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How To Assess The Impact Of A Tongue Tie On Patients: Osteopathic Considerations

Why The Tongue Is So Important

 

Assessing A Tongue Tie: An Osteopathic PerspectiveThe tongue is the only muscle, or really group of muscles, in the body that has one freely moveable end. Not only is it attached to most fascial planes directly or indirectly, but it also has attachments on the hyoid bone, mandible, temporal bones, and other structures in the head. Structurally it can affect the digestive tract and respiratory tract. It has innervation from five cranial nerves – the  trigeminal, facial, glossopharyngeal, vagus, and hypoglossus nerve. The tongue is complex and its involvement in swallowing and speaking are some of the most important functions to survive and communicate.

Lingual frenulums often produce tongue ties (ankyloglossia) in adults. Even if minor and considered “insignificant,” the frenulum inhibiting the normal function of the tongue seems to have powerful impacts on the overall structure of the body. The tongue tie will tighten the fascia associated with it and will often anchor the hyoid bone superiorly under the mandible. This pulls the trachea and esophagus superiorly with it. By producing so much tension in the front if the body, it pulls the body downs to a kyphotic posture and pull the shoulders forward. I strongly believe that this is what is often the culprit with the “bad posture” and as we learn more about this, it will require us to look at the body differently.

Embryologically, the anterior tongue has a right and left side that come together and then extends outward during development. The frenulum is meant to recede completely. If it does not, which is quite common, it will affect the function of the tongue and many of the structures associated with it like the hyoid bone and mandible.

 

What Patients Are Noting

Instantly after correcting her tongue tie, my mom described being able to stand up straight for the first time in her life feeling “unwound.” She felt tension in her rib cage and spine release that allowed her to pull her shoulders back comfortably. I had a similar experience after having a lingual frenectomy and based on the findings below, I recommended it for my mother. The experience has given me good insight on assessing repercussions of tongue ties. I have had many powerful osteopathic treatments, but nothing has produced the changes and relief I experienced with the lingual frenectomy. Since the procedure, several patients of mine have commented that even though they could not put a finger on it, there was something different about my appearance. A tongue tie can affect far more than we may currently realize. The anatomy will be discussed in detail in further posts.

The effects of tongue ties in adults is something I have been learning more about recently and have found some interesting correlations that I would like to share. Correcting a tongue tie in adults can save an osteopathic provider much time and frustration with many musculoskeletal issues. The best time to correct this is with newborns and infants to prevent future problems. For many of us it is too late to have it done as babies, but we can still benefit from having a tongue tie corrected.

I am finding that the areas listed below if positive as a group tend to be associated to tongue ties. Although the lingual frenulum is a midline structure, it often affects one side more than the other. This can be felt by palpating the frenulum and how it anchors the tongue to the floor of the mouth. The problems described are not a complete list nor does it mean all of these areas are always affected. Lingual frenulums have much variability and can therefore produce different problems in different people.

Evaluation:

Sternum: Place a hand over the sternum and gently “spring” over the sternum. A sternum that does not spring well is positive. In addition, any areas of the sternum that feel dense or harder may be a result of a tongue tie.

 

Anterior Neck / Sternocleidomastoids: Gently spring over the lateral areas of anterior neck. Lack of pliability and tenderness may be associated with a tongue tie. In addition, gently squeeze the sternocleidomastoids bilaterally throughout. Tenderness and hypertonicity may indicate a tongue tie. The side that feels most dysfunctional is usually associated with the side of the tongue most inhibited by the tongue tie.

 

Posterior Upper Cervicals: Palpate the OA for range of motion. In addition sweep you fingers left to right lateral to the midline feeling for hypertonicity and tenderness.

 

Hyoid / Trachea: Translate the hyoid bone side to side. Hyoid should glide freely left to right. Any muscle tension may indicate a tongue tie. The position of the hyoid is also important. A tongue tie may pull the hyoid superiorly. Translate the trachea side to side to the end feel. The side most inhibited by the frenulum will have diminished translation away from it.

 

Supra Hyoid Area: Palpate the muscles using side to side motions perpendicular to the muscle bellies under the mandible including the digastric muscles. The muscles should feel soft and pliable. Hypertonicity may be associated with a tongue tie. There is not often tenderness felt here.

 

Floor of Mouth / Tongue: With an index finger, gently palpate the floor of the mouth looking for hypertonicity. Then look for tension at the base of the tongue lifting it up towards the roof of the mouth. The floor of the mouth should not be pulled up when the tongue is lifted towards the roof of the mouth. I have noted that the right side is more often affected. Also pinch the tongue and roll your fingertips looking for any knots. Be gentle as this area can be very sensitive and will be more so based on the severity of the tongue tie. Compare sides for hypertonicity and tenderness and correlate with your other findings.

At this point, evaluate the tongue tie by having the patient put the tip of the tongue to the roof of the mouth and open their mouth as much as possible. Sweep your index back and forth perpendicular to the frenulum. If it feels like you are strumming a guitar string, that is a positive result for a tongue tie.

 

Masseters / Buccinators: Place your fingertips over the muscle belly of the masseter muscles and glide side to side perpendicular to the muscle fibers. Note hypertonicity and tenderness here. Next do the same on the cheek over the teeth looking for hypertonicity and tenderness.

Other areas where some have felt relief are in the arms, forearms, thoracic spine, lumbar spine, sacrum, pelvis, and psoas muscles to name a few. Although I am just starting to learn about this, some of the patients who are good candidates are reporting dramatic relief. By placing so much tension on the throat and esophagus, could a tongue tie produce a hiatal hernia? I have no evidence but it seems strongly possible from what I have been seeing.

How Does A Frenectomy Fit With Osteopathic Principles?

Osteopathic principles are about structure and function and the body functioning as a unit.  Treatments are aimed at restoring anatomy as much as possible to the ideal perfect. Understanding normal embryologic development, the frenulum is a structure that is meant to regress and not inhibit the normal function of the tongue. Therefore, the frenectomy is about completing the process that nature started to free the tongue so it may function optimally. This allows the body to function more optimally.

After evaluating the above structures, treat nothing but the tongue. Use osteopathic principles to treat the tongue and reassess to see how all those areas have changed or not. The changes are generally minimal compared to having a frenectomy because the tethered tongue cannot be overcome from my experience. Realize that the lingual frenulum will prevent permanent changes from taking place. Have the patient consider a laser frenectomy if they are good candidates. Laser frenectomies have shorter healing times and do not require stitches. As long as it is done well and completely, this can provide the most complete and long-lasting relief. After the frenectomy, re-evaluate how the areas above have changed from before to after. Once healed, recheck the frenulum to see if it has been completely corrected and does not need a revision.

 

Daniel Lopez, D.O.

Author Daniel Lopez, D.O.

Daniel Lopez, D.O. grew up with a lot of pain trying many things that did not help. Realizing that if he could not help himself, he would be unable to help others effectively, he dedicated himself to finding real answers. Since that time, Dr. Lopez has found a unique but powerful style where he has patients from around the country and the world that travel to see him for headaches, TMJ issues, eye issues, neck pain, back pain, and more. Daniel Lopez, D.O. is an osteopathic physician with Osteopathic Integrative Medicine. Prior to that he had a private practice in NYC for 6 years. He is the author of the Amazon best seller "Unwinding the Body and Decoding the Messages of Pain: An In-Depth Look into the World of Osteopathic Physicians and How They 'Magically' Use Their Hands for Healing." He lives in Aurora, CO with his wife and daughters.

More posts by Daniel Lopez, D.O.

Join the discussion 16 Comments

  • Jeff says:

    That is an excellent description of how the tongue contributes to the function of the body but there is more. Consider resting tongue position and the effects of face formation and also airway issues. Most people do not understand that the airway and posture contribute to breathing habits and these cause physiologic changes to the body that affect growth and development. In many cases, not treating this would be like having a plant and giving it much less sunlight and less water and wondering why it doesn’t thrive.

  • Katie says:

    So as a lay-person reading this, how would I go about finding a practitioner who knows what on earth I’m talking about if I seem to have a tongue tie?

    • Daniel Lopez, D.O. says:

      Hi Katie, unfortunately it’s not easy. The information I provided here is what I have found. You could consider a frenectomy and I had to do research and contact people to find out about that, but without evaluating I really could not tell you if I think it will help or not. It seems this is still a vastly unexplored field.

      • Melanie Waters says:

        I love your information! As a speech language pathologist who recently participated in a week-long class on orofacial myology, I’ve learned a lot about tongue tie. I’ve also realized how much more I need to know! Your articles provide excellent information about how tongue tie affects the whole body. For those who would like to know someone who could help in their area, a speech language pathologist trained in orofacial myology (many have an IAOM certification) could help with exercises after they have a frenectomy.

    • Dawn Lockrow says:

      Each state has a Facebook group of Tongue tie support and education. Includes list of providers, reviews, questions, answers and helpful advice.

  • Toby Hughes says:

    I really appreciate your article. I have been struggling with several musculoskeletal issues my entire life. I have spent thousands with chiropractors and also had to have a cervical fusion. I now have a six year old daughter that is already displaying similar symptoms. After obsessing over my symptoms the last two years, I linked everything back to my tongue. I am now about to have a Lingual Frenectomy to test my theory. I feel like this is commonly overlooked due to the fact that I can make the floor of my mouth look normal by drastically “compromising” the integrity of my cervical curvature. I have never read anything that promotes evaluating for Ankyloglossia after making sure the Skull is in optimal alignment to the spine. Obviously, if the chin is tucked unnaturally, one could incorrectly assume no issues with the frenulum. Anyone I try to explain this to looks at me like I am crazy…including my doctors.

  • linda says:

    I have been doing bodywork for 32 years & recently learned a technique for stroke victims holding points on their tongue. Having never encountered this knowledge I workied on my own tongue and concluded it must be tied to the central nervous system and the entire spine.
    thanks for showing me that yes the tongue is associated with the entire body

  • Chantal Lavigne IBCLC says:

    If an adult have an issue with that, Imagine a baby with an ankyloglossia. I’m a lactation consultant and I see babies with tongue tie having a lot of suckling problems (not gaining weigth, swalloing air, painfull breastfeeding for the mother), reflux, etc. This need to be adress as soon as possible.

  • Elissa O'Brien says:

    Always such a wealth of knowledge, thankyou!

  • Loved the video on tongue tie assessment. I see a lot of patients with these issues, training the tongue neuro-muscularly is very important once released.

  • andrea says:

    Great information! What are your thoughts on after care in regards to bodywork? I am getting my lower frenulum lasered later this morning (and I am so excited as bizarre as that sounds) and I was wondering if you think it is important to follow up with some sort of OMT/CST/ect?

    • Hi Andrea, sorry for the delayed response. I’ve had some technical issues. It may be too late, but I’ll answer anyway. I do think it’s important to get bodywork afterwards. Especially in the tongue and hyoid bone area. I would definitely try to follow up with something to make sure there aren’t other problems contributing that can be resolved.

  • Kayla says:

    Hi there, I just got mine lasered a few days ago but my dentist did not tell me weather I should be doing stretches.
    I have found some stretches online but I was wondering if you did stretches/ how often?

    Thanks!

    • Hi Kayla, I would recommend doing stretches for several months after the procedure. Even if all you do is pull your tongue out with your hand and move it around. I was told to do it for a few weeks but really, I find the longer you do it will prevent the scarring from retightening in the area.

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