As a speech-language pathologist specializing in orofacial myofunctional therapy, I’ve witnessed firsthand the profound impact of tethered oral tissues. Commonly known as tongue ties, lip ties, and cheek ties, these tethers are small but mighty.
These conditions often go undiagnosed in childhood, leading to a cascade of issues in adulthood. Issues may include snoring, sleep apnea, temporomandibular joint disorders (TMJ/TMD), neck pain, headaches, and even anxiety.
Fortunately, myofunctional therapy offers effective solutions to address these challenges. By targeting the root cause myofunctional exercises address the function and mobility of the orofacial muscles.
What’s the Controversy in Myofunctional Therapy?
While it is widely accepted in physical and occupational therapy, the concept of exercise is met with objections in speech therapy fields.
These objections stem from professionals who believe that speech and swallowing skills are independent movements that cannot be mimicked in an exercise.
Practice Makes Perfect
The prevailing thinking within this naysayer group is that one cannot teach a speech sound by teaching an exercise. Rather practice makes perfect for a speech sound. Simply practice over and over and eventually, you will learn how to make an S R or L sound correctly.
The speech therapist believes they need a functional reason such as speech drills, to justify therapy. As children, we often receive this speech therapy through our schools.
A school speech therapist carries one of the largest caseloads known to therapists in any discipline or setting.
Some therapists can have upwards of 120 students on their caseload, all to be seen weekly in five days.
That computes to 4 students every hour with no breaks every day. Some how these amazing therapists manage these caseloads and students do make progress.
I use this example to highlight that the ability of an overworked therapist to utilize oral motor techniques is limited.
A schedule like this does not allow the time or space to conduct myofunctional therapy. This cohort of therapists makes up a large number of the overall population of speech therapists.
Hence, differing viewpoints on how therapy can be conducted.
If you’re an adult who had speech therapy as a child, and you still struggle with confidence in how your speech sounds, myofunctional therapy exercises may just be your answer.
Interconnections of Movement
Those of us who have learned to address the underlying muscle structure see more clearly the patterns of movement required for speech tasks. The interconnectedness of movement and the compensation that develops to achieve a skill.
Also, just because we practice oral motor myofunctional therapy does not mean we abandon all other therapy techniques.
Rather we incorporate all components of speech, feeding, and oral motor techniques to maximize therapy progress.
A great resource for locating preferred providers is Tongue Tie Life, where you will find a state-by-state list of therapists dentists, and doctors.
Then there are these tiny little bands, tethered oral tissues (TOTs), that play havoc on the oral muscles. Let’s take a look at a major one, tongue ties.
Understanding Tongue Tie and Its Implications in a Myofunctional Therapy Plan
A tongue tie, or ankyloglossia, is a condition where the lingual frenulum—a band of tissue connecting the tongue to the floor of the mouth—is shorter or tighter than usual, restricting tongue movement.
While this condition can be identified in infants due to breastfeeding difficulties, many cases persist undiagnosed into adulthood. Leaving a restricted tongue to poorly perform speech and feeding tasks.
In adults, an untreated tongue tie can manifest in several ways here are some of the most common:
Speech Difficulties:
Limited tongue mobility can hinder articulation, making it challenging to pronounce certain sounds. Also, fatigue or strain when speaking, especially when speaking at length.
Chewing/Swallowing Complications:
Adults with ties tend to have some picky eating or restrictions in their diets.
Some have open-mouth chewing and report feelings of food being stuck in the throat.
Dental Issues:
A restricted tongue can exert abnormal pressure on teeth, leading to misalignment or gaps.
Two and three rounds of braces are noted, and some have permanently fixed retainers to maintain alignment.
Digestive Problems:
Inefficient chewing due to limited tongue movement can result in larger food particles entering the digestive tract or too much air being swallowed with the food.
This has the potential to cause gastrointestinal discomfort such as belching, gas, and bloating.
TMJ/TMD Pain:
When the tongue moves poorly the jaw will follow and try to help.
The jaw will glide right to left and jut forward to assist the range of motion limitations in the tongue. Over time this will break down the joint leading to pain and discomfort.
Recognizing these signs is crucial for seeking appropriate intervention. A myofunctional therapy program is not just a list of exercises. It’s a whole program targeting functional movements for both speech and feeding tasks along with resting tongue posture.
If ties are in the picture, then we will need to build the program toward a surgical release, then recovery, and then function building.
The Fascial Connection: How Tongue Tie Affects the Entire Body
Fascia is a continuous web of connective tissue that envelops muscles, organs, and structures throughout the body. The tongue is intricately connected to this fascial network, particularly influencing the head, neck, shoulder, and diaphragm regions.
When the tongue’s movement is restricted due to a tie, it can create tension and misalignment in these areas, leading to:
- Forward Head Posture: Restricted tongue mobility can pull the hyoid bone and associated structures forward, resulting in a forward head posture. This misalignment often leads to neck pain and headaches.
- Breathing Difficulties: A restricted tongue may impede proper nasal breathing, leading to mouth breathing. Chronic mouth breathing is associated with snoring, sleep apnea, and other respiratory issues.
- TMJ/TMD: The imbalance caused by a tongue tie can affect jaw alignment and function, contributing to temporomandibular joint disorders, characterized by jaw pain, clicking, and limited movement.
Understanding this fascial connection underscores the importance of addressing tongue ties not just as isolated oral issues but as factors influencing overall bodily health.
Restoring proper alignment and function through a myofunctional therapy plan often includes addressing issues with ties.
Myofunctional Therapy: Restoring Function Through Targeted Exercises
Myofunctional therapy involves a series of exercises designed to improve the strength, coordination, and function of the orofacial muscles. For adults, this therapy aims to:
- Enhance Tongue Mobility: Exercises focus on stretching and strengthening the tongue to improve its range of motion.
- Promote Proper Oral Rest Posture: Training the tongue to rest against the palate with lips closed encourages nasal breathing and reduces mouth breathing.
- Improve Speech and Swallowing Patterns: Correcting speech and swallowing mechanics can alleviate undue pressure on the temporomandibular joint and surrounding muscles.
Consistent practice of these exercises can lead to noticeable improvements in tongue mobility, oral posture, and associated symptoms.
One of the drawbacks for adults with busy work and family life is finding the time to dedicate to a myofunctional therapy program. Grabbing yourself a co-pilot in the form of a trained myofunctional therapist can make a big difference.
Too often as adults, we try to find a shortcut to save time. Searching YouTube for an exercise program and going alone may seem easy. However, the intricacies of ties and their impact on oral facial structures are unique to each person.
While there are volitional exercises we will review here, they are not the full answer in any plan. But before I list some of those for you let’s review myofascial release and its place in a myofunctional plan.
Incorporating Myofascial Release for Comprehensive Treatment
Given the tongue’s connection to the fascial system, incorporating myofascial release techniques can enhance the outcomes of myofunctional therapy.
Myofascial release involves gentle, sustained pressure on the fascial tissues to release restrictions and improve mobility. For individuals with tongue ties, they may also need to include:
- Craniosacral Therapy: A form of bodywork that addresses the craniosacral system, which can help alleviate tension associated with TMJ disorders and improve overall orofacial function.
- Targeted Body Fascial Release: Techniques focusing on the head, neck, and shoulder regions can reduce compensatory tension resulting from restricted tongue movement.
Integrating these therapies provides a holistic approach, addressing both the muscular and fascial components of dysfunction.
Myofascial release can first be targeted to the areas where the frenulum attaches to the gumline. If the frenulum is restricted it is imperative to alleviate the strain before surgical release. This helps to allow for a complete release.
If they are not tied it is a great place to start and build out to any soft tissue areas that feel stuck or tight. There are seven areas where the oral frenulum attaches allowing us several starting points. The tongue has four regions to release around the frenulum which also positively impacts hyoid and laryngeal movement.
Often pain is a factor at the onset of release work. I like to use a 1-10 scale to give an idea of where the pain is at the onset of treatment. Then continue to monitor pain levels as the weeks progress and get a subjective measure of improvement.
Active Exercises Utilized in Myofunctional Therapy
Here we will review some common exercises utilized in myofunctional therapy. These are not all-inclusive and are not specific to any one diagnosis.
· Tongue Suction:
Suck your tongue to the roof of your mouth and hold for 5 seconds building to a one-minute hold with mouth closed and nasal breathing. If you feel it slipping down swallow and let the tongue suck back into the palate with each swallow.
· Tongue clicks:
building up to 50 strong clicks – begin with 10 clicks. Suck the tongue up and with force snap it down to produce a loud click.
· Tongue lateralization:
touching back bottom molar with tongue tip building to 50 reps and increasing speed. Begin slowly making sure the jaw does not slide side to side with the tongue movements. The objective is for the tongue to move freely without help from the jaw. Start at 10 and slowly build reps and speed of movement.
· Tongue up and down alternating:
touch just behind the front teeth building to 50 reps and increasing speed. Open wide so the tongue has to stretch up. Try not to rock the jaw up and down as the tongue moves but it hold it in a steady open placement.
· Tongue lift and hold:
hold up into the palate while opening and closing the jaw -build to 50 reps and increase width of the jaw opening.
· Lip purse/smile:
alternating the movements while holding the jaw still. Build to 50 reps. Gently hold the teeth together as the lips move freely in and out of the smile pucker movements.
· Lip squeeze:
hold a tongue depressor between the lips and pout just a bit. Hold for 15-20 seconds repeat 3-5 times. No teeth on the depressor, just lips.
· Lips on straw tip:
keep them pursed no rolling inward -drink 4-6 ounces without biting straw or rolling lips inward. Remove the straw and start again.
· Cheek Resistance Exercises:
Use your fingers to apply gentle pressure from the outside while puffing out your cheeks to enhance muscle tone. Use the cheek muscle to resist the finger push.
· Cheek resistance:
blow up balloon build to 25 times with new balloon. A new balloon has max resistance. If this is hard start by stretching the balloon out first.
· Cheek:
straw drink and squeeze cheeks in creating a line down the cheek build to 4-6 ounces. No biting the straw and keeping lips pursed.
This provides an idea of how myofunctional therapy can target different muscle groups to build strength and coordination in that muscle. These are active exercises meaning they require volitional active movement of the muscle to achieve the desired improvement.
Myofascial is passive. The finger manipulates the fascia and muscles, providing input.
Combining passive and active exercises allows for optimal improvement in the oral facial muscles.
Addressing Common Adult Issues Through Myofunctional Therapy
Many adults remain unaware that their chronic issues may stem from undiagnosed tongue ties. Here’s how myofunctional therapy can help:
- Snoring and Sleep Apnea: By promoting proper tongue posture and nasal breathing, myofunctional therapy can reduce airway obstructions during sleep, alleviating snoring and sleep apnea symptoms.
- TMJ/TMD: Improved tongue function and oral posture can decrease undue stress on the jaw joint, reducing pain and dysfunction associated with TMJ disorders.
- Neck Pain and Headaches: Correcting forward head posture through tongue and fascial exercises can alleviate chronic neck pain and tension headaches.
- Anxiety: Chronic pain and breathing difficulties can exacerbate anxiety. Addressing these physical issues can lead to a reduction in anxiety symptoms.
By targeting the underlying causes, myofunctional therapy offers a pathway to relief for these common adult concerns.
Conclusion Myofunctional Therapy
The intricate relationship between tongue function, the fascial system, and overall health is profound.
For adults grappling with the effects of undiagnosed tongue ties, myofunctional therapy, complemented by myofascial release techniques, offers a comprehensive solution.
By addressing the root causes of dysfunction, individuals can experience relief from a myriad of chronic issues, leading to improved quality of life and well-being
At Lynn’s Tied Together Hub we have resources and articles to help you navigate all things tied together by oral ties. Please check out our other articles on myofunctional therapy at the BLOG.