Episode 154: Fascia and Function Throughout The Body with Daniel Lopez, D.O.

Hi and welcome to episode 154 of the Untethered Podcast. Today we have Daniel Lopez joining us. Daniel is a doctor of osteopathy. He's a board certified hands on osteopathic physician who has been studying and pioneering how the tongue affects the rest of the body for over seven years. After he and his daughter had tongue tie releases, he wanted to have anatomy based explanations for the body wide changes he and his patients were experiencing. His journey gave him a unique perspective on the effects tethered oral tissues cause and the bodywork required required to deal with them. Quick Disclaimer all information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider.

Welcome to the Untethered Podcast.

I am your host, Hallie Balkan. I'm a certified orofacial myologist, feeding specialist and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, tethered oral tissue and airway space. I challenge you to keep an open mind and join my mission to get this information out to the masses.

Let's get started. Well Daniel, welcome back to the podcast. I'm excited to chat with you again today.

Thank you. I'm really excited to be here. I've got some exciting things I want to, I definitely want to talk about today. So thanks again for having me.

Of course. And I've been following you and I know you've had like new courses and things come out too. And so I'm always excited to talk about the topic that we're going to dive into, which is really the need for bodywork and the connection. You know, I always say like we're connected from the tip of our tongues to the tip of our toes and you know, fascia and just everything's interconnected. And so I get a lot of patients who are like, but why, why do I need bodywork? What does it do for me? So I know we're going to jump into that a bit today, so I'm excited for that. But I also know you have your story to share and I would love to lead in with that. So can you tell us a little bit about what you know, a little bit about you and what's going on with you and your, your story in this space?

Yeah, so that's a great place to start. So just real briefly, I'M sure you may have covered this in the introduction. I'm a board certified osteopathic manipulation medicine specialist. And so that means every day I'm helping people out of pain with my hands and I'm studying how everything affects everything else in the body. So this is something that I'm looking at with people every day. When I finally, I spent several years before ever even learning about tongue ties, trying to figure out the jaw I had, my masseter muscles were always just tight, painful, and I could figure out how to get them to release. But then I was like, then they never stay. Like that pain would just keep coming back. And I would always keep asking like, why does that happen? And people would just say, well, it's stress. And then my patients would ask me like, why does that keep happening? And I'd be like, stress? But then they'd be like, well, I pretty much left your office, went to the plane, was on vacation, came from my vacation, like left the plane and came back to your office. And I haven't had any stress, so why is this tight again? And I just would be like, I don't really know. But then when my oldest daughter was born back in 2014 and I watched her get a tongue and lip tie release and I saw how her face and her face changed and how she could move her job better and, and all that, it then it suddenly dawned on me. I was like, do I need to be paying attention to this for my patients? And then, but then I was like, I need to find somebody who's tongue tie released. And this is how. Who's tongue tied? And I was like, so kind of ignorant at the time that I didn't realize I was tongue tied. But once I finally had that understanding, I went and had a tongue tie release and it was incredibly powerful for me. I was like, wow, that changed so many things, but I think there's still more. So I went back to the same person and had it done the same way. And then the second time it really didn't make much of a change. So I thought, okay, I might have maxed that out. But then a few years later, I kind of revisited the issue and realized I still had a large piece left intact that I had to. And once I could feel what it was doing to me, I went and had that released as well. But ever since that first tongue tie release, I've really been trying to study the anatomy behind this, the tongue and tongue ties, and trying to understand how it relates to the whole body. Because anybody who's Had a tongue tie release that will oftentimes. You know, many people experience changes in. In places they don't expect. It's like your neck feels different, maybe your throat, your chest, you feel like you can stand up straighter. I notice changes in my arms, you know, my low back, things like that. So I really wanted to be able to understand that beyond just saying, well, everything's connected. Like, I wanted to really be able to dive into that and. And really be able to understand it well. And that kind of took me through trying to understand the anatomy of the fascia and everything like that. So there was that aspect of things. But then I also want to talk about another piece which became. Which eventually I kind of tied together, but I didn't understand how it was all connected. But I grew up with a lot of pain. I was. I was one of those kids in high school who every 20 minutes or so was trying to twist in my chair, trying to see if I could pop my spine, trying to crack my neck. And I was just always uncomfortable in my body. But one of the things that I always despised, I was an athlete, and I hated stretching my hamstrings. It was a weird kind of pain that I would get. I didn't go very far. It was like hitting a brick wall. And then if I reached back and felt my hamstrings, they felt honestly, like steel, like a steel rod or mass in there. And I was like, I'm never going to bust through that no matter how much I stretch. And I tried stretching, I tried stretching consistently, but it became more and more irritated, and I didn't really make much progress. And any progress that I did make, the moment I stopped, I would. I would lose it. So there was always that part that I also was kind of in my mind trying to figure out, and that was actually trying to solve. That was one of the reasons I got into the work that I went into in the first place. But I always just wanted to figure out why I couldn't get more flexible. And that was just something that stuck with me. So there. So that's my story in terms of that. But now I want to kind of tie it back to. To tongue ties. Because we, you know, we talk about tongue ties and people talk about the fascia of tongue ties. And just real briefly, you know, there's the mucosal layer, then we have the fascia layer and the muscular layer. And, you know, we. We oftentimes do talk about the fascia, but it's like, we talk about it from, like, here to here, you know, like, it's not very far. And we're kind of forgetting that that fascia is really a body wide, continuous 3D matrix. So. But the thing that I think is missing with when we talk about fascia is, and I'll ask you, like, like, what are the dynamics of fascia? Like, what is fascia really doing, like, you know, through, through the body? Do you have any, like, would you be able to give a clear explanation of how the fascia is working and helping, you know, like on a, on a regular basis?

So my, my general understanding, and obviously I'm more focused from like the neck up, is that our fascia encompasses more than just, you know, muscle and skin and, you know, it's basically this entire system. And so if one thing is tight or tense or off, then we start to have compensation. Right. So my understanding when it comes to talking about fascia, and I'm definitely not a fascia expert, is really more so what I see functionally in patients and these, you know, they call them fascial restrictions. Right. A tongue tie or. I'd had a conversation with Ron Ruska at one point and he talked about the ties within us and that there are ties throughout the body, not just these, like, tongue ties, but just these fascial restrictions. And a simple restriction in one area can then throw other things off kilter, put other things out of place, then we start to compensate. And so for me, when I talk about fascia, I'm really thinking more so about, I'm thinking beyond the tongue tie itself to the compensations that it's leading to and then how it's impacting function generally, which I know then can wreak havoc throughout the body.

Yeah, I mean, and the thing about it is it's not necessarily that it's wreaking havoc throughout the body. The way I look at it, it's just if the fascia is doing the best it can to provide structural support for the body with all those restrictions that are there, it's not necessarily that it's causing problems, it's dealing the best that it can with what it has. But the thing we always hear, for example, the term myofascial, and I feel like that's a trendy term nowadays. People are always talking about myofascial and we gotta release the myofascial system and all that. The thing I feel like happens is that people don't really understand fully how to release the muscles and the fascia. And first we need to understand how they work together. Because in order to really understand what's happening with everything, even with the tongue and the fascia, we have to understand how the myofascial system is working together. Now, the Fascia is a 3D continuous whole body matrix that provides structural support. So we need to understand that everything is connected to everything else. And when you have a problem in one place, it's just simply going to affect the whole system. But fascia, you know, it inner penetrates, it doesn't just envelop the muscle, but it inner penetrates into the muscle and then surrounds the muscle fibers themselves. And so that's part of, part of the function of fascia isn't just the structural support. It actually has many functions, but part of it is allowing muscles to be able to glide independently of each other. So when you contract one muscle and the other one is not as contracted, it's got to be able to move. And so that's part of what the fascia allows. It's very slippery. People describe it as wet ice. Slippery, what, Sliding on wet ice? But even deeper into the muscle. When you contract the muscle, not every muscle fiber contracts at a time. You don't have 100% of the muscle contracting. So all those cells, when they contract, have to also be able to kind of have that gliding in between each independently of each other. But the point about that is that we have to understand is the fascia is surrounding every muscle fiber. So what happens when a muscle fiber contracts? It's changing its shape. And what that's doing is the outside area around it also has to change its shape. And so that means that the fascia is also being affected in its tension with the muscle. And I believe that that is part of what that is designed that way to allow for a more efficient muscle contraction. So then that allows the fascia to act like a tension rod. For example, if you looked at where the bicep attaches right beyond the elbow, and you're looking at that anatomically and you're like, how is it that the bicep contraction even bends the elbow? How can we lift like, you know, 20 pound, a 20 pound weight with, based on where it's at? And I used to wonder that. I mean, I'm kind of nerdy that way, but those are things that I used to wonder. And eventually it dawned on me that, you know, with, with the, when the muscle contracts, it's basically taking the fascia and pulling it into it, and that's tensing up the fascia kind of upstream and downstream. And then that's allowing the Fascia to act like a tension rod. So that that allows for a more efficient muscle contraction. And partly because of that, you know, we have to understand that fascia isn't stretchable. Because I don't know if you're, if, you know, I think a lot of people think fascia is stretchable. I hear a lot of healthcare professionals, and I'm sure you have too, where they're like, don't worry about the tongue tie. It's just going to stretch and all that. And the reality is fascia is not stretchable. That is just defined that. Because stretchable means, for example, Let's say you have an object and you stretch it out and you keep it there and then you let it go. It stays in that shape that what that you had stretched it out at. So it kind of deforms from its original shape. Fascia has some elastic properties, and that part of that depends where you're at. And what that means is more like a band. You know, you stretch it out, but then when you let it go, it goes back to its original shape. So there, there is, there is. Based on where you're at, there's going to be some elasticity to the, to the fascial system. And is this making sense so far?

Yeah, yeah, I know. I'm sitting here thinking about, you know, in respect to, like, tongue ties, for example. Right. So I know, you know, in my line of work, we talk about fascia, but we focus a lot more on the muscles, right. We focus on what's inside and covered. The fascia cover is what we're generally, you know, talking about with tongue ties that are restrictive. Right. That are too tight, you know, so I think it would be helpful to explain to people because, you know, I'm with the, the mindset that you can't stretch a tongue tie. That is fascia. It is. If it's truly. It's causing functional issues and we have that restricted tissue. We have a tongue tie. Right. Or a lip tie or a buckle tie. But, you know, I think there's this. And I would be curious to know your perception on this. And this may be kind of going off topic after a release when, you know, the frenulum grows back because we do have a regrowth of tissue at the site, typically it tends to be more pliable, especially if it heals properly. And so, like, my daughter, for example, had a laser release at 24 months. And, you know, if you look under her tongue, people say, oh, she's still got a tongue tie. And I'm like, no, she has a frenulum. It's not causing any issue. And when she suctions her tongue to her palate, it's pliable, it's stretchy. It's not, you know, and so I guess, is it a different type? I think people are curious to know, is it a different type of tissue that's. That's healing in that space? And it's not a fascial restriction at this point point, it's a more stretchy, pliable connective tissue. You know, Is it something different? Like what. What's happening if you.

Yeah, I'll probably go into that, into that a little bit more, but. But briefly, like, it's not that it's a different type of tissue or anything like that, but the best way I can describe it and the way I describe it is imagine you take a band and you stretch it out kind of like as far as you can. Then at that point, there's not much more give to that. Now when you do a tongue tie release, it's like it takes some of that tension and gives it a little bit of slack. Then it's not that it's more stretchable, but you've increased the elasticity to the tissue, if that makes sense, because that does affect the ability of the tongue to be able to rise, rise and fall. And so that's, I think, part of what we're seeing. And that's kind of what I think people sometimes interpret as stretchability to that fascia. But really it's more. You've increased the elasticity that is. That is happening there.

But I've got one other question too, if I can. Okay, so in talking about these fascial restrictions and in the compensations, you know, we typically will see, like floor of mouth compensation. We'll see, you know, maybe with myofunctional therapy, for example, we might be able to get some more range of motion. And it's not because we, and I always explain, it's not because we are actually changing the frenulum itself. We're maybe relaxing the surrounding muscles. We're increasing function of those muscles because we're basically saying, hey, we know there's a restriction here. We know that you've compensated for so long. Let's see how far we can get addressing some of the surrounding muscles. So, you know, with that, I think sometimes what I've been able to show patients too, and maybe this is more of a comment than a question, but, you know, we still see that frenulum remain intact in the same space the frenulum does not stretch, but we see, oh, wow. It appears like we have more range of motion because we've relaxed some surrounding muscles, we've decreased some compensation. But ultimately, like you're saying, that doesn't always hold if there truly is a restriction in place, because oftentimes, over time, you'll go back to, you know, compensating the same way again and end up back where you started. So is that something that you also see in your practice in terms of, you know, the surrounding compensations, in terms of gaining more range of motion? Maybe, if you're addressing surrounding muscles, but with the understanding that. That. That tongue ties really is not stretching.

Yeah. So, okay, let's kind of go back to what we were talking about then with the muscles and the fascia. So, like talking about how a muscle, when it contracts, it's taking the fascia and pulling into it kind of parallel to the contraction, and then when it relaxes, it lets go. But what I see is something that I've just termed it chronically partially contracted muscles. So what that means is you have a muscle that should be relaxed, but it's not. It's just stuck in this state where it's partially contracted. And so it's not contracted all the way, but it's also not relaxed. Now, if you think about it, if it's pulling the fascia into it, then that muscle is increasing the body wide fascial tension just by simply holding it there and being stuck in that state. I often see that in the mouth with the tongue ties. I do believe that the tongue ties do cause the muscles to be stuck in this partial state of contraction. But it's not a phenomenon that just happens in the tongue. This is something that's happening in the rest of the body. Because this is the insight that I finally had to have, and that finally made sense to me is think about your hamstrings and your quadriceps and all these muscles. They're huge muscles in your body, and many of them are stuck in this partial state of contraction. And the best way I can explain that to people is it's like if you're sitting in a chair, pull your knee up to your chest and then try to straighten out your leg. If you feel the back of your thigh when you do that, most people are not going to be able to straighten out their leg all the way. If you can't straighten out your leg all the way, if you feel the back of your thigh, you're going to feel that hamstring feel really hard and solid. Most of us haven't really spent much time thinking about what that means. But in a sense, the best way I can describe that is imagine with your arm, for example, if your bicep was so tight that whenever you pulled your arm back that your elbow would start to bend because your bicep is so tight. It's like the same thing is happening with the hamstrings here. And there's a lot of your other thought, like leg muscles and all these muscles throughout your body. And each one that is stuck in this partial state of contraction is tightening up the overall body wide fascial tension that we have. It's like everything is being wound tighter from the inside, and everything is just stuck in this way. And it's like the more pronounced it's stuck in this way, I think the tighter the fascia is. And then ultimately that shows up more. To me in the tongue and the hyoid bone. And I think part of the reason for that is because of the uniqueness to it. This is what I have observed with patients is when we have all this fascia wound up, it's kind of the. I kind of see like, the core of it being like in the front of the chest, like down lower, kind of where that chest and your abdomen, that junction there in the lower part of the lower part of the chest, that's kind of where I feel everything kind of pulls it into. And part of the reason I feel that way is because, you know, as we, as it tightens and we get older, everything kind of gets pulled into that. You know, your shoulders get pulled forward. You kind of like, if you start hunching forward, you're bending into that space. It's never like, no one ever gets, like, older and their shoulders open up and they bend backward. You know, it's, it's. It's going into that, into that space. But that part of that is just that internal fascial system that's pulling everything kind of into that. And so kind of going back to why the tongue and swallowing and the, you know, all those are more susceptible to those kinds of things in my mind, is because the tongue is the only muscle or group of muscles really, that have a freely movable end. They're not anchored at two places because they have that freely movable end. If your hyoid bone, for example, again, which is also unique in that it's a free floating bone, if you increase the tension from below and the hyoid gets pulled down from below, then the tongue is also Going to be affected by that. You know, there's, there's, there's nothing anchoring those, those structures like they are in other places. So has an effect on them more strongly. And I see that with, with whiplash injuries too is like the tongue is, because it's not, it's fixed, tends to often be injured more than, And I mean, nobody ever comes in complaining of, hey, my, you know, I had this car accident, my tongue hurts. Nobody ever comes in complaining of pain there. But you see that when we find it, they're surprised at how painful things are there.

I mean, that also be just connected by like the location of like the hyoglossus. And I'm not going to get into too many muscles here or anything, but you know, how everything is then so interconnected between the neck and the tongue. I know the tongue is free floating, the hyoid is too. But you know, when I, in my course that I, my, my course that I teach, I, I took a deep dive into a lot of the muscles in, you know, in the face, the head, the neck. Because I think people really need to have an understanding that at least I work with patients in this space of, you know, the extrinsic and intrinsic muscles of the tongue and how, you know, I think people look at the tongue as like this one big unit. And I'm like, the tongue is, you know, we could spend six hours today just talking about the tongue and all of its intricacies. So that's very fascinating that you're seeing that. But it, you know, when you stop and think about it, I feel like that makes a lot of sense. Sense because of how highly interconnected we are throughout this area.

Yeah, I mean, the other thing to me that I've also just come to understand and realize, you know, is that we call the visceral fascia layer, you know, the fascia layer that is continuous with the tongue, that anchors up to the base of the skull, that is considered the strongest fascial layer, you know. So it's like what I see is when that, when everything tightens up fascially throughout the body like that, that fascia layer is often wound up really tight. And so that is part of what then for me pulls the whole head down, the tongue, you know, the hyoid down and all that into a forward head posture. I know a lot of people just say, oh, it's a reflex to open the airway. But that's not what I see happening because when I, when they free up their fascia, they're able to stand up immediately taller. And I know people can argue that's a reflex, but I don't see it because they've got a lot less tension in their chest. They're not being anchored down. And the more I've worked with people where we've released their whole body, then that changes too.

Well, and I know you, so I don't know if I'm jumping ahead here, but now I'm just thinking about this conversation about how tight hamstrings, Right. Can impact the ability to swallow. Because I know that's something we wanted to talk about and sure, my brain's just going to like the palatal glossus and you know, these other muscles where, you know, we, we've always said in, in the speech pathology, swallowing world, we, you know, in the ots will say this too. What you see on the hips, you see on the lips, you know, we always say it's very critical that with our feeding patients that we, you know, regardless of age, but we focus on this a lot for our pediatrics, that they're seated, right. So they're seated in that 90, 90, 90 where their hips, their knees and their ankles are all in a 90 degree position. They have support for their feet, whether it's an infant who's nursing or, you know, a child who's eating solids. And I think that we work with so many children who unfortunately have dysfunction throughout the body that these supports are necessary to address skills while they're also, you know, we're also addressing the rest of the body as well. But it just, you know, talking about how highly interconnected we are and the impact of either insult, injury, tension compensation and other areas, I want to dive into that a bit because I think it's just so fascinating how that impacts the swallow.

Yeah, I mean, and that's the thing is like, you know, we take lots of muscles, they're all pulling in, they're all tensing in the internal fascial system. All the fascial layers, as much as we separate them out, are also continuous with each other. They're connected. So. So it's not as simple as, you know, or it's not. It's not that when you release one fascia layer, there doesn't have an effect on all the others. But that really does affect, to me, it pulls everything down from below. That's what I see. And so I want to talk a little bit about that because I actually want to describe what I see in people with tense fascia. Now, you're not going to see this as much with say like babies or kids. And the way I describe that for people is because sometimes I've heard people say, well, I'm an adult, what's the point of doing a tongue tie release for me, Like I'm fully grown and all that. And the way I describe it for people so that it kind of makes sense is I tell them, imagine you have this balloon that is deflated and it has a kink in it. When it's deflated, that kink is not going to have as much of an effect on the overall shape of it. But when you start blowing up that balloon and it starts expanding and it has that kink, the shape suddenly then gets affected more and more and it warps the tension of the overall balloon. The more you blow it up, the more it changes that. And that's kind of what I think is happening from a baby who has that kink. For example, it's pronounced, it's there, but it's not necessarily going to be as pronounced as in an adult. And we think that, oh, I've grown up, I have, I don't have these issues anymore. But what I often have seen with, with, with adults, both experience personally, is when you have a tongue tie release, it's kind of like taking that kink and letting it finally release. And then you can feel the fascia just, kind of just goes as they're, as they're like going into it, it's happening instantaneously where that fascia is just like letting go and they're like immediately changing their overall shape. But what I see when people have tense fascia and this is not a. I also don't want people to get the impression that this is some kind of like bottom shaming or body shaming or anything like that. This is just observation and understanding of the anatomy. But what tense fascia looks like to me when things are too tight is kind of like a vacuum sealed bag. So when you have a storage bag and let's say you have clothes in there and you vacuum seal it, if you were to shine a light on it, the shot, the light reflects very sharply back at you, you can see the contours of everything very like very well. Versus like if you have a vacuum or a bag with storage clothes and it's not vacuum sealed, if you shine a light on it, it kind of reflects back dull. But then also like you don't see the contours as clearly of things over that. So when the fascia gets tight, it creates that appearance where these structures become A lot more prominent. So it's like. So I look at it like someone who is, for example, an athlete. And they're. They're super defined and there's. But they're really defined when they shouldn't be. Like their muscle, if they're relaxing, you can see every muscle fiber, you know, and things like that. But when I see it with, with. With the tongue ties and the issues that sometimes it causes is more in the front of the neck. And I see like, you can see the super sternal notch kind of gets sunken in because that's the fascia pulling in. And also the front of the neck gets very. It's. It's like very tight. And I think part of that is because if you understand the anatomy, there's three fascial layers in the neck. One is kind of goes all the way around the neck. Then you can look at one tube that's inside of that and then another tube behind it. But two of those three fascial layers are attached to the hyoid bone. But also in the front of the neck, they kind of fuse together as they come down and then they split apart. One goes deep into the rib cage, the other one goes out externally. And so because they're kind of fused here, it makes these structures show up a lot more pronounced. So if you can see like the Adam's apple super tight and the SCM muscles and all that, then that's something that I see as a sign that there's very tense fascia. Especially then you can, if you can see the supra sternal notch. Because if you know the way you can mimic that is to where you can have this show up is if you were to blow out all your air and then kind of like hold it. As soon as you try to have that air hunger and you try to breathe without letting yourself do it, you're going to see that notch sink in. And that's kind of how you mimic that. But that's going to affect. If you were to maintain that, that would affect your ability to move and everything like that. And we're going to show later that that can affect tongue posture. So what I see is, you know, when we have all this tense fascia, then that affects the resting tongue posture. And I feel like that's a missing piece that doesn't really get talked about. Everybody talks about the tongue being able to rise eyes and everything, but it's like, what is that? Like, what is it that keeps the tongue where it's at? And if the tongue has A harder time rising then isn't there something making it harder to rise? And, you know, we talk about that just being the tongue tie, but I think there's also the whole fascial tension from below. And I think when you release that, that's going to allow the tongue to also rise further. Does that kind of make sense?

Yeah, no, absolutely. And you know, in my world, in the myo world, you know, we do focus a lot on what exactly what you just said with not just can we elevate our tongue and depress our tongue, can we also have our tongue live in the palate without having to think about it? And, you know, can we teach it to exist up there? And can we teach the whole tongue to exist up there? Because some people will say, oh, my tongue rests up there. And you look and it's like the front third. And we're like, that's not your tongue resting in the palate. But I also think that it's very fascinating too, because, you know, I'm constantly looking at different pictures that people post online of patients. And, you know, sometimes they're saying that this patient has graduated, and all I see is tension all over the face and neck. And I'm like, but how is this patient graduated? You know, they're not going to maintain this. It's not going to stick. So, you know, it's a really interesting conversation because we do get those patients sometimes where we go, they can do it, they can suction their tongue to their palate, they can hold it up there, like when they're conscious and thinking about it for, I don't know, 30 seconds, 60 seconds. But why is it not sticking? Why is everything we're doing not holding? And so I think that really lends to this conversation.

Well, I think personally, the way I see it is it's not always going to be as simple as teaching somebody to do it. They may be able to do it, but when I think it turns into a problem is, yeah, sure, they may be able to do it when they're conscious. But then what about when they're not conscious, when they're sleeping? You know, it's like, then that, you know, that's where we want to be, really be putting our attention to is like, what is, why, what is that tension that is then pulling things, forcing them to then bring their tongue down, open their mouth, you know, and things like that, which I think then can create also a more of a mouth breathing kind of thing. So let's, let's talk or let, let's do some exercises that kind of describe some of the things we've been talking about. Because before I've kind of explained some of these things, but I've never. Not in the depth that we're going to today. What I've told people in the past to do is when they're sitting in their chair, have good posture, I tell them to look up as much as they can, and then try to swallow. There's usually three groups. There's usually going to be the group that, if they're doing it right, will not be able to swallow at all. No matter how much they try. There's going to have people that are going to have a hard time with it, and there's usually a small group that are like, okay, that's easy. But now what I tell people to do, to really try to drive home the idea of what I'm trying to explain is I have them do that, but rather than just looking up and swallowing, I tell them to first take a big inhale as far as you can hold it, and then do that. Okay. And just kind of make a mental note of how that feels.

And yeah, I mean, for me, I'm swallowing air. If I try to do that, it's not easy. And then.

But then I'm like, okay, now we're going to do the opposite. I want you to exhale all the way, hold it, and then try to look up and swallow. And then kind of make a mental note of like, what that's like.

Okay, so I can't.

So you did that. Like, which is harder.

So exhaling was harder for me. But I have to. I almost like, want to redo the first one where I inhaled, because I'm wondering if I breathe, if I took a breath before I swallowed, because I don't think I can actually do that either.

Sure. Yeah, but. But you noticed that it was harder during exhalation.

Yes.

Okay, so the, the point of that is one, it's like trying to understand that if what's happening in your body has no effect on swallowing, then that shouldn't affect your ability to do that. But when you're in exhalation, like when we were doing that vacuum sealing kind of exercise before, where we took that internal fascia and tightened it up, and then you're trying to swallow, you're going to find that it's much harder to do that. So that's kind of what we're trying to explain there. And then you'll notice when you do take the big exhalation in your chest, is Rising up. Even your hyoid and your trachea are raised a little bit, so it's easier to swallow in those cases. So then the question is, where does that tension come from when you're exhaled and all that? And we talked about that. That's that fascial tension that we're winding up and then trying to also just wind up and take that slack out of the fascia. Now I want you to do that exercise one more time, except we're going to do it a little bit differently this time. We're not going to do it breathing, inhale, or exhalation, but just I want you to look up like that until you've gone as far as you can. And now try to glide your jaw forward. See if you can just glide it forward. And you may find that if you have a hard time swallowing, your jaw may not be able to go forward hardly at all. At all. Were you able to get your jaw to come forward?

I was, yeah.

Okay. So a lot of people who, for example, the ones who can't swallow once, because what's happening is they've taken all the slack out of their. In their hyoid bone is then immobile. Their jaw will not come forward. You know, and part of what I'm trying to explain with that is, is the relationship between the hyoid and the mandible and the jaw, because we don't really talk about that enough. And I don't think people understand it well enough. I mean, very few people are like, well, if you're. If your hyoid can't move, your. Your jaw's gonna move. But. But try this. Just put a hand on, you know, over your. This area here. You can. If you know how to find your hyoid, just do that. And then just open up. Open as wide as you can and close. And open wide as you can and close and just feel what's happening to your hyoid and even your trachea. What happens when you're opening and closing? You should feel when you open your hyoid, drop down a little, and when you close, it'll come back up. Now, the point of all that is like, okay, you've got muscles from your hyoid, your mylohyoid, that attaches to the inner surface of your jaw. So all of that has to work in conjunction. If your trachea, your hyoid, all that's being pulled down. That is also putting extra tension on your jaw and can be a factor. In my mind, that also is a reason for that can be a reason or a factor for mouth breathing. I don't just purely see it as how we're looking at it as, as we've been looking at it before. I'm seeing it now like, okay, you've got this extra tension, your jaw's kind of getting oftentimes pulled down and then that's going to promote mouth breathing and you're going to lose nasal breathing from that. So that's also how I'm seeing the fascial system affecting what's happening there. And so I'm also looking at it in terms of with all this that's happening, is this like, to me, it's like also understanding how this could be affecting obstructive sleep apnea. For example, we talked about how when you're not conscious, if you have this extra tension from below, you may be able to overcome it during the day, but at night your highway starts to get pulled down. That means your tongue is getting pulled back into your throat, your jaws being pulled open, and then you're going to be mouth breathing, your tongue's going to be pulled back into your throat. And I feel like when you start to resolve that body wide fascial tension, that doesn't happen as much. And so far the only person I have for experience for that is myself. But I've noticed once I stopped, I was able to resolve a lot of my body wide fascial tension. I don't have trouble wake, like sleeping now, keeping my tongue on my palate, keeping my mouth closed like, like I used to. I mean, I, I don't feel as much of a need for lip taping because I don't have those forces pulling me down. So does that make sense? Are we kind of.

Yeah, no, absolutely. I think as I was mentioning before, you know, I have this whole module just on the muscles. And I really wanted to drive home, not just, you know, hey, we have these muscles, they exist. I know in a lot of courses it's, it's talked about like, hey, you need to know the muscles, you know, like how everything's interconnected, but no one really takes it a step forward to talk about, well, how does that impair function? What is the functional impact of this muscle not functioning properly? Whether it's too tight or, you know, it's being, it's compensating for another, you know, nearby a neighbor. And so that's something that I really looked into and dove into in my course because I wanted, I wanted the myofunctional therapist going through it. To have a deeper understanding of, well, what happens when we have this tension. And I think it also really is a great introduction into why we need bodywork. Why we need to refer out to an osteopath. Why we need this work goes really hand in hand with what we're doing. We always say the tongue tie releases one piece of the puzzle. The ENT or the allergist may be another piece. If you have nasal obstruction or allergies, the myofunctional therapist, you know, the osteopath or body worker who you know, and whoever else may, you know, the TMJ specialist, whoever else may be on that, that dentist or ortho who may be on the case. But there's so many pieces of the puzzle and I think that people really just don't have a good grasp on why the body work is needed. I hear that come up a lot. So I think this has been very helpful in understanding, like how critical this is. We can't say skip the bodywork piece because we don't understand it. It's really critical in helping us maintain those long term goals that we've set that we're starting to achieve in Mayo. And I think especially more so for those individuals who we do things in, at least in my MYO program, we do things to help through subconscious programming and everything for nighttime and keeping that tongue up and nasal breathing and closed lips and. But you get, so you still get a lot of patients who just, they can't, they can't or it doesn't maintain.

Right.

It doesn't generalize and become subconscious. So it's. This is critical.

Well, this, this was the piece that finally like made sense to me. This was when I kind of started to feel like, okay, this is all kind of coming together because I started to look at as, you know, a tongue tie release to me now is more part of the whole bigger picture. It's again, kind of like we were talking about. If the fascia is this elastic band and you take it and you stretch it out almost as far as it can go, let's say we're doing it this way, then you're going to have a harder time swallowing because you've already taken out a lot of the slack in that elasticity. So it's harder for the tongue to be able to rise and fall. It's going to get pulled down easier, but. But then we're stuck there. The tongue tie release, the way I kind of see it now is we've got this band and that's kind of already kind of take. Got the slack taken out of it. It helps take some of the slack out of it, but not all of it because then there's still all the other fascial, the things that are creating fascial tension from the body. So if you do a tongue tie release and you get some of that slack out, but there's still a lot of, a lot of tension throughout the rest of the body, then to me, it's not going to be as successful because they're still going to have those, those poles from below that, that are being missed. And you know, the goal of the tongue tie releases to get function back. But I think we also need to look at the bigger picture of that. And to me, that one of the struggles is, is releasing fascia. Like really releasing fascia is a lot harder than I think people realize. You know, you get a lot of body workers that do, even people that are like, I release fascia, you know, Rolfers and other kind of myofascial release specialists and things like that. But I think a lot of them, and I'm not saying this to necessarily be trying to be critical, I think a lot of them are not being as, are, are not as effective as, as they could be. And I know people are probably going to be like, ah, you know, there's probably, I'm going to get backlash from that. But, but what I mean by that is again, taking these partially, these chronically partially contracted muscles, I'm like, I went to body work and got worked on by a lot of people, you know, massage therapists, chiropractors, osteopaths, all kinds, you name it, I had it all done. At the end of the day, my hamstrings were as tight as ever having all that done. And so I was like, well, they're, they're not able to release those things. So I'm like, you know, if, if, if you're in the audience and you're going, well, but my body worker is the best, then I'm like, if you did that, that test where you brought your knee up and you try to straighten out your leg, and if you couldn't, then I'm like, go to your body worker, tell them you want to have, you want that to resolve and you know, have them work on it as much as they want and see if they're able to resolve it. Because if they're not, they're not able to. They're not getting that fascial myofascial tension released, you know, and what I, what I Upseeing is that, you know, a lot of, a lot of myofascial or fascial workers are great at releasing superficial fascia, which is wonderful, but they're not able to get to the deeper layers as effectively. And part of that goes back to fascia being designed to glide over itself. If you're talking about wet ice on wet ice, if you're trying to force do a fascial stretch, it's going to help superficially, but it's not going to be as effective with those deeper layers. And it is going to have an effect on them to a certain extent because like we said, they're all connected. But I don't see that changing quite as much. But for, for me, like body work to really be effective, if, if you're wanting, there needs to be like specific tongue related body work. You know, I don't, I don't anymore feel like, okay, you're going to have a tongue tie release. I'm just going to send you to whoever and they're just going to be like, okay, I don't really know what this is about, but we'll do some body work. And you know, that may work in some degree, to some degree, but I think there needs to also be more specific manual treatment of the tongue and the body that's specific to what people are trying to do. The way I've come to work now is I do manual treatment of the tongue. I do think that it's super important, especially because the tongue tie, what it's doing to the fascia and the face affects this area the most. So I do feel like releasing those muscles, especially before and after a tongue tie release, is super important because that helps kind of get again, take some of that tension off the fascial system. Then I feel like they can do a better job with the release. But then there also needs to be the looking at all these large and specific chronically contracted muscles throughout the body and work on releasing those, especially the ones that are related to those layers that are going in affecting the trachea and the tongue. So do you have any comments about that?

No, I think it's fascinating. I was sitting here thinking about a colleague who had a functional frenuloplasty done and who said, and she's done years of bodywork, all kinds of body work, different specialists, and has now worked with some big names in her area. She's a myofunctional therapist and speech pathologist. And she said, you know, it held maybe for about a year, all of the Results held and then they've returned. And she, she used to have pain like that's like wearing a sports bra. She would have pain in her back and that went away after her tongue tie release. And, and she said it felt like this just whole like release like throughout the body like you said, you know, you can just kind of feel like the fascia just release and relax. But I was, you know, just sitting here going, wow, I wonder like what is happening that she, you know, that things have started to return despite the fact that her tongue tie is, it didn't reattach. You know, she's got full range of motion with her tongue. You know, she's in, she's a therapist, she's in therapy regularly. But at the same time, you know, it's like, huh. I mean, is from a maintenance standpoint then, right? Do you recommend people come back every so often? Is it more just like if symptoms pop up once you kind of dismiss somebody, like what do you have any type of protocol for that?

Well, at this point, you know, I ended up kind of discovering a way to finally get to those deeper layers of fascia. And so, you know, I, I kind of stumbled across it, trying to search, figure it all out. Like, like I said, I've had a lot of body work and a lot, none of it really touched a lot of that. Like I said, my hamstrings were still just as hard before and they were just as hard after having my tongue tie releases and everything. So, so there was, there was, I was like, there's still something going on there. I just, you know, couldn't, couldn't quite figure it out. But eventually when I did figure it out and I figured out how to do it, the nice thing about it is the changes that took place stayed. They didn't keep coming back. So it was like now, for example, like if I bend forward and try to stretch or stretch my hamstrings, they feel a lot softer than they used to. And I still have a ways to go with that, but I don't have the same kind of pain when I stretch now. It's not painful, I do feel the stretch, but if I don't stretch for three, four months, that doesn't revert back. I can go that long and then bend forward and it's still the same as it was when I did it. So that was something that I had to figure out. And so with my patients now, I treat them a lot more with this method now, but I've also put together this whole at home program. To teach them how to release that on their own. And that's what I have them do between visits because then that can be a lot more effective if they're able to be releasing their own fascial system, a body wide fascial system that between, between appointments, then I can be a lot more effective that way I can really do, do more, more then. And so I don't know if that fully answers the question, but that was.

Kind of like what that's, I think that's what everybody hopes for, right? They hope that, that the work that they're going for is going to be, there's going to be longevity to it and that they're not going to have to keep coming back after a certain point. Point. So that's amazing. So where can, where can everybody find you? I know you've got some courses and you've also got your practice, so share with us where we can find you.

Yeah, so I've got, I can be found in a lot of different places. I've got a website, daniellopezdio.com if you want to check out that home program that I've, that I've put together that I've, I've called it global, global active myofascial stretching. The website for it is gam g a m stretching.com and, and so that's something that, that's, that's where I have that course if you want to check it out. And then yeah, everything else that you want to look at for me is usually@daniellopezdo.com and that's where you'll find a lot of, a lot of information for, for me. But yeah, I think, you know, with everybody that does bodywork wants to have things hold and that's. And the same for me. I want things to hold for my patients. And what I've come to realize, what took me, what I've come to realize is if things don't hold, then you've missed, you know, the right pieces. It's like if things aren't holding, then hopefully you know the person you're going to or the bodywork that you're doing isn't the same exact thing every time. Because if you're, if it's not holding and you're doing the same thing, like why would anyone expect it to suddenly be different at any point? So, you know, when people come to me, for example, I'm always searching for other things, new things, different things that could be affecting if we're not, if things aren't holding and sometimes, yes, we have to just treat certain things for multiple visits, but they usually will be progressing. But sometimes we also have to look for other things that could be, that may not even seem related, that are actually what the underlying causes are. And when we find those, that's when things hold and stay. So that's, I think, what we want to happen.

Yeah. Well, I love that. And thank you. So we'll make sure that the GAM stretching.com is in the show notes for everybody. We can put daniellopezdo.com in there as well. And thank you again for returning to the podcast. This was such an amazing conversation. Anytime somebody asks me now, why do we need bodywork with this, you know, with a tongue tie release or with myofunctional therapy, I'm just gonna say, you need to go listen to this episode, because episode 154 is where you need to go. So thank you. This is fabulous.

You're welcome. I hope that adds clarity for everybody, because I know that's something that I've just noticed there was a need for. And even I struggled to fully understand it for a while, but once I kind of put it all together, I was like, all right, I need to start getting this information out there for people.

Yeah. And I love that you did. So thank you.

Yeah, thanks. Thanks again for having me.

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