Hidden Health Impacts and Effective Solutions
Many adults live with unexplained health issues such as persistent snoring, poor dental health, chapped lips, nasal congestion, TMJ pain, or even chronic vocal strain. Never realizing that the root cause may lie in an often-overlooked condition: posterior tongue tie.
Similar to its more obvious counterpart, the anterior tongue tie, this hidden problem can have far-reaching effects on your health.
From repeated orthodontic work to relationship struggles due to loud snoring, the impacts of posterior tongue tie are more common than you might think.
In this blog, we’ll dive into what a posterior tongue tie is. Why it frequently goes undiagnosed, its wide-ranging health implications, and the steps you can take to resolve it effectively.
What Is Posterior Tongue Tie?
Posterior tongue tie is a condition where the frenulum—the thin band of tissue that connects the tongue to the floor of the mouth—is too tight or short. Specifically, it restricts the movement of the middle and posterior (back) parts of the tongue.
This subtle yet impactful restriction is not much different from an anterior tongue tie. An anterior tie affects the front of the tongue and is often easier to detect.
Unlike the anterior tie, which visibly limits tongue mobility (often noted in infancy or early childhood), a posterior tongue tie can go unnoticed well into adulthood.
The tissue anchoring the mid-back of the tongue affects not only speech and eating but also breathing, jaw position and posture. Over time, it can contribute to a variety of health problems that, when left untreated, can severely impact your quality of life.
Why Posterior Tongue Tie Often Goes Undiagnosed
One of the most perplexing things about posterior tongue tie is that many people live with it for years. Sometimes their entire lives—without realizing the root of their symptoms. This can happen for several reasons:
Harder to Detect
The subtlety of the Condition. Unlike anterior tongue ties, which can often be seen easily and diagnosed early, posterior tongue ties are less visible and harder to detect during a routine exam. They hide beneath the tongue, limiting function without being immediately obvious.
Often a practitioner will simply ask you to stick out your tongue. In doing so they believe they are checking the range of that tongue muscle and thereby deciding whether or not it is tethered.
This type of assessment completely leaves out a visual inspection. To truly identify a posterior tongue tie the assessment needs to include a visual inspection along with a more dynamic motor movement inspection.
Require Dynamic Elevation Placements
Being able to stick the tongue out is actually a very immature motor plan utilized by babies in the 8–12-month-old range, while they are learning to orally explore items and eating their first foods.
We watch those larger excursions of movement refine into controlled fine motor movements by age 18 months old. Here we now see the tongue remaining inside, the child holding food and chewing nicely inside the mouth with very little food loss.
When you think about it, we really only need to stick our tongues out to lick an ice cream cone and pronounce the TH sound.
Rather a practitioner should be asking you to click your tongue, click and hold it up, and point the tongue straight up behind the teeth. All of which will give a clear view of the frenulum.
As we observe the tongue moving in these types of ranges, we can more easily identify restrictions in movement and limited range of motion.
Varying Knowledge Among Health Professionals:
The understanding of tongue ties, especially posterior ones, varies widely among healthcare providers. For instance:
ENT
ENTs (Ear, Nose, and Throat specialists) may focus more on breathing and airway-related issues, and be experts in adenoids and tonsil disease, but may not fully consider how tongue mobility impacts oral function or posture.
This is why we have specialties. Every major medical field has them. Sadly, those who do not specialize in posterior tongue ties or tethers as they are often referred to, will adamantly disagree with the very existence of ties, let alone the potential impact they might have.
Dentists/Orthodontists
Dentists and orthodontists might notice issues with dental crowding or narrow palates, but often don’t connect these with tongue mobility unless they specialize in airway dentistry.
Often the favorite orthodontist for the family who is beloved by all who have seen them may have little to no training in tethered oral tissues such as posterior tongue ties.
Speech Therapists
Speech-language pathologists (SLPs) may notice functional speech problems, but without specific training in oral restrictions, the connection to a posterior tongue tie will be missed.
SLPs will be very black and white on the issues involving oral motor, myofunctional therapy, and tethered oral tissues. They either do it or they don’t and many will vigorously argue that there is no scientific evidence to support releasing posterior ties.
There is in fact research on the benefits of releasing posterior tongue ties. But if a practitioner is not following the field of study they will simply not look for this research and just repeat tired old mantras they’ve heard since college.
A great book on the subject that is well-researched is Dr. Richard Baxter’s book, Tongue Tied, which you can find here on Amazon Tongue Tied By Dr. Richard Baxter DMD, MS.
Given these disparities, many adults attribute their chronic symptoms—such as snoring, sleep apnea, sluggish speech, TMJ, and persistent orthodontic issues—to other causes, never realizing that a posterior tongue tie is at the heart of their problems.
Health Impacts of Posterior Tongue Tie
The consequences of a posterior tongue tie extend far beyond the tongue itself. Because the tongue plays such a vital role in breathing, eating, and even posture, its restriction can set off a cascade of health problems.
1. Airway Obstruction, Snoring, and Sleep Apnea
One of the most serious consequences of a posterior tongue tie is its impact on your airway during sleep. When the tongue cannot rest properly against the roof of the mouth, it may fall backward into the throat, partially or fully obstructing the airway. This causes:
Snoring: The vibration of airway tissues due to partial blockage leads to loud, disruptive snoring. For some, this snoring can get so bad that sleeping apart from a partner becomes the only option. The strain of this separation can take a toll on intimacy and relationships.
Sleep Apnea: In more severe cases, the airway can become completely blocked during sleep, leading to obstructive sleep apnea (OSA). This condition results in interrupted breathing, fragmented sleep, and reduced oxygen levels.
Over time, untreated sleep apnea increases the risk of heart disease, stroke, and high blood pressure.
For many people with posterior tongue tie, snoring and sleep apnea diagnoses lead to treatment with CPAP machines and other devices, rather than addressing the root cause—tongue restriction.
2. Repeat Orthodontic Work
If you’ve gone through braces more than once, only to find your teeth shifting again, a posterior tongue tie could be the culprit. The tongue is essential in guiding the development of the palate and teeth. When the tongue cannot function properly due to a posterior tie, it can lead to:
Narrow palates and crowded teeth: A lack of proper tongue pressure on the upper palate during development can result in a narrow upper jaw, leading to crowded teeth.
Evidence is emerging that your tongue is a natural palate widener! Meaning you can effectively create the space you need to help your teeth stay put if you can learn to keep your tongue up in the palate.
Some people have more narrow and rigid arches than others and may require additional orthodontic work with palate wideners to really get the space they need. Either way, improvements are possible, and straight teeth are achievable without regression.
Some patients go through multiple rounds of braces or palate expanders without ever realizing that restricted tongue movement is a driving factor. By addressing that factor, any additional orthodontic work you may need can likely be your last!
3. Pelvic Floor Dysfunction
Surprisingly, a posterior tongue tie can even affect the pelvic floor. The tongue is part of a larger network of fascia, a type of connective tissue that spans from the head to the diaphragm to the pelvic region and through to the feet.
When the tongue is restricted, it can contribute to forward head, poor posture, Dowager’s hump, misalignment, and excess tension throughout the body. This tension can make its way down to the pelvic floor, leading to:
Pelvic pain and dysfunction: Chronic pelvic floor issues that persist despite physical therapy or other interventions may be linked to poor tongue function.
Misalignment in the head, neck, and jaw caused by tongue restrictions can lead to compensations in posture, which directly impact the pelvis.
The term recruitment means my body will borrow from one area to assist another that is weak or misaligned. There have been moments in treatment sessions where a patient was receiving input and stretching into the tongue fascia and could feel a tightening in their pelvic muscles.
When the tongue fascia is released and relaxed there is a report of the recruitment being nonexistent and the pelvic strain being significantly less.
A magic trick of sorts that has been trialed at the pre-surgical release of posterior tongue tie is to bend over to touch your toes. Take note of how far you can bend.
Then immediately following the release procedure, bending again, taking note of the ease of the movement and the increased range. Usually being able to touch the toes for the first time! Magic in a release!
This is one example of the release of tension that can occur in the body when a posterior tie is released.
4. Vocal Strain and Speech Issues
The tongue’s role in speech is well-known and obvious. But when its movement is restricted by a posterior tongue tie, vocal quality, and speech clarity can suffer. Over time, you may notice:
Vocal strain: Constant tension in the tongue can place excess strain on the mylohyoid muscle, which connects to the larynx. This tension often results in vocal fatigue or difficulty projecting your voice during prolonged speech.
The feeling of the voice trailing off and becoming scratchy when talking for more than a few minutes. Then the need to drink water because it feels dry and scratchy is often reported.
Speech impediments: In some cases, a posterior tongue tie can contribute to a lisp or other speech difficulties, especially when it goes undiagnosed in childhood and remains untreated into adulthood.
You may recall years of speech therapy in which you were frustrated by drilling and practicing, with no real improvement.
Even if it is only noticeable to you, speech issues can impact work and social interactions. Choosing to say less, so you can control the queasiness in the voice and the slushy excess spit that builds up in your mouth.
A posterior tongue tie inhibits the harmonious flow of quick-quick-quick fine motor movements required for speech sounds. Making it feel more laborious to talk. Thus one speaks less to exert control over this uneasy feeling.
Why One Might Have Made It Into Adulthood Without Knowing They Had a Posterior Tongue Tie
With a condition that can manifest in so many different ways, why do so many adults reach their 30s, 40s, or beyond without knowing they have a posterior tongue tie? The answer lies in several factors:
Gradual symptom onset
Because the symptoms of posterior tongue tie tend to worsen over time, many adults chalk up their discomfort to stress, aging, or unrelated medical conditions.
We accept things like braces and snoring as normal, something everybody experiences. Many don’t seek help until a loved one steps in and points out that in fact, this is not normal.
Adaptive behaviors
Over time, many people unknowingly compensate for their restricted tongue movement by adjusting their posture, speech, or breathing patterns. It is this very compensation that eventually breaks down.
These compensations can mask the symptoms of the tie, making it harder to pinpoint as the cause of persistent issues.
This is when more painful red flags such as TMJ issues flare up or root canals are added to your new monthly payment plan.
Overlooked by general practitioners:
As mentioned earlier, the subtlety of the posterior tie means that many healthcare professionals miss it visually. This is especially true for those not specifically trained in oral restrictions. They don’t check for it during exams or connect its impact to symptoms.
Myofunctional Therapy: A Comprehensive Solution
If you suspect that you may have a posterior tongue tie, the good news is that effective treatment options are available.
One of the most effective therapies is myofunctional therapy, which focuses on retraining the muscles of the tongue, lips, and face to restore proper function.
1. Soft Tissue Releases
A key component of myofunctional therapy involves soft tissue releases to free the tongue from its restricted position. These releases can:
Improve Tongue Elevation
By freeing the restricted frenulum, the tongue can move more freely. Most importantly this will improve its ability to rest against the roof of the mouth. This will support proper breathing, swallowing, and speech.
Creating space in this way allows for jaw-tongue disassociation. This means we can better move the tongue. The jaw does not need to compensate for the lack of range in the tongue. It no longer needs to move itself either forward or side to side.
Alleviate tension on the hyoid bone
Releasing the tension caused by the tight frenulum also reduces the strain on the larynx. This will improve vocal quality and reduce vocal fatigue.
Next, combine soft tissue releases with muscle exercises to encourage improved function.
2. Exercises for Muscle Strengthening
Along with soft tissue releases, myofunctional therapy includes a series of exercises. These target muscle function directly and are designed to:
Enhance airway function:
Strengthening the muscles of the tongue and mouth can improve your ability to maintain an open airway during sleep. This helps to reduce snoring and the risk of sleep apnea.
Support orthodontic treatment:
Strengthened tongue and facial muscles can help stabilize the results of orthodontic work. This can reduce the likelihood of teeth shifting out of alignment after braces.
Exercises are targeted to the individual based on where they feel weaknesses and where limits in range of motion are noted.
Tongue clicks and tongue suction into the palate are two common exercises. But what if you can’t click? Many can’t when they begin treatment.
The objective is to implement a daily practice routine guided by a trained professional until that muscle learns a new pattern and can reach the palate. Some can do it in a week, others a month, but progress is steady in most people.
Surgical Release for Posterior Tongue Tie
You’ve created space between the tongue and the floor of the mouth. You are capable of getting that tongue up into the palate. Congratulations, you are now ready for the surgical release of the posterior tie.
A trained release provider will use either a laser or scissor approach. Either instrument is equally effective in the hands of a trained provider.
They will examine the posterior tie, confirm that it needs releasing, and then perform the procedure. Some will do it same day if you come in prepared with a strong oral motor program.
Once released, you will have a surgical site to manage for approximately two weeks of direct healing.
Pain at the site is common for about 2-3 days typically managed with over-the-counter pain medications. Though some report none needed at all. There may be some slurring of speech for a day or two while swelling is present. But most return to normal activities and work the next day.
The exercises for soft tissue releases and muscle-based will continue throughout the healing period.
Real-Life Transformations
Many people have experienced profound relief from chronic symptoms after undergoing myofunctional therapy for posterior tongue tie.
One patient surgically released two months before this text, shared this water kayaking experience with her son:
“Arms are dead lol but I will say I do not have an occipital headache and could actually feel my core activating as I paddled!!!! Maaaajor tie release win!!!”
She, for years, had accepted that she just felt crappy and had constant headaches when doing outdoor activities.
Noticing that her body performed better and that she did not have a headache was indeed a major win. She was not necessarily expecting to have this win when releasing her posterior tie.
Take the First Step Towards Better Health
Have you been struggling with any of the symptoms mentioned in this blog? A posterior tongue tie could be the underlying cause. Myofunctional therapy offers a natural, effective solution to relieve muscle tension. It can improve your airway for restorative sleep. Even create improved body connections, and guide you to improved overall health.
Check out the 1-2-3 handout for a simple and quick way to check if you have a posterior tongue tie. The 1-2-3 Tongue tie check.
If you’re ready to begin your search for a qualified team you can start here with a state-by-state guide. But remember not all providers are created equal! Research your providers before jumping in.
Keep an eye out for new blog articles about all things Tied Together by Tethered Oral Tissues (TOTs). Check out our other articles here on Lynn’s Tied Together Blog.