Clinical Notes: Core Withdrawal and Nervous System Regulation

Core Withdrawal Reflex is a primitive defensive pattern that emerges in response to perceived threat, overwhelm, or lack of postural security. Though often overlooked in traditional therapeutic models, its ongoing activation has profound implications for motor coordination, autonomic regulation, digestive function, and emotional resilience.

This article outlines the physiological, structural, and functional consequences of core withdrawal, and offers integrative clinical considerations for supporting re-patterning in both children and adults.

Reflex Background and Co-Activations

Core withdrawal presents as a full-body flexion and inward collapse, primarily involving deep axial structures—especially the diaphragm, psoas, and spinal column. It is frequently seen in conjunction with:

• Moro Reflex: Particularly in high-tone presentations where startle responses co-occur with withdrawal.

• Tonic Labyrinthine Reflex (TLR): Flexor/extensor imbalances and gravitational insecurity compound the collapse.

• Fear Paralysis Reflex: Contributes to immobilization, breath-holding, and autonomic rigidity.

Physiological Dysregulation

Breathing Patterns

In the presence of core withdrawal, the diaphragm becomes rigid and non-dynamic. This leads to:

• Clavicular or upper chest breathing

• Inability to initiate or sustain diaphragmatic expansion

• Breath-holding and paradoxical respiratory patterns

Clinically, this may present as:

• Reports of “not being able to catch a full breath”

• Compensatory breath control strategies (e.g., over-sighing, restricted speech phrasing)

• Sympathetic activation overlaid on dorsal vagal shutdown

Digestive Compromise

The fascial collapse associated with core withdrawal can significantly disrupt gastrointestinal function. Key patterns include:

• Compression of the viscera and motility pathways, particularly around:

  • Diaphragmatic hiatus

  • Solar plexus

  • Ileocecal valve

  • Sigmoid colon

• Disruption of vagal tone, reducing peristalsis and digestive enzyme secretion

• Hypertonic or hypoactive pelvic floor and abdominal musculature

Common presentations:

• Chronic constipation

• Reflux, nausea, or early satiety

• Painful bloating with no clear structural findings

• Digestive “shutdown” under emotional or sensory stress

Anxiety and Affective Regulation

Core withdrawal frequently presents with what appears to be "high-functioning" anxiety, though the root is often a freeze-based dissociative state. Typical indicators include:

• Flattened affect or emotional constriction

• Panic-like sensations triggered by trapped breath or digestive discomfort

• Delayed emotional processing or incongruent affect

• Difficulty accessing needs, preferences, or assertive boundaries

These clients often describe themselves as “calm until they’re not” or “numb, but overwhelmed underneath.” Standard behavioral interventions frequently miss the underlying autonomic state.

Structural and Fascial Impacts

Clients with persistent core withdrawal may exhibit:

• Fascial rigidity at the thoracolumbar junction

• Restricted diaphragmatic glide and loss of abdominal motility

• Hyperlordosis or swayback posture due to deep flexor shortening

• Disconnection between ribcage and pelvis (“floating ribcage” phenomenon)

• Poor core pressurization and collapsed or unresponsive pelvic basin

These patterns impede postural alignment, dynamic movement, and sensory integration.

Functional Manifestations

In Children

• Delayed postural reflexes and poor trunk control

• Difficulty with crawling, sitting, or walking transitions

• Speech and feeding challenges linked to weak breath support and oral-motor disorganization

• Interoceptive unawareness, particularly regarding hunger, fullness, and toileting needs

In Adults

• Chronic fatigue and structural instability

• Shallow breathing and reduced vocal resonance

• Impaired digestive capacity under stress

• Persistent sympathetic-dorsal toggling without sustainable recovery

Clinical Red Flags

• A child who appears behaviorally "compliant" but avoids dynamic movement

• Chronic GI symptoms in the absence of medical findings

• Clients who cannot sustain diaphragmatic breathing, even in relaxed states

• High masking behaviors (especially in children with neurodivergence or trauma history)

Integration and Intervention Considerations

Effective resolution of core withdrawal requires a bottom-up approach that prioritizes safety, awareness, and re-patterning of foundational systems.

Recommendations include:

• Diaphragmatic re-engagement through indirect techniques (e.g., craniosacral work, rhythmic breathing, reflex release)

• Use of side-lying and flexion-based movement to decompress the spinal column

• Avoidance of force-based core strengthening in early stages

• Reintroduction of reflexive movements (e.g., developmental sequences that integrate TLR, Moro, Core Withdrawal)

• Gentle release of psoas and pelvic floor musculature through breath, positioning, and neurofascial work

Behavioral outcomes (improved regulation, engagement, vocal expression) typically emerge after the body has re-established core safety and midline orientation.

Closing Note

Core withdrawal is not simply a motor pattern—it is a lived state of disconnection, often mistaken for calmness or control. Recognizing this pattern in clients allows us to support reorganization at the level where true change becomes possible: the body’s internal sense of safety, breath, and connection.