Hello,

The Vegas nerve has points in the ear that you can needle.

Do you by chance have a waiver that I could borrow for dry needling?

Thank you

I am mentored by a PT who teaches the ECHO program for the Ehlers-Danlos Society. She is also conducting research in compression syndromes. Visceral manipulation therapist, with deep rooted neuro background. This is her approach for gastric dumping and improving motility through improving vagus nerve function via dry needling. her approach is as follows:

"The technique that I use in office is addressing the sympathetic ganglia or the plexuses through dry needling but with a neural manipulation or cranial sacral-like approach. Therefore, the specific nerves are addressed with intention, but rather than pistoning or dropping and leaving needles, the practitioner keeps their fingers on the needle and waits to feel the rhythm of the plexus or ganglia and re-balances it. This can be done at the sympathetic ganglia that sits in front of the thoracic facets. Therefore, an approach to the deep multifidi at the specific level in question would bring the practitioner closer to the sympathetic ganglia that is on the other side of the lamina."

Consider T6 paravertebrals additionally to the needling in the ear for the vagus nerve stimulation. Remember the role of T6 in autonomic function. I remember this easily considering pathology associated at the T6 spinal level. Autonomic Dysreflexia in SCI population ring a bell? best way I can think to look at it is thinking of your needling approach like unkinking a catheter in comparison. hope this helps. 

If you're looking to help regulate vagus nerve function, the anococcygeal point in the lumbopelvic needling course is sometimes helpful. My explanation/theory for why is lengthy, so bear with me. We'll have to talk pudendal neuralgia and autonomic dysreflexia to get there.

The pelvic splanchnic nerves on the anterior/ventral side of the tailbone have significant sympathetic influence. A sympathetic ganglion impar block injection (imaging guided) is a helpful forefront treatment in managing pudendal neuralgia.

In the pelvic PT world, pudendal neuralgia is challenging to treat. Patients maintain tension in their pelvic floor muscles despite the fact that the tension results in ongoing chronic pain and overuse related trigger points.
In my mind, it begs the question, why would a person's body continue to hold them in a painful position? Typically, our bodies avoid pain at almost all costs. Except, per the pain science education nerd in me, if there is a more threatening survival need. (I.e. the analogy of spraining your ankle while walking across the street, but not feeling pain because a bus is coming at you. The brain down regulates the ankle sprain pain response, because the bus is the greater threat.)

Which leads me to the question, what is the greater threat? What benefit do we obtain by maintaining high muscle tone in our pelvic floor muscles? One potential answer is that they adjust the position of the coccyx. I am curious if the elevated pelvic floor muscle tone is a coping strategy to self regulate autonomic function via the sympathetic influence of the pelvic splanchnic nerves.

If this was helping someone to maintain better blood flow to their brain, the body may see that as essential, vital to life, at a level that it chooses to perpetuate pelvic flood muscle tone in spite of pain.

The primary trigger for autonomic dysreflexia is a full bowel/bladder. The neural innervation for this is predominantly from the sacral nerves. There has also been some discussion about the preservation of sexual function in women with SCI's being related to vagus nerve influences in the pelvis. 

As I have worked with POTS patients, and IC patients, there are people who report that emptying their bladder improves some of thermoregulation and HR/BP issues. Autonomic dysreflexia isn't fully understood, but there is probably some relation here.

My last experiential argument for this point, is that I've had dysautonomia patients that routinely have syncopal episodes when having blood drawn, be able to reduce or eliminate their syncopal episodes, by tensing their anal sphincter and pelvic floor muscles during their blood draw.

While I recognize this is more based on my experience and biological plausibility than research articles, I hope it can help other people.
If anyone wants to chat about dysautonomia they're welcome to email me at dr.heather.swain@allytotalpt.com