:35:14 Holistic approaches to nervous system regulation
0:35:39 Identifying clients who might benefit from vagal tone work
0:36:14 Vagus nerve and inflammation
0:38:12 Changing perspectives on manual therapy approaches
0:39:39 Role of education in treatment
0:41:16 Ear stimulation techniques
0:42:52 Cautions about ear work
0:44:46 Polyvagal theory overview
0:45:59 Criticisms of polyvagal theory
0:46:21 Misconceptions about vagus nerve stimulation
0:49:25 Key takeaways about vagus nerve
0:50:24 Importance of context in nervous system regulation
0:51:49 Comparing vagus nerve to mystique of psoas muscle
0:52:41 Sponsor acknowledgments
0:53:24 Closing remarks and contact information

Resources discussed in this episode: 

• Article: Luchau, Til: 'Working with the Vagus Nerve' Massage & Bodywork, 2017. https://bit.ly/luchau-workingwiththevagusnerve 

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🎙What can trained hands feel in irradiated tissue—and how might that inform both research and practice?

In this episode, Til Luchau and guest cohost Cathy Ryan, RMT, talk with neurobiologist Dr. Geoffrey Bove and manual therapist/speech pathologist Holly McMillan about their collaborative animal study. They explore how massage therapy may influence radiation-induced fibrosis, the use of palpation as a formal outcome, and the challenges of correlating what we feel with what science can measure. This wide-ranging discussion offers practical takeaways for manual therapists working with inflammation, scarring, or post-radiation clients.

Stick around after the outro for a candid “off-mic” bonus segment where Holly describes her hands-on work in surgical oncology settings.

⏱️ Key Topics:
• 00:01:31 – Introductions: Cathy Ryan, Geoffrey Bove, Holly McMillan
• 00:03:09 – Why this study was exciting to manual therapists
• 00:04:18 – Geoffrey Bove on inflammation, nerves, and fibrosis research
• 00:08:14 – Holly: how findings might apply beyond radiation cases
• 00:13:20 – Holly explains what she was feeling for in irradiated limbs
• 00:14:23 – “Buoyancy” and the difficulty of articulating touch-based findings
• 00:18:25 – How palpation findings relate to pathology and imaging
• 00:20:59 – Fibrosis and lymphedema as a clinical continuum
• 00:23:36 – Timing differences in fibrosis between surgery and radiation
• 00:24:52 – Study limitations: assay sensitivity vs. palpation sensitivity
• 00:27:00 – Movement’s role in mitigating radiation effects
• 00:29:00 – The importance of community, alliance, and social touch
• 00:33:27 – Timing of manual therapy before and after radiation
• 00:35:00 – Prevention vs. treatment of fibrosis
• 00:37:18 – What kind of touch is most helpful, and when
• 00:40:00 – Oncology-specific timing considerations for manual therapy
• 00:42:29 – Manual therapy goals in early vs. late stages post-surgery
• 00:44:09 – What practitioners are really touching: inflammation, edema, fibrosis
• 00:45:49 – Apprenticeship vs. protocol-driven training in touch therapy
• 00:47:34 – Final thoughts from Geoffrey and Holly
• 00:50:56 – Bonus: “Off-mic” conversation—Holly’s stories from surgical manual therapy work
• 00:51:09 – Holly describes doing manual therapy in open surgical fields
• 00:52:13 – Avoiding surgery or enabling access through touch
• 00:53:27 – “Sun-dried tomato” vs. “beef jerky”: metaphors for tissue change
• 00:54:15 – Scar tissue, fibrosis, nociceptors, and innervation
• 00:55:57 – The gap between pain-focused and function-focused care
• 00:57:08 – “The Diary of Holly” and the value of descriptive clinical cases

Resources discussed in this episode: 

• Study:
  • Bove, G. M., McMillan, H., & Barbe, M. F. (2024). Evaluating massage therapy for radiation-induced fibrosis in rats: preliminary findings and palpation results. Cancer Biology & Therapy, 25(1). https://doi.org/10.1080/15384047.2024.2436694 
    https://www.tandfonline.com/doi/10.1080/15384047.2024.2436694  and supplemental file https://advanced-trainings.com/materials_ttp/147_bove_supplemental_kcbt_a_2436694_sm2290.pdf 
• Also mentioned in this episode:

  • McMillan, H., Barbon, C. E. A., Cardoso, R., Sedory, A., Buoy, S., Porsche, C., Savage, K., Mayo, L., & Hutcheson, K. A. (2022). Manual Therapy for Patients With Radiation-Associated Trismus After Head and Neck Cancer. JAMA otolaryngology-- head & neck surgery, 148(5), 418–425. https://doi.org/10.1001/jamaoto.2022.0082

  • Hutcheson, K., McMillan, H., Warneke, C., Porsche, C., Savage, K., Buoy, S., Wang, J., Woodman, K., Lai, S., & Fuller, C. (2021). Manual Therapy for Fibrosis-Related Late Effect Dysphagia in head and neck cancer survivors: the pilot MANTLE trial. BMJ open, 11(8), e047830. https://doi.org/10.1136/bmjopen-2020-047830

  • McMillan, H., Warneke, C. L., Buoy, S., Porsche, C., Savage, K., Lai, S. Y., Fuller, C. D., & Hutcheson, K. A. (2025). Manual Therapy for Fibrosis-Related Late Effect Dysphagia in Head and Neck Cancer Survivors: The MANTLE Nonrandomized Clinical Trial. JAMA otolaryngology-- head & neck surgery, 151(4), 319–327. https://doi.org/10.1001/jamaoto.2024.5157

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