Do you have TMJ pain?

Everyone knows TMJ pain is caused from teeth grinding and jaw popping right? Well, hold on a minute. Have you ever considered the role of your tongue in TMJ? I ask because I am a speech language pathologist, we are the “tongue specialists” and I never really thought about the connection until I saw first hand what happens when complex TMJ patients who have been through the gamut of treatment options decide to address the tongue and lo and behold, the TMJ pain resolves!

This discovery made me dig a little deeper. Did you know that your tongue is not just one simple muscle? It is in fact 8 muscles working in synchrony to create very unique and dynamic functions such as chewing, swallowing, speaking, singing and just hanging out resting while you breathe. If you look at the muscles of the tongue you realize that the tongue actually hinges through the styloid process just under the temporal mandibular joint (commonly referred to as TMJ). This is the extrinsic lingual muscle known as the styloglossus muscle, which works in tandem with the other 7 muscles for the tongue to have fluid, effortless movement as it goes about its duties.

muscles of the tongue

But what if it doesn’t? What if those 8 muscles are out of balance? What if they aren’t working in tandem? What if 1 or 2 or 4 are working more than they should because others are working less than they should? What if that hinge is out of balance and it creates tension or pressure? Could it cause pain? Would that pain be in the TMJ region? Could it radiate to the neck, shoulders, head? What if you brace it or impede it so that they “have” to work in synchrony? Does it work? Maybe. Until the muscles figure out a way to compensate around it.

What if you train the muscles to work in synchrony? Does that work? Yes! Creating balance of strength and function of the tongue both at rest and in motion can eliminate the need for mouth-guards or appliances worn to prevent contact or misalignment that is likely caused by a tongue that is out of balance. It certainly is preferred over surgery or injections.

This tongue imbalance is common with tongue thrust because the front of the tongue is doing all of the work and pulling in a forward and downward position both at rest and in motion. Over time misalignments can become malformations. Don’t believe me, check out the gait pattern of a person with a chronic knee injury or what about kyphosis of the back? These are larger structures and we know muscles working incorrectly affect posture, development, alignment and function. Why haven’t we made this connection with the smaller more specialized muscles of the tongue that impact the facial structures?

Tongue thrust is not a cosmetic issue. Tongue thrust is not an articulation issue. Tongue thrust is an issue of function and structure and the long-term implications for swallowing disorders and often pain are significant.  It’s time to look at effective tongue thrust therapy, the elimination of the tongue thrust, as a viable treatment option to remediate the potential underlying cause of the TMJ pain and stop the chronic, progressive and debilitating condition.

The Stone Tongue Thrust Protocol is a clinically proven treatment protocol that efficiently eliminates the tongue thrust by targeting the imbalance of the tongue muscles aligning their function at rest and in motion. When the muscles are working properly the condition is eliminated.

Almost always clients are in treatment with orthodontia and/or TMJ when they come to us. It’s no big deal, remember we’re working with the tongue rather than the teeth and the jaw. The tongue is quite resilient and accommodates the environment so our job is to make sure it is not creating a more unnatural or abnormal posture as we work WITH the orthodontist or TMJ specialist to enhance the treatment so that in the end the patient no longer has a tongue thrust and the work done in orthodontia becomes permanent and/or the TMJ issues are relieved.

Wouldn’t you like to eliminate the pain once and for all? Wouldn’t you like an efficient and proven method to retrain the tongue? It’s time to consider the impact of the tongue on the TMJ and utilize the Stone Tongue Thrust Protocol to eliminate the imbalance in the tongue once and for all.

Breaking Down Barriers


In 1999, I was working on a trauma team in a local hospital outpatient clinic when my first tongue thrust patient landed in my clinic chair. He bore little to no resemblance to the patients I was used to treating that had medical diagnoses like TBI, stroke, Parkinson Disease, ALS etc. This 15-year-old young man was healthy, athletic, and academically talented (that’s the fancy way to say smart!). He had no disease, no paralysis, no articulation errors, no visible oral malformations, no developmental delays.

His orthodontist had referred him to a speech therapist for tongue thrust therapy because he had his braces taken off a year or so earlier and his teeth had moved back where they started. Not something anyone wants to see after that type of time and financial commitment. The orthodontist had determined that he was tongue thrusting and it was contributing to the drift and wanted to have it corrected. Because I was the only in network speech therapist for their insurance plan he ended up coming to me, but honestly I was NOT prepared. I was skilled with disease and disorders…not “normal”. What to do?

Well of course I did what any responsible clinician does when you are faced with a population that is within your scope of practice and related to what you do but not within your skill set. You reach out to the colleagues that do work with that population. You get into the literature and research and find out what is standard practice. What is working?

The results of my collaboration and research revealed a standard practice approach that involved retraining tongue placement by focusing on the “spot”. Traditional tongue thrust therapy took on average a year to retrain the tongue placement and often required “tune ups” as regression was quite common. Very little research was available (and very dated…1970s) and when diving deeper it became very controversial with some experts denouncing the diagnosis of tongue thrust stating that it was a behavior and did not require therapy because it was not a disease or disorder.

I proceeded to treat this young man given the tools and mentoring I had, but quickly realized that he was not going to invest his time in therapy every week for a year, nor was his insurance company going to pay for a year of therapy! Cancelled sessions and poor follow through was looming. If I didn’t get some real results quickly and make it stick the whole thing would be a waste of time and resources. This dilemma and my experience with dysphagia, apraxia, articulation disorders, and dysarthria came together as I added my neurogenic and oral motor experience into the mix. We had success! His tongue thrust was improved.


Patients often come in clusters. Once the word gets out that you are a good therapist in a particular area they seem to multiply and suddenly you have quite a few who are looking for the same results. That is what happened, and in 2003 when I started a private practice this reputation followed me and before I knew it we had a reputation for treating tongue thrust. It was in 2005 when I started training my employees to do my technique that we started to realize the consistency with our tongue thrust clients. We realized that they never seemed to need tune ups. We realized they were usually in and out in less than 10 sessions. We realized that their tongue thrust didn’t just improve, it was eliminated. We went back through the clinical data and began following up with previous clients and monitoring current clients and found that indeed, NO regression for up to 5 years (after that we stopped asking!). The average length of treatment was 7 sessions.

Honestly, I was pretty humble and sheepish to share these results because they are so remarkable and NOT standard practice. I was skeptical of my own data, so we kept taking it and kept getting the same results across multiple therapists and multiple years until I was so confident in replicating the process that I published the Stone Tongue Thrust Protocol as an Assessment and Treatment tool for the identification, diagnosis and treatment of tongue thrust in 2008.


Nearly 10 years after that first 15-year-old came into the clinic I had perfected and systematized the elimination of tongue thrust! So now, almost 20 years later, you would think that there would be more understanding of tongue thrust, more awareness, more effective therapies because we have had so many advances in our scope of practice, research, technology, education…right? Wrong!

I still, on a very regular basis, hear from dentists and patients that nothing can be done (or needs to be done) for tongue thrust; that therapy doesn’t work; that you just need to teach them to put their tongue on their spot. I see patients after they are on their second or third set of braces (and a variety of placement appliances specifically tailored to prevent tongue thrust) with everyone frustrated because the teeth just keep moving. I see patients who are facing major jaw surgeries to address misalignment and TMJ issues. I see patients who have serious TMJ issues that have been treated by a variety of disciplines with no relief. Guess what they all have in common? Yup! They HAD tongue thrust and we eliminated it (as well as the other issues that were being caused or exacerbated by the tongue thrust)!

So no longer am I sheepish and quiet about my technique. You can’t argue with 18 years of clinical refining and outcomes.  In our current climate of transparency, clinical outcomes, and managed care there is no space for 1970s practices that take a year and don’t stick. Poor outcomes have perpetuated the myth that tongue thrust therapy doesn’t work or isn’t needed when in fact it is not the therapy it is the skill set of the clinician. The STTP Training Center was created to train professionals in the Stone Tongue Thrust Protocol so that we can change the face of tongue thrust therapy. Eliminate the misconceptions, take down the barriers and create access to unprecedented outcomes through exceptional training and support.

The STTP Training Center is found online at and provides education for the general public about tongue thrust what it is and what can be done. Education for professionals who most often identify tongue thrust, dental and speech language pathologists, about how to recognize and refer to a qualified provider. Education for professionals who treat tongue thrust and want to have an effective skill set to eliminate tongue thrust and build a niche service line in their clinic with exceptional outcomes. Together we are committed to changing the face of tongue thrust therapy and breaking down the barriers of access and outcomes.




Cease & Desist

If you are a clinician who is not certified in the use of the Stone Tongue Thrust Protocol you need to read this. It is important.

For those of you who know me, you know that there are few things I enjoy more than teaching. I love it when the light bulb goes on and a new concept is learned or a new skill developed.  I really love it when an individual is able to implement that teaching and do it as well as, or better than, the teacher.  Likewise, I also tend to be very generous in my teaching and keep it positive. I tend to teach by a carrot, not the stick…BUT

The time has come for me to bring out the stick.

You may not be aware that the Stone Tongue Thrust Protocol (STTP) is a copyrighted intellectual property and in order to have rights to use it you must be trained AND certified in both the assessment and treatment aspects of the STTP. I am aware of individuals and clinics who claim to be trained in the STTP who are not. I know that some of this is because of my teaching at the University where we used some of the tenets of the STTP in clinical practice or as you may have been introduced to the niche population of tongue thrust. This does NOT give you the authorization to use the STTP or train using the STTP in your clinical practice.

Now let me tell you why.

The Stone Tongue Thrust Protocol (STTP) is proprietary because of the structure and combination of education, muscle isolation, training sequence, intensity and OUTCOMES. We are consistently able to ELIMINATE tongue thrust in an average of 7-10 sessions with no regression. There is no other treatment method that has clinical data that supports those outcomes and especially in that time frame and the reason is because they do not have the proprietary formula.

I am not trying to be a big shot know it all expert. It is imperative that we maintain the integrity of the outcomes by ensuring that those who are using the STTP are trained in the ENTIRE formula and have the knowledge, expertise and skill to get those same outcomes.  If you have not completed the training and competency skill assessment to demonstrate that you have that knowledge, expertise and skill then you are not certified and you need to cease and desist using the STTP until you are.

I have had certification students validate the value of this certification and training process who were previously “trained” by someone in their clinic who had been exposed to the STTP either by me or by another clinician and they were not doing it correctly. They did not understand the protocol. They were not getting results. If you are going to use the STTP in your clinical toolbox you MUST be certified in the protocol. It is essential to protect the integrity of the protocol as well as the clinicians who are certified.

Consider becoming a Certified STTP Clinician!

I am in no way trying to withhold valuable, effective clinical methods! I WANT everyone to be a Certified STTP Clinician. However, it isn’t for everyone. Not everyone wants to work with the niche tongue thrust population.  But if you do, this certification is the most valuable you can have because…

You will be trained in the identification, assessment, diagnosis and treatment of tongue thrust

You will be able to achieve the unprecedented, duplicateable, efficient and effective outcomes of the STTP

You can freely and openly use the name, reputation, and outcomes of the Stone Tongue Thrust Protocol in your clinical practice and niche marketing

You and your clinic will be listed on the website where clients and referral sources look for the certified experts in tongue thrust

You will have access to ongoing education, mentoring and support offered only to Certified Clinicians

The Certification process is extensive, but every single person who has completed it agrees that it is so valuable and extensive that they couldn’t imagine doing it without (some had tried).

Your first tongue thrust client will pay for your certification! Everything after that is profit and growth! I can’t think of any other certification I have had that pays for itself so immediately.

Finally, you no longer have to schedule a 3 day workshop, travel, and take time off work, in order to become certified. The STTP Training Center is now online and allows 2 months to complete the training, skill development, and competencies. So convenient, so affordable, and YES so effective!

That’s how we roll! There’s not a lot of fluff.  There’s no BS.  Once you are trained and CERTIFIED you are welcome to use the STTP, market with the STTP, share your results with the STTP. In the meantime, please CEASE and DESIST until you have completed the Certification.

Information about STTP Courses can be found at You can also like and follow us on Facebook at Stone Tongue Thrust Protocol: STTP Training Center for information, announcements and community.

Don’t believe it! Something CAN be done!

Another mind-blowing experience I had the other day. I am going to change the names here to protect the innocent and the ignorant but unfortunately this story hit so close to home that I KNOW it is happening everywhere, all the time.

The situation takes place in a well-respected and highly knowledgeable dental office where the dentists, assistants, and hygienists have all received education about tongue thrust.  A 10 year-old child sitting in the dentist chair is accompanied by his mother and the dentist mentions that the boy has “tongue thrust”. The mother says “What is that?” The dentist briefly explains to the mother that it is the forward pushing of the tongue against the child’s teeth and it is contributing to his dental problems. The mother says “What do we do about it?” The dentist says “Nothing really”. No one else (assistant or hygienist) chimed in and mentioned tongue thrust therapy and that it can eliminate the tongue thrust resting posture and active thrusting. The mother left overwhelmed with a “problem” and no solution. The dentist will likely wait until the boy has all of his adult teeth mostly in and then refer to the orthodontist to have the palate spread, tongue basket or spikes, and braces followed by a permanent retainer.  After a year or so, the boy will be back at the orthodontist for a second set of braces because the teeth have moved again.

When this conversation  was shared with me I was so sad and frustrated. I don’t know why the dentist didn’t share tongue thrust therapy to eliminate the tongue thrust as an option. Was it because he has referred in the past and it wasn’t eliminated? Was it because it was too time consuming and the patient won’t stick with it? Was it because he didn’t know?

Please share this information with families, dental professionals and speech therapists! There IS effective tongue thrust therapy that is clinically proven to eliminate tongue thrust. The Stone Tongue Thrust Protocol has an average remediation time of 10 sessions which is completed in a few short months. Clinicians who are Certified using the Stone Tongue Thrust Protocol are trained to recognize who is and isn’t a good candidate for remediation to maximize participation and accountability. Which sounds like a better option for you as a patient or parent? 3 months of tongue thrust therapy with a clinician trained in the Stone Tongue Thrust Protocol or years of orthodontia, appliances and maybe even surgery?

Let me be clear, the Stone Tongue Thrust Protocol does not REPLACE orthodontia, but the dentists and orthodontists who refer for it tell our patients what a difference it makes, and some won’t even begin orthodontic treatment until the tongue thrust has been eliminated. It’s painless, efficient, and cost-effective. It SUPPORTS the orthodontia because it puts the oral muscles in the correct place to work in synchrony so that the structures stay in optimal position for efficiency and effectiveness when at rest and in motion. What patient wouldn’t want to know they have this option? What dental practitioner wouldn’t want to provide best care to their patients? What therapist wouldn’t want to have the best tools to treat their clients? This is a game changer and more people need to be aware of this option! “Nothing really” should never come out of a dentists mouth when asked what can be done about tongue thrust!


The Stone Tongue Thrust Protocol (STTP) is a clinically proven effective tool for the elimination of tongue thrust for individuals over the age of 8.  Cally R. Stone MS, CCC-SLP is a state licensed and nationally ASHA certified clinical Speech Language Pathologist who developed and authored the STTP.  Her clinical work with tongue thrust came initially as an outpatient hospital clinician who received referrals for tongue thrust due to the insurance company contract with the hospital providers.  Frustration with traditional tongue thrust resources falling short in the limited time allowed by the payors, as well as poor follow through by patients led to the integration of techniques used with neurogenic patients who demonstrated oral phase dysphagia.

When Cally became a private practice owner in 2003, she was able to further refine her tongue thrust treatment methods and consistently achieved exceptional results in a shorter amount of time that did not require the “tune ups” reported throughout the tongue thrust literature.  Her practice became well known for the Stone Tongue Thrust Protocol (STTP) with patients and practitioners recognizing the value and lasting results of eliminating tongue thrust by training a new resting posture and posterior swallow. The STTP is now available for a second generation of therapists to become certified in the appropriate identification and use of the Protocol for the assessment and treatment of tongue thrust.

Kudos to the Parents!

I am continually amazed that in 2016 we still have these perpetuated myths about tongue thrust, whether it exists, what to do about it and whether it matters. I guess I’m amazed because I’ve been effectively treating and eliminating tongue thrust for almost 15 years so when I hear these reports from clients, friends, or family I just shake my head in disbelief! Once I get done shaking my head, I get busy educating because that’s what I do!

Here’s the situation I’m going to start with because it just happened yesterday! Completing an evaluation with a 15 year old young man who has had speech therapy not once but twice in the past 10 years because of concerns with tongue thrust  by the PARENTS because of mouth breathing and jumbled dentition. He of course sees an orthodontist who uses appliances not only to spread his palate but also hinge his jaw to aid with dental alignment. The orthodontist agrees there is an issue with tongue thrust and refers to a speech therapist that is close by his office.  Unfortunately, this therapist is not trained in the elimination of tongue thrust so she does an articulation approach (understand that this child had no articulation errors) and no one sees any results or understands what is even to be expected.

Fast forward 5 years or so and the speech therapy is long gone, the braces are off and low and behold the teeth are going right back where they started! Maddening!  Kudos to the PARENTS who know this isn’t ok. Their child has had sinus surgeries and massive orthodontia and 10 years later is still breathing through his mouth and thrusting. He is now old enough that he doesn’t want his teeth to go back to an open bite (which it already has) and his parents are concerned that the open mouth posture is indicative of something else. Well yes it is! It’s tongue thrust and if you understand why his palate needed to be spread and his jaw needed hydraulics, you understand that it all has to do with the oral muscles we use to swallow. If you have a reverse swallow the front of the tongue is doing all of the work and not distributing the tongue where it should be as you mature from an infant to a toddler to a child to an adolescent and finally an adult. Yes, these mouths are changing for many years and if the muscles are not working properly you have all sorts of maladies like jumbled dentition, misalignment of the jaw, TMJ, articulation disorders, and now research is pointing to progressive swallowing problems as we age.

It’s kind of like the toddlers who walk on their tip toes and as they get older they receive physical therapy to release the tight tendons and retrain their gait so that it doesn’t throw off their muscles, spine and posture as they grow. Unfortunately, most people don’t “see” the effects of the reverse swallow and certainly don’t equate it to a tongue thrust so nothing gets done until the structures are set and even then they treat the symptoms with appliances and surgeries rather than fixing the underlying muscle and swallowing issues that are causing it all to begin with.

I have decided that these stories can be used to debunk the myths and bring both professionals and consumers into the reality that tongue thrust most definitely does exist, tongue thrust therapy can be done by a variety of professionals but the important thing is that they have specialized practical training in the elimination of tongue thrust as a swallowing disorder not just a tongue placement issue. I treat very few clients these days as I have changed my focus to educating the professionals with effective tongue thrust identification and elimination using the Stone Tongue Thrust Protocol. Because of this I feel confident that the word is spreading and people are getting it…  Then I have experiences like the one I share from YESTERDAY.  Oh boy! We still have a lot of work to do! Thank goodness for parents who are persistent and trust their gut.