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The rule of thumb is bodywork 48 hours before and after the release for all ages. Additional sessions are usually required but the ending point is at the discretion of the provider. This is done to achieve the best possible outcome for long-lasting good health and optimal results. A professional who does bodywork is trained to manipulate hard (bone) and soft (connective tissue, muscles). They should be familiar with how ties affect the entire body and trained in Cranial Sacral Therapy (CST), Craniosacral Fascial Therapy (CFT), or traditional Cranial Osteopath. Some Myofunctional Speech-Language Pathologists also have manual therapy training in myofascial release, reflexes, and cranial nerves who can manually treat the areas of, and related to the mouth and facial structure.
Before surgery always, see a qualified bodyworker like a Cranial Sacral Therapist (CST), Osteopath, Chiropractor, Occupational Therapist (OT), Physical Therapist (PT), or Infant/Adult Massage Therapist. If you see a Chiropractor or Occupational Therapist make sure they do soft tissue/fascia work. The reason this is so important is that recent studies are finding that the frenulum (which everyone has) is actually a fascial fold, and restrictions in the area can decrease its movement and functionality; spinal manipulation usually will not address this problem completely alone. Always follow up shortly after surgery with your bodywork professional to help calm things down. Your muscles will try to go back to what it knows as “normal”. You want to give your body a new “normal”. Please note that using an International Board Certified Lactation Consultant is considered bodywork as well. Anyone possessing a license to touch and assist with neuromuscular re-education falls under the category of bodywork.
CranioSacral Therapy (CST) addresses functions of the craniosacral system, the membranes, and fluid that surround and protect the brain and spinal cord. By using a soft touch, CST identifies restrictions in the fascial system of the central nervous system. These fascial restrictions can affect the musculoskeletal system, organs, and vascular (blood vessel) structures, as well as tissue of the central nervous system, keeping those tissues constricted. CST therapy encourages the baby’s body to self-correct; bolstering natural healing.
It is beneficial to see a provider that has breathing training based on nose breathing. Nose breathing is essential for proper resting tongue position and optimal orofacial function. Some methods include Buteyko (pronounced Boo-tay-ko) and Restorative Breathing. Many offer online teletherapy services as well. The evaluation should be performed before surgery. Any infant or toddler who requires a release for restricted tethered oral tissues will benefit from pre and post-therapy. These therapies can include reflexes, stretches, cranial nerves, oral motor therapy, and feeding therapy. Therapies need to be tailored to the age being treated. Older individuals require weeks of training with a professional trained in Orofacial Myofunctional Therapy (OMT) prior to surgery, and continued therapy after the release addressing the individual’s particular OMT needs and goals. You may hear it being referred to as Oromyofunctional, Orofacial Myofunctional, or Myofunctional therapy. It is a type of therapy that various professions can provide. It is not a profession in its own right, but a type of therapy. Being certified in OMT is not a legal requirement in any state. Registered Dental Hygienists (RDH’s) and Speech-Language Pathologists (SLPs) have it in their scope of practice and can provide it as long as they are well trained. They do not need to be certified to do it. The International Association of Orofacial Myology (IAOM) provides a registered Certified Orofacial Myologist “COM” trademark showing those who have completed their organization’s certification requirements. You want a professional who is well trained in OMT with experience. Optimal oral function is desired from birth through the lifespan. Professionals who have OMT in their scope of practice and have training in myofunctional therapy should adapt appropriate therapies to the individuals in the age groups they treat. Each person should have an individualized treatment plan taking into account their abilities and limitations with exercises specifically designed to help them achieve optimal oral function.
A myofunctional therapist will help tone and strengthen tongue, facial, and upper airway muscles but to achieve the best result consider expansion of the palate/mouth before release to ensure there is enough room for the tongue to sit properly for correct tongue posture. A myofunctional therapist can help determine if there is enough room in your mouth for your tongue before a release. Many myofunctional therapists are qualified to evaluate/treat infants through adulthood. If you cant find a myofunctional therapist that evaluates and treats infants then see the provider section that lists Speech-Language Pathologist (SLP) Feeding Specialists. Additionally, Occupational Therapists who are trained in Tethered Oral Tissues (TOT’s) and feeding can be utilized for evaluation and treatment as well. Occupational Therapists should possess a Specialty Certification in Feeding, Eating, and Swallowing (SCFES or SCFES-A) by the American Occupational Therapy Association (AOTA). They must successfully complete a peer-reviewed process that includes: demonstration of relevant experience, a reflective portfolio, and ongoing professional development.
Myofascial Release. When we experience even slight tissue damage- pain signals are sent to the spinal cord which then triggers the muscles around the injury to contract in order to provide support and protection for the surrounding tissues. This response, left unchecked, creates pain as more blood flow is restricted to the contracted area. As more signals are sent, more muscles tighten to protect a growing area of pain. Myofascial release techniques (MFR) are designed to go in and smooth out those tight knots, returning the fascia to its normal fluidity. In MFR specifically for babies, gentle, sustained pressure is applied to points of restriction, allowing the baby’s connective tissue to release.
According to the American Speech-LanguageHearing Association (ASHA), Orofacial Myofunctional Disorders (OMDs) are patterns involving oral and orofacial musculature that interfere with normal growth, development, or function of orofacial structures, or call attention to themselves (Mason, n.d.A). OMDs can be found in children, adolescents, and adults. OMDs can co-occur with a variety of speech and swallowing disorders.
Signs and symptoms include but are not limited to:
Causes of OMDs
Orofacial Myofunctional Disorder (OMD) Team
Multiple professionals are involved in an OMD team. These professionals include: Speech Language Pathologist, Oral Surgeon, Dental Registered Hygienist, ENT (Ear, Nose, and Throat doctor), Physical Therapist, Occupational Therapist, Orthodontist, and Sleep Specialist
The goals are to:
If breastfeeding seek an International Board Certified Lactation Consultant (IBCLC). If using bottles, see an SLP/OT that specializes in feeding.
If you can’t see one in person, many offer telehealth/online/remote services. Set up a provider before surgery and follow up with after surgery as well. If breastfeeding is not being achieved then pre-release manipulation may be necessary.
Care should begin within 48 hours before surgery as well as 48 hours after surgery.
A newborn baby’s vertebra can get out of alignment as a result of the birth process or their in-utero positioning. The misalignment (called “subluxation” in chiropractic lingo) can be very traumatic on an infant’s spine. Chiropractic adjustments help to prevent or return proper body alignment, balance, and development, improving a baby’s overall health and specific health issues like tongue-tie.
As mentioned, damage to the body happens as early as in utero. Some babies are even born with torticollis which is a sign of ties. When there are oral restrictions there will be significant tension in the fascia and muscles prohibiting optimal movement. Therefore, babies will not have a full range of motion so often tummy time will be uncomfortable/impossible until the tension is released. The fascia starts in the mouth and extends all the way to the toes in one connected piece. When tension is present in the mouth/jaw, it will have a ripple effect all the way down.
Correcting the tether can allow for improved function but it takes therapy and retraining for it to automate in the system. For example, a myofunctional therapist can retrain your body to nose breathe (since most people are open mouth breathers) but it may take months of training to achieve this goal.
Many adults begin to feel the effects of being tied in their 20’s and beyond. The inability of the tongue to elevate to the palate (top of the mouth) is associated with changes in dentofacial development with high narrow palates that the tongue cannot make contact with. The narrowed opening forces the tongue further forward than it should be. Over time these subtle adjustments cause strain, pulls, and tension. These cause a lot of compensation which can lead to migraines, Temporomandibular Disorders (TMJ), clenching of the jaw, choking, forward head posture, digestive issues (acid reflux), sleep apnea, speech problems, orthodontic relapse, and arthritis in the neck. Even bunions in the feet are caused by ties. The tension in the mouth causes strain on the rest of the body as the legs pronate and pull the ligaments on the side of the toes.
The tongue is a complex organ composed of eight muscles that are involved in feeding, breathing, speaking, sleep, posture, and many other essential functions. Ideal tongue function and muscle rest postures also provide a mold for proper growth and development of the dental arches and facial/airway development.
The tongue is the first muscle to provide head/neck stability for the human body. As we grow, the importance increases as do the complexities of lingual movement required for sucking, swallowing, breathing, and chewing. The frenulum (the skin under the tongue) is made of tight collagen bands of the fascia. Over time the tension leads to compensations in the body, Chronic jaw shift is common. This forces the accessory muscles of the hyoid, shoulders, scapula, and thoracic area to also compensate.
Pediatric dentists and oral surgeons possess extensive knowledge in this area. There are a few highly specialized ENT (ears, nose, and throat) doctors that are trained as well. However, most pediatricians and ENT doctors don’t appear to understand the magnitude and long-term effects of ties and tend to misdiagnose and brush off parental concerns. During the evaluation for tethered oral tissues, if a provider is willing to jump into the procedure without seeing you again for follow-up and not offering stretching exercises, please see someone else. Also, if the doctor is not checking for ties in three locations including the lip, tongue, and cheeks – (buccal ties) then you are not receiving a thorough examination. Additionally, if you are older and the doctor is willing to do the procedure without at least three weeks minimum of myofunctional therapy before a release, it is highly suggested to see someone else who cares about the best possible outcome. These are major red flags! Follow-up should be within a one-week and two-week mark to make sure no reattachment occurs. Some doctors ask to send pictures rather than come into the office. Reattachment can happen very quickly!