A lot of clients I see in my private practice are experiencing breastfeeding problems that are either complicated by or caused by deficits in the mobility of the infant’s tongue, jaws, neck, shoulders, ribs, and hips. In today’s blog post, we are going to look at a recently published case study that ties into some of the observations lactation consultants and parents see in babies.
A tongue-tie, or ankyloglossia, is defined as a condition present at birth in which the lingual frenulum is shortened, excessively thick, or attaches closer to the tip of the tongue and/or front of the floor of the mouth which causes restrictions in the mobility of the tongue.
“Improper tongue mechanics have an impact on breathing, and impairments can cause a strain on the diaphragm, muscles of the head and neck, as well as the pelvic floor via connective tissue and fascia.” -Jennifer Guan PT, DPT, MA
Many adults with impaired tongue mobility, or tongue-tie, describe certain experiences that, through observational and circumstantial evidence, we believe may be associated with tongue-ties. These include neck pain, TMJ dysfunction, back pain, hip pain, pelvic pain, exercise intolerance, poor posture, excessively tight upper trapezius muscles, tension headaches, and migraines.
Many infants with impaired mobility are also described as having co-occurring torticollis (a limitation in the mobility of the neck), reflux symptoms, aerophagia (swallowing excessive air), plagiocephaly (flat spots on the head), general body tension, tummy troubles (excessive gas, watery stools, mucusy stools, or constipation), fussiness, and being, in general, babies with higher needs for comforting from their parents. Furthermore, many parents complain that their babies can’t tolerate tummy time or being laid flat.
Could infants be experiencing the same body discomforts that adults describe?
The case study we are looking at today was published in December 2023 by a physical therapist in the Journal of Women’s & Pelvic Health Physical Therapy. In this case study, Jennifer Guan PT, DPT, MA, describes the course of care for a pelvic physical therapy patient.
The patient was a 31-year-old female who came to physical therapy care with a chief complaint of pain with sexual intercourse related to not being able to relax her pelvic floor which had been present for some time but had gotten much worse after having a baby. The physical therapist noted that this patient was improving much slower than other patients being treated for the same problems.
Six months after starting physical therapy and receiving manual therapy for connective tissue restrictions, muscular restrictions, and myofascial trigger points, the client was diagnosed with ankyloglossia or a tongue-tie, and a frenotomy procedure, or surgical separation of the frenulum under the tongue, was performed.
The very first time the patient attempted to have sexual intercourse after the procedure she noticed a huge change in her pelvic pain with intercourse and reported that she was finally able to relax her pelvic floor voluntarily.
Now, many people may read this case study and say that the tongue-tie release procedure resolved this patient’s pain. However, if those connective tissue restrictions, muscular restrictions, and myofascial trigger points had not been addressed with manual therapy and physical therapy first I truly doubt the patient would have noticed such a marked and immediate result.
I believe the combination of manual therapy and tongue-tie release resolved this patient’s pain.
I think this explains perfectly why some people who seek a tongue-tie release procedure either for their baby or themselves without advanced skills lactation support or myofunctional therapy and manual therapy first don’t see as good of outcomes after the procedure as those who undergo these therapies before and after a procedure.
The truth is that because of these mobility limitations, people build compensations - or their body says well, I can’t do this easily the way I want, so it just adapts and does it a different way - and those compensations are what causes the restrictions in connective tissues and muscles. The body is always seeking homeostasis and if that isn’t easily achieved, the body will compensate.
An example for health care providers would be: a patient with COPD has chronically low oxygen levels resulting in high carbon dioxide levels in the blood. The brain and body’s job is to keep you alive and it can’t grow new lungs, so what does it do? The body wants homeostasis, so it compensates by elevating bicarbonate levels in the blood so that the blood pH remains normal, and therefore, the person remains alive, albeit not under ideal circumstances.
The connective tissues and muscles do the same thing when mobility in the body is limited. The brain says, we need homeostasis, but we can’t move our neck into extension or flexion, so instead, we’ll just tighten up all those neck muscles chronically to provide the cervical spine with stabilization. Now we can’t break our neck as easily and we can stay alive, albeit not under ideal circumstances.
Another example is when a baby skips milestones. Modern babies are still cave babies when it comes to survival. If the body cannot move well enough to crawl, the brain and body know that the baby needs to be able to move to escape predators, so it will build compensations so that the baby can walk and escape, but it might be up on their toes instead of normally because they never had the opportunity to integrate primitive reflexes and build those base movement skills.
Without first addressing the body's symptoms, those compensations, or bad habits the body has slowly built up to keep you alive, will likely just remain after a tongue-tie release procedure or take a very long time to work themselves out.
In conclusion, we can draw on the information we know about how tongue-ties affect the entire adult body to make some assumptions about the experiences that babies with tongue-ties are having. When we consider that these babies may be having significant body discomforts related to their mobility restrictions and subsequent compensations, we can understand why babies with tongue-ties may be more fussy and have higher needs for comfort from adults than what is expected of them.
Sources:
Guan, Jennifer PT, DPT, MA. Ankyloglossia, a Contributor to Pelvic Pain: A Case Report. Journal of Women's & Pelvic Health Physical Therapy 47(4):p 271-277, October/December 2023. | DOI: 10.1097/JWH.0000000000000284