Written and illustrated by Tad Wanveer, L.M.B.T., C.S.T.-D.

“Through stimulation of the lips and tongue, the infant receives important impulses for the development of the nervous system, speech and personality…If the chewing, suckling or swallowing reflex is disturbed, complex masticatory patterns, phonation, voluntary suckling and swallowing will later be impaired and may be executed with diminished coordination.” —Torsten Liem

The Tongue: How Craniosacral Therapy Can Help This Important Muscle, MASSAGE Magazine

Normal tongue structure and function are crucial during such essential activities as chewing, sucking, swallowing, breathing and speaking. Dysfunction of these activities can occur when either the form or position of the tongue is disturbed; when structures attaching to the tongue are compromised; or when the tongue’s neurological pathways are adversely stressed.

Craniosacral therapy can help the body create optimal, balanced free motion of the tongue by decreasing dysfunctional biomechanical or neurological strain upon it.

What is the tongue?
The tongue consists of muscles that form the tongue itself, called intrinsic muscles, and muscles that attach the tongue to surrounding structures, called extrinsic muscles. The tongue is a central muscular organ used in chewing, sucking, swallowing, breathing, speaking and tasting, and it is covered in mucous membrane.

A reciprocal balance
The tongue’s extrinsic muscles connect it to the head, soft and hard palate, jaw and throat. An ongoing balance in tension of the tongue’s muscles and structures with which it connects creates a kinetic chain of reciprocal control. In other words, the tongue affects the structures with which it connects and, in turn, they affect the tongue. 

Conditions can arise that challenge the smooth operation of one or more components within the tongue’s kinetic chain. This may lead to dysfunction involving activities in which the tongue is directly involved, such as speech, or activities that do not directly engage the tongue, such as balance or rib-cage motion.

What happens when tongue position or movement is compromised?
Abnormal tongue position or motion may lead to a range of issues, some of which can be severe (inability to swallow) or mild (difficulty forming tongue shape in order to whistle).

Difficulty sucking, swallowing, breathing, speaking and chewing can occur when the tongue does not work in synchrony with the muscles of the mouth and throat. These issues can also arise when the tongue cannot move freely. Some examples include:
• When tongue stress impedes soft-palate closing of the area of the upper throat behind the nose (nasopharynx), or when the tongue cannot properly move substances to the throat behind the mouth (oropharynx), then difficulty or inability to swallow can occur.

• Backwards displacement of the tongue can diminish the size of the oropharynx, causing difficulty swallowing and breathing.

• Decreases in normal tongue range of motion, or speed of motion, can create difficulty with: 1) forming tongue shapes or oral-cavity shapes necessary when making language sounds, or 2) smoothly changing from one sound to another while forming a word or sequence of words. Both can create difficulty speaking.

• If the tongue drags the nasal area forward and down, thereby obstructing free passage of air through the nasal region, then mouth breathing may occur.

What causes tongue malposition?
Many issues can bring on malposition or restricted motion of the tongue, for instance:

• A narrow maxilla lessens space for the tongue, so the tongue may shift itself forward.

• Temporal bone restrictions or imbalance affect the mandible—and since the tongue connects to the mandible and temporal bones, the tongue can be abnormally displaced.

• If any of the tongue muscles, either intrinsic or extrinsic, are too short, too long, twisted or constrained, then the tongue may be pulled out of optimal position.

• Restricted or imbalanced muscles connecting the nasopharynx to the soft palate can convey stress to the tongue (since the tongue has a pair of muscles connecting it to the soft palate).

• Stress, imbalance or altered motion of throat muscles, or restrictions of the hyoid bone (bony anchor of the throat), can affect the tongue in a multitude of unfavorable patterns, since the tongue directly connects to the hyoid bone and indirectly connects to the throat.

• Shortening of the midline fold of mucous membrane under the tongue, called the frenulum linguae, can hold the tongue in a downward position. Or,

• Neurological stress can alter normal motor or sensory nerves of the tongue.

Neurological strain may challenge the tongue
If one or more tongue nerves become damaged, then the muscles will not move or sense properly, which can lead to dysfunction. All of the motor and sensory nerves associated with the tongue are cranial nerves that have their nuclei in the brainstem. Neurological compromise of these nerves can be caused by many issues, such as adverse strain of the membrane encasing the brainstem; distortion of the membrane encasing cranial nerves; deformation of the openings in the skull through which the cranial nerves travel; or structural stress of face or throat tissue.

Tongue adverse strain can affect many areas and processes
Less than optimal tongue position can cause strain in areas of the body other than the mouth and throat. Consider when tongue stress alters the normal position of the hyoid bone. The hyoid bone is a connecting place for the tongue, cranium, scapula, sternum, clavicles, pharynx and mandible. Structural stress and functional disturbance of any of these structures can occur when abnormal tension pulls upon one or more of them.

One example is how hearing disturbances or vertigo can occur when tongue strain or hyoid bone malposition alters normal temporal bone placement or limits its motion. Excessive strain upon structures housed within the temporal bone can occur, leading to dysfunction of the nerve of hearing and balance (vestibulocochlear nerve). This can lead to dizziness or loss of hearing.

Difficulty breathing is another example; it can take place when tongue stress is transmitted to the collar bones (clavicles). If the clavicles pass this stress onward to the rib cage, then muscles that lift and help to expand the rib cage during breathing can become restricted. As a consequence, the rib cage can ultimately lose some of its ability to move fully, which, in turn, can diminish lung capacity.

How craniosacral therapy can improve the way the tongue works
One primary goal of craniosacral therapy is to help the body create optimal form, with the understanding that form and function are interrelated and interdependent. In essence, as form improves, then the body parts that produce an activity or series of activities are less strained so they can work at their highest and most integrated level. Then, in response, function, integration, self-correction, compensation and adaptation can improve.

The craniosacral therapy practitioner can identify areas of the body that may be adversely affecting the tongue by feeling the way the body responds to its own craniosacral system motion. Once these areas have been identified, the practitioner uses gentle tissue traction, along with release and balancing techniques to help the body decrease these strains. 

We often take tongue function for granted when it is working normally, but when tongue movement or position is disturbed, the consequences for the individual can be heart-wrenchingly difficult. Working with the tongue, its associated structures and the body as a whole may help alleviate dysfunctional biomechanical or neurological strain in such a way that the tongue can establish optimal position, movement and function. This can then lead to enhancing fundamental activities, such as chewing, sucking, swallowing, breathing and speaking.
 
References

  • Carreiro, Jane E., D.O., An Osteopathic Approach to Children, Churchill Livingstone Elsevier Science Limited, London, England, 2003.
  • Fehrenbach, Margaret J., R.D.H., M.S., and Herring, Susan W., Ph.D., Anatomy of the Head and Neck, Third Edition, Saunders Elsevier, St. Louis, Missouri, 2007.
  • Kopf-Maier, Petra, Dr., Atlas of Human Anatomy, Volume 2, Karger, Basel, Switzerland, 2001.
  • Liem, Torsten, D.O., Cranial Osteopathy, Principles and Practice, Second Edition, Elsevier Churchill Livingston, London, England, 2004.
  • Sergueff, Nicette, D.O., Cranial Osteopathy for Infants, Children and Adolescents, A Practical Handbook, Elsevier Churchill Livingston, London, England, 2007.

Tad Wanveer, MASSAGE MagazineTad Wanveer, L.M.B.T., C.S.T.-D., is a licensed massage/bodywork therapist and is diplomat certified in craniosacral therapy (CST). After graduating from the Swedish Institute, College of Health Sciences in New York City in 1987, he established a private practice in New York City.  In 1993, he began specializing in CST. 

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