How Heart Rate Provides Insight Into Nervous System Resilience
In this episode of the Unreal Results podcast, I unpack the connection between heart rate, heart rate variability, and the autonomic nervous system and how these measures can give you real-time insight into your clients’ state of regulation.
You’ll hear about what heart rate variability and respiratory sinus arrhythmia actually reflect, why vagal tone matters, and how to recognize when someone’s nervous system is stuck in a sympathetic “on” state versus a dorsal vagal “shut down.”
I also share practical ways to assess and interpret these measures in session, from using a simple pulse oximeter to tracking changes over time. You’ll learn how to connect what you see in heart rate data with what you observe in body language, facial tone, and treatment response, so you can make more informed clinical decisions and better support your clients’ healing.
Whether you’re working with athletes, complex pain cases, or anyone dealing with chronic stress, this episode will help you see heart rate as more than just a number but as a window into the nervous system and a guide for creating real, lasting change.
Resources Mentioned In This Episode
Episode 38: Accessing the Parasympathetic Nervous System without Focusing on Breath!
Episode 86: Decoding The Nervous System For Health Pros
Exercise Video: The Basic Exercise from Stanley Rosenberg
Get the book Accessing the Healing Power of the Vagus Nerve by Stanley Rosenberg*
Get the book New Approach to the Vagus Nerve and Autonomic Nervous System by Eric Marlien
Get the pulse oximeter that I use HERE*
Learn the LTAP™ In-Person in one of my upcoming courses
*This link is an Amazon affiliate link, meaning I earn a commission from any qualifying purchases that you make
Considering the viscera as a source of musculoskeletal pain and dysfunction is a great way to ensure a more true whole body approach to care, however it can be a bit overwhelming on where to start, which is exactly why I created the Visceral Referral Cheat Sheet. This FREE download will help you to learn the most common visceral referral patterns affecting the musculoskeletal system. Download it at www.unrealresultspod.com
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Anna Hartman: Hey there and welcome. I'm Anna Hartman and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs in the nervous system on movement, pain and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.
I'm glad you're here. Let's dive in.
Hello. Hello. Welcome back to another episode of the Unreal Results Podcast. I, where have I been? I've been here, I've been home for the most part. Um, started the online LTAP level one course. So after, you know, as you know, I do a big push for that course. It only happens twice a year, so, um. After the door is closed enrollment, it, it, I have like a little crash out in terms of just like being tired and like creatively a little drained.
Uh, but yesterday we had our, or not yesterday, two days ago, we had our first live call and it was great, great talking to new group and uh, I'm looking forward to the next seven weeks. It will go by so fast. This I know to be true. Um, it's the eighth time I've done it, so it, it just flies by. So anyways, um, I'm feeling like, okay, what do I wanna start talking about on the podcast now?
Like, what's on my mind? Um, and I thought I would share, I thought I would do a quick episode, a little bit about heart rate and heart rate variability, respiratory syn. Sinus arrhythmia, what that all means and how I use it clinically. Uh, when I do use it, I don't always, I don't always use it, but when I do, it can be very helpful and, um, it also comes up.
So, so what made me think of this? It's two things. One, I'm preparing to, um, open up the doors to the revitalized mentorship, uh, for the first time in. A couple years, and I'm super excited about that. So it just has me thinking about all the content that is inside the mentorship. And also too, just like the overarching, like what do I want people to get out of it besides supporting them and, and, and, and becoming like a calm, confident practitioner that gets great results, uh, utilizing the ltap.
Um, and so. You know, one of the cornerstones that we end up talking about a lot in this work is the autonomic nervous system, and both the importance of us as the practitioner taking care of ourselves. So we are coming to the table, we are coming to our appointments with a very regulated nervous system.
Because the more regulated we are, the better we can help people regulate their nervous system and the clearer the messages from somebody else's body to ours because we won't be distracted by the noise happening within our own body. And so, um, this is an important like concept of the self-care part of professional development.
There it is a, it is can't, I think in my opinion, it is very hard to continually improve as a professional without entering in the realm of taking care of yourself personally. So that is like a big cornerstone of the mentorship. Um, the other reason this came out is, um, some of the. One of the treatment options both in, I think I, I, yeah, it's in the missing link.
So if you, if you did the free missing link course, um, you might have seen this treatment option. It's in the treatment options for the locator test assessment protocol level one course. I don't think it's in the treatments, in the go-to treatments course, because it's not actually one I use a lot, ironically.
But the cool thing about this treatment, this treatment, it's a, it's a drill called the Basic Exercise from Stanley Rosenberg. He writes, he wrote, he wrote about it in the book, accessing the power of the accessing the healing power of the vagus nerve, I think is the name of the book. I'll have Joe link it in the show notes along with the link to the basic exercise.
So the, what the basic exercise is, is basically, um, the patient is lying, typically lying down in the supine position with their hands under their occiput, um, elbows slightly forward, and then giving a slight upper cervical nod open up the suboccipital space there. Um. Uh, with like the, the nod with your hands there creates this like feeling of a very minimal traction.
I, my, I will stress don't do a lot of traction. Um, it's not about the traction, uh, it's about the cervical nod and the length in the back of the neck, the, the length and space in the suboccipital space. And then what you do is you move your eyes to one side. And you wait for a nervous system response, a parasympathetic nervous system response.
That's sometimes like a deep breath, sometimes a sigh, sometimes a swallow. Um, everybody's a little bit different and it can take sometimes, sometimes it's quick. Sometimes it, you know, I'll have people wait like 30 to 60 seconds for a response before kind of giving up on it. And you can go eyes to one side.
You can go eyes to the other side. It doesn't really matter which side you do. You can do both. The, the, the theory or the reasoning behind it is you're using the relationship between the eye muscles and the suboccipitals. So if you don't know that relationship, there is a relationship between the um, medial and lateral muscles of the eye and the role in focusing our eyes and, um, turning our head right, our eyes, our eye, wherever our eyes go, our head usually goes. And so the movement of our head is dictated or controlled by the suboccipital muscles. Some of them, I mean, there's more of them, right, but the suboccipitals are very directly linked to your eyes.
And so this eye movement stimulates a like isometric contraction, right? Because we're not letting our head move, just our eyes are going, but it's an iso. It's basically an isometric contraction of the suboccipital muscles and that those muscles originate in the area of the cran. Between the cervical spine and the occiput in that area is a foramen called the jugular foramen.
The jugular foramen contains our vagus nerve, accessory nerve and arteries veins. Right. So it's like a, a really. Important foramen. And basically the theory with this exercise is that isometric contraction is almost as like a contract relax in the area, to open the space in the, in that area of the jugular foramen to allow better blood flow and neural flow, cerebral spinal fluid flow.
'cause it's also like right at the um, myodural bridge there, um, to. So all of that helps to facilitate a parasympathetic response and downregulate the nervous system, downregulate the nervous system by upregulating the blood flow, the vagus nerve input the accessory nerve frame, which share some common connections.
Um, anastomosis is in the nervous system and um, even. Areas of the brainstem. So, um, the other thing, it does that motion because looking to the side, obviously the side you're looking at, that same eye would be lateral rectus. That's cranial nerve six controls that. Cranial six is abducens nerve. The other eye is going medially.
That's ocular motor nerve cranial nerve three, cranial nerve three. Is also a parasympathetic nerve. So the clinical reasoning behind that exercise is interesting because it's like, what's really happening? Don't really know. Is it really a changing of the neural flow or the blood flow at the drug for amen from the position?
From the connect, the isometric contraction from a muscle energy technique thing, is it just the cervical nod portion of that opens up that space and gives a little stretch on the dura? Is it the hand placement? So here's another thing. The hand placement on the occiput is potentially, um, stimulating or affecting the, um, greater occipital nerves and the greater occipital nerves.
Um, the nerve of Arnold. And the lesser occipital nerve in that area also have a recurrency back into the cranium and innervate. The meninges, the tentorium. And so we also could have a reflexive effect of cranial flow, decreased cranial tension from just that stimulation of our hands. Um, or is it this parasympathetic response with ocular motor nerve?
The, at the end of the day. I don't think there's a way to determine exactly what is the mechanism that's happening with the basic exercise, but as you can see, as I describe, it has potential for a lot of rich inputs that can have a direct effect on both. The autonomic nervous system and the central nervous system.
Now, if you don't realize there's a difference between the autonomic nervous system and the central nervous system, I'm gonna refer you back to another episode. Of the podcast that I've done, I'll have Joe link it in the show notes when I talk about the nuances between the two. Yes, there's overlap. Yes.
They're a part of like, they influence each other, they're part of each other. Everything is like, you know, nervous system. It's like the autonomic nervous system. I always kind of dumb it down and be like, the autonomic nervous system is the physiology and the central nervous system is more of the anatomy and the location.
So, um. Either way, though both are important to influence and they are interconnected and influence each other. What people often get wrong is when I start talking about central nervous system tension, they think I'm talking about autonomic nervous system tension in the form of a hyperactivity of the central nervous system or a, you know, so more sympathetic and parasympathetic resilience balance.
Um, so there is a difference and that's why we will refer you back to that podcast. 'cause I did a whole podcast episode on it, talking about the nuance of all of it. So anyways, uh, where am I going with this and how does it relate to heart rate? So in the video that I have in those courses, I demonstrate the basic exercise with a patient.
You know, with a model and I am observing her heart rate pre and post and, um, I'm observing her heart rate pre and post with this pulse oximeter, right? Like a little pulse oximeter that you put on your fingertip to measure your oxygen saturation and. It's a quick way to measure heart rate, right? Like if you've ever been to the hospital, they put one on to measure your vital signs.
Like right now it's telling me that my heart rate is 70 beats per minute and my pulse ox is 97. Um, and so a lot of the questions I get because this is fancy and it gives us a number, a lot of the questions I get around that treatment intervention is, do I need to buy a pulse oximeter? And what does the heart rate change mean?
And part of that is like my fault. Um, you know, you film one video of an exercise and then you, the, the, when you filmed it, it's not the reason often of where it goes into a future course. So it's a little bit of like, oh well. It's not the point of this course. I filmed that basic exercise video, um, during creating content for the mentorship for the autonomic nervous system and polyvagal theory module.
So because we do talk about the autonomic nervous system, more polyvagal theory, more, and utilizing heart rate and respiratory sinus arrhythmia as a way to evaluate and have measurements of someone's autonomic nervous system resilience or flexibility, and how important this is because as I talk about, you know, the body is designed to heal itself.
And we have optimal health. Well, well, when we, when our health is optimal, we are in that state of self-healing and that is that self-healing state happens in a parasympathetic nervous system state. And, um, we learn too that the parasympathetic, apathetic nervous system inputs, the parasympathetic inputs is actually what regulates the.
Sympathetic nervous system, right? So when we, this concept of being hyperactive, sympathetic response, being stressed out, if you will, oftentimes people think that in order to change that you have to remove stress, but it's actually not true. And I talk about that in that previous podcast episode. And there might even be another one that Joe and link, I'll make sure we link all the necessary things, but it's actually you don't have to remove stressors. In order to have a balanced autonomic nervous system, you have to improve and optimize and increase your parasympathetic inputs. Okay, so this is why there's such an obsession with the parasympathetic things, because it is the switch that turns. It's the on switch basically that turns the other stuff off.
But, um, and, and then so, and this is how it goes to heart rate because it literally is. So when we talk about autonomic nervous system, another term that gets thrown around a lot is like, um, vagal tone and, um. Your vagal. You want a high level of vagal tone. A high level of vagal tone is another way of saying a robust parasympathetic input.
And this is what actually puts the break. It's called a vagal break on our heart and our heart rate. So our primitive nervous system, and you see this in babies, I've talked about this in babies. Baby's heart rates are much higher than adults. That's because they, their parasympathetic nervous system and their vagus nerve has not been fully applied.
The break has not been fully applied to bring the heart rate down. That is why when a baby is born, co-regulation with the adults, with the other people is such an important part of the nurturing and development. Of their entirety, not just their nervous system, but like this co-regulation. And this vagal break really determines like their health and ability to thrive.
And so when we look at someone's heart rate. We understand that the, the, the resting heart rate is an indication of the strength of that vagal break. So that in itself means that if we just look at someone's resting heart rate, we can start to get a window into how resilient their nervous system is. In a way in terms of if they have a tendency towards being in a hypers sympathetic state or being in a, um, para sympathetic state.
So a too low of a state, and this is going to convey are we in a fight flight response or a freeze fun response. So when we see a heart rate. Over 80 beats per minute. That is more indicative, and this is a resting heart rate, not just any heart rate. This is resting heart rate over 80 beats per minute.
This is indicative of a hypers sympathetic state, which is called sym sympathetic. Sympathetic atonia. Sympathetic atonia, which is basically increased tone of a sympathetics.
Why this matters? Two, like, like it's always like kind of goes back to, so why do we care? Why do we not want to be in a hypers sympathetic state all the time? Because when we are in this state of increased tone of our sympathetics, the um. Tissues, especially the tissue surrounding our arteries, surrounding our arteries get very stiff and then that stiffness changes our blood pressure.
And then now we have this nasty cycle of, in order to overcome the blood pressure we and the cardiac output, we have to affect the heart rate. And then we get stuck in the sympathetics and then we're just at risk for heart attacks. Right. So that's why we care. And that's why, that's part of the reason why, you know, if you've ever wondered why like stress is a bad thing for your health, that's why.
'cause it actually increases the stiffness of the tissues in the very important tissues that need to maintain a degree of VE elasticity. So anyways, um. When the heart resting heart rate is below 60, that's indicative of a little bit more likelihood of an exhaustion of a hyper sympathetic state and entering into that dorsal vagal freeze mode or fawning mode.
Now, this where it gets a little confusing too, is. Most of you, especially in the sports world, have probably learned that if your heart rate's under 60 beats per minute, that means you're just really healthy and it can be true. And that's why you have to then kind of take it in context of the person in front of you.
If the person in front of me isn't Olympic, or not even Olympic is like a regular runner, marathon runner.
I might be more convinced that a heart rate under 60 is good and healthy. If it's not a, not someone like that, I'm going to start questioning it. And if it's, you know, some people are like, and this is where I think a little bit gets loft in the mix of, even in a doctor's office looking at this, that somebody can come in with.
And be presenting with their symptoms and maybe even how they look not healthy. And now that you can. C Health, but sometimes you can. But, um, and if their heart rate's under 60, the doctor's like, oh, your heart's healthy. And I'm like, mm, not that, nah, that's not true. That's not true. You could just have exhausted, almost being like an adrenal f fatigue, exhausted your sympathetic response and now you're in a freeze mode.
And this is most recently, you know why I even have the heart rate monitor out is most recently, this is what I've been seeing. This is what I saw with my, um, Navy Seal guys that just went through hell week, like a month ago, is during that, well, during the whole first phase of BUDS training, their nervous system is taxed to the max, and then the, the week of hell week, which is week four of like six weeks of first phase, is, um, designed to completely.
Deplete them and they all end up being by the end of the week, you know, besides being sleep deprived, like literally over five days, they get like less than two hours of sleep. But, um, besides being sleep deprived, their nervous systems are all in a very dissociated, dorsal, vagal state freeze mode. Um, you see this in their face.
You see this in their. Capacity to communicate. You see this in their interactions with their families afterwards, like literally everything. They just completely check out and, um, as, as I would, as one would expect. And so to me it was very interesting to be able to measure. This in them and to kind of track how long it takes them to get back to a more balanced nervous system state.
Um, in general, even without, if I'm not even tracking their heart rates, which I kind of slacked off the last couple weeks. But, um, just judging by their, um, body language and their facial tone and their. Capacity to interact socially. Uh, it's, it takes about a month, which is kind of what they were told to by people who've already gone through it, which I thought was really interesting.
But yeah, I'm seeing it too. It's like, okay, we're like. Five, six weeks out now and they're like finally coming back to normal. Um, so I should actually take their heart rate again just to kind of see. But so what I was noticing with the heart rate is what I look at is one, their resting heart rate and then two, um, sometimes even more valuable of information than the resting heart rate because like I said, the resting heart rate.
There's a lot of factors that factor into that too, of like, you can't just be like, oh, if you're over, you're under 60, you're dorsal vagal. And if you're over 80, you're hypers sympathetic because you know, the range is a little different. Um, for these guys who are by all means, basically elite athletes, um, you know.
80 might be a little ridiculous to wait till that high saying that they're sympathetic and under 60 might be, um, a better, I mean more dorsal vagal. I don't know. So you can't always go in on that. But it's in interesting to think about and track, right? All of some of these markers are not indicative on their own of a big deal, but it's like we should track 'em.
We should see. But the other markers that can be really helpful when we're looking at evaluating or assessing the autonomic nervous system is the respiratory sinus arrhythmia and the heart rate variability. And so, um, here's the thing, heart rate variability is the more famous one. Um, because so many apps nowadays and so many like things that are trying to make money off of people's recovery and telling them when they're recovered and telling them how their bodies feel.
Which you can tell I don't love. I mean, I'm all for data. I'm all for data. But at the end of the day, when you outsource things that in intercept, you should be able to feel on your own. It's just we get in murky territories of losing our autonomy. And so I don't love those apps. But anyways, I, I digress.
Um, heart rate variability has become the more famous one. Even though arguably respiratory sinus arrhythmia is easier to measure, um, heart rate variability is like what it is, is a measure of variation in time between consecutive heartbeats. It's a non-invasive indicator of the autonomic nervous systems control over the heart that vagal break.
It reflects the balance between the sympathetic and the parasympathetic nervous systems, and it's measured through complex calculations that analyze the timing of a series of heartbeat. Um.
It says, often using spectral analysis to look at different frequency bands. So it's basically the measure of the variation in the timing of the heartbeats. The, the like optimal would be the higher the heart rate variability, the more resilient or balanced your autonomic nervous system, meaning the more.
Time between beats or the more time between vari variations of beats, the better respiratory sinus arrhythmia is the natural change in the heart rate due to the respiratory control. So as we inhale, our heart rate naturally increases. And as we exhale, our heart rate naturally decreases. This is because of the role of inhalation and exhalation.
On the vagal break. When we have exhalation, it is like applying the vagal break and it brings our heart rate down. And when we inhale, it's taking the break off. And so we start to increase our heart rate. So the more variability we have between the. The heart rate on an inhale and the heart rate on an exhale the more distance we have between beats.
Okay? So that's how heart rate variability and respiratory sinus arrhythmia are related. So basically, if we can lengthen out the distance between the heart rate at the inhale and the heart rate, at the exhale, it is in, at least in the short term, going to. Be related to an increased heart rate variability.
So, um, and like I said, it's a little easier, especially when you have a pulse ox. You can't, it's hard to measure when you're doing, measuring someone's respiratory or heart rate by palpating it and counting and doing the math. So this is nice because you get to see it change in real time. So like right now I'm at 78.
We will let it, we'll let it, I'll rest my hand. We'll let it regulate for a second.
All right. 70 67, 66, 65. Without me talking, that's, that's pretty darn close to my heart rate as I'm talking. It's gonna change, even though talking is an exhale. It's an open mouth. Exhale. And probably more related to my inhale breath, but we'll go ahead and do an inhale
and you see it increase
long. Exhale, drops it out.
So there's a little lag in the monitor between what's going on, but it's important to see what my range is, right? So I'm basically ranging between like 66 and 70. 5 78. Yeah. Um, which is good, which is actually really good. Could it be better? Of course, there's always room for improvement, but I like to see people with at least eight beats per minute between an inhale and an exhale like that.
And, um, anything less than that, I'm like, oh, okay. You're autonomic nervous System's not very balanced. And how I use it clinically is I'll assess it before we start and then. Says it at the end. And I just wanna see, did we shift things? And you can leave the monitor on as you're doing treatments, and sometimes it's cool to see a response to treatment, change the heart rate, change, the oxygen saturation, but sometimes the treatment we're doing, especially if it can be a very specific treatment, we're actually creating a little chaos in the system.
And so sometimes we'll see the opposite effect that we want, but. What I also really care about is not so much pre and post within a session, but pre session to session because I wanna see like are we shift? Especially in the case of like my Navy seals up to hell week, I wanna make sure that yes, I'm making a difference in one session.
But also like, are they coming in the next session with a little bit more resilience, a little bit more balanced, a little bit more space in the re respiratory sinus arrhythmia, and getting an idea of. What is truly their heart resting heart rate, and how is that correlating to their symptoms and their ability to like, heal themselves and, and all those factors, you know, is it as, is it as precise or specific as heart rate variability?
No, but. True. Good heart rate variability is hard to measure without a very fancy device, and I don't mean a fancy device like your whoop band or your Oura Ring or your Garmin or whatever. Those are actually not that reliable. Like technology wise that, um, heart rate variability, as far as I know, the Omega wave is still like one of the best ways to measure it.
And it's like, you know, electrodes on your head and hands and like, it's more than just the monitors that, um, all the current wearables to use those wearables are not the most accurate. Um, so yeah, hopefully. Hopefully those is not confusing. Hopefully you start to kind of see like it can be a helpful tool.
Is it like a tool I use all the time? No, but is it, um, interesting. Yeah. Can it be helpful when you're like wondering how someone's on an. Nervous system is, especially as you're learning how to imp interpret the messages from their face. Yeah, of course. Um, and then also it's just nice to have like an objective measurement of change.
Another tool that I use, um, and I give in the mentorship for assessing autonomic nervous system is a, um. ANS questionnaire. Um, there's a short one that Steven Porges put out called The Body Perception, body Perception Questionnaire or the Body Perception Index or something like that. And then one of my teachers, Eric Marlin, he wrote the book.
Um, I'll have the book linked is like vagus nerve and the autonomic nervous system, I think is the name of it. Where is it? Yeah, the new approach, the vagus nerve and the autonomic nervous system, it's one of the Barral Institute instructors and books. Um, he has a very robust questionnaire that gives you great information.
It's, it takes a while. It's like a longer questionnaire to do. That's really cool to track. Um. Because some of the symptoms, so when our autonomic nervous system is out of balance, that's when we actually start seeing symptoms. The symptoms we see, like, um, having a hard time coordinating, breathing and talking, having a hard time coordinating breathing and eating.
Um, swallowing, um, indigestion, irritable bowel, gas aches and pains like skin irritations like. It runs the gamut of things, feeling cold, feeling hot, feeling chills, feeling bloated. Like all the things that we would feel in our body are all autonomic nervous system reactivity, markers. And so the more you perceive those re activities, the more unbalanced you are.
Right? And so it's like all of our functions of our body should be functioning without us perceiving them. So when we start to perceive functions, it's an indication of things being unbalanced. And usually they go together in sections. And the sections that are more prominent can give you an understanding of like, are you hyper sympathetic?
Are you starting to be in that exhausted, more dorsal vagal state? Right. So, um, it's a whole journey, understanding the autonomic nervous system, understanding polyvagal theory, understanding how we influence it. The things we can do to support it and the treatment strategies, because the treatment strategy for someone in a hyper sympathetic state is going to be very different than a treatment strategy for somebody in a dorsal vagal state.
And so understanding the difference can be really powerful. When I'm choosing treatment tools, of course, the LTAP is going to direct me where to go, which is like the first step and important. Meets the body where it's at and honors whatever state it's in and helps it shift outta that protective mode.
But it's also like nice to keep these in mind when I'm picking the type of tool if I have it. So hopefully this is fun insight. Also link, 'cause everybody will ask me. I'll link the Amazon link to this pulse ox seminar I use. It's nice to have. It's not a have to, but it's nice to have. It's fun, especially if you're curious, um, about what's going on and how you're shifting things.
So that's it. Hope you enjoyed it. Have a great day. See you next week.