Treating the Tensor Veli Palatini
I don't tend to have a lot of reason to work on intraoral muscle tissue, as I find that such tightness in muscles of mastication that we see with TMJ-D and similar issues is much more quickly alleviated with appropriate nerve work and then tracking down 'upstream' causes. But, the tensor veli palatini is in a uniquely high impact position and role that when irritated can cause seriously annoying symptoms or even long term damage to the body. This is because it is one of the muscles with attaches to the eustachian tubes, and can have a substantial and direct impact on ear pressure, as well as having the potential to through this connection, affect balance, hearing, some important nerves, sinuses, and then even the entire spiral line due to its intimate connection with the temporal bone. The good news is, it responds very well, and often very quickly, to manual work.
And crucially…when it's needed, it's needed,.with little else having adequate impact compared to manually working on this muscle.
When to expect an issue with the TVP
I most frequently see irritation in this muscle when there's been an ear infection or sometimes when in the adjacent systems of the sinuses. This is most notable when it's a recent and more substantial ear infection, but I've also had this be a lingering issue affecting someone's palatine/jaw mechanics, sinuses and ears for decades after a bad infection. So with any history of these kinds of issues, and related symptoms, it's worth a look.
A few years ago I had a patient who came in because she'd recently had an ear infection and the left ear had never drained of accumulated fluids. She had limited hearing out of that side (I had to kind of shout during our sessions) and some significant discomfort. And more importantly, the doctors were worried about the high sustained pressure leading to permanent hearing damage, and if it did not come down, they were going to have to puncture the eardrum to drain it. Even a medically punctured eardrum is a severely undesired outcome as that itself has some serious consequences that I am often having to treat in my patients years or decades after such an event.
As soon as we approached the TVP, she felt some immediate draining; it was stuck in an inflamed semi-spasm state which was not allowing for appropriate eustachian tube clearing and normalization of ear pressure. By the next session she had fully normalized hearing and pressure and felt back to normal. We did approach some neurological work with ear pressure and auditory nerves and so on, which helped prevent long term issues, but the matter at hand needed direct muscle work and nothing else would likely have had any adequate effect.
Symptoms/affected systems:
Ear pressure. It can negatively impact draining, as we see in the case above.
Hearing. Mostly as an effect of ear pressure issues.
Balance. Anything affecting the temporal bone and its various inner apparatus can have a large impact on vestibular function and overall balance.
Local cranial and jaw issues, especially those affected by the temporal and palatine bones.
Note via the roof of the mouth this includes lateral function not just locally in the jaw or even neck, but the hips and back; maxilla/palatine displacement can lead to migraines but also is a strong contributor/cause to sinus problems and quadratus lumborum dysfunction, which happen to be two of the biggest reasons I actually look to these bones to start with, besides symptoms of jaw dysfunction or history of local trauma.
The spiral line (think Anatomy Trains or similar) due to the TVPs impact on the temporal bone. Namely rhomboid/levator, serratus anterior, a range of abdominal tissue ipsi to contralateral, contralateral TFL down the IT band (I rarely see issues on the posterior spiral line from the spiral line itself).
Symptoms aside, if they have a history of ear infections and they're in my office, I probably want to check this at some point even with an absence of relevant symptoms. A patient may not have hit a symptom threshold that makes things really noticeable even when we definitely have work to do.
Treating the TVP
A few points first:
First and foremost, make sure you have the requisite training and coursework that may be required by your state board.
It's obvious but I want to say it anyway: sterilize and then glove for this work. I double glove as a default and that isn't thick enough to be a problem for oral nerve work so won't be a problem here either.
Describe what you're going to do with your patient before you start and what to expect, and let them know that if they are having panic or comfort issues, need to just have a break to swallow or adjust, etc. that they can just grunt at you or such and you'll remove your hand. Patient comfort is vital for this kind of work, especially as without being physicians or dentists, it's less expected and normal, which can compound any personal comfort or trauma history issues they may have. If they have a known strong gag reflex or other similar issue, I'll actually encourage them once I'm in position, to relax their jaw and if needed push their tongue against my hand (not licking obviously, just contact), as that proprioceptive contact will help them feel more in control and aware of what's going on.
So that said, let's get started.
I'll approach by having the patient open their jaw in a relaxed fashion, and I will put my finger just behind their upper teeth and slowly move back along the medial aspect of the teeth until I get towards the back of the palatine bone, letting my patient know as I move that we're almost there. I'll then flatten my fingertip on the palatine surface instead of the teeth and feel for the TVP just posterior to that, though I may have to go slightly superior as well, depending on their anatomy. Once I'm there I'll check in and make sure the patient is doing okay.
Ideally the muscle should be palpable but not aggressively so, being fairly soft and harder to make out. But if we have reason to be here it will likely either feel like a taught and dense cord, an inflamed cord, or some lovely mixture of both. I will continue my palpation from that lateral aspect going a bit more medial to check the length of the muscle (which is usually fairly uniform in its feeling), and narrating that I am going to move medial etc. so the patient isn't surprised (this can feel like someone is reaching down your throat at times, so I'm happy to over communicate).
I will start the treatment itself by doing gentle sawing like moving transverse to the fiber (sagittal), sliding coronally as I do so bit by bit. I'll probably only take 20 seconds or so doing this step. I will then contact a bit more solidly and with a bit more pressure with the pad of my finger, and slide medial and lateral like I'm doing a one finger pin and stretch. This tends to be pretty noticeable to the patient in a range of ways, and can have some nerve sensations, draining, feeling it in the eustachian tubes, and so on, so while I say more solid contact, we still mean very gentle.
This would also be the point, for you fellow neuro folks, I would add our parasympathetic stims as we laterally tension, especially as this will give the most direct force to the eustachian tube itself.
I will usually only take one minute or so to do this whole process on a side, but due to directly shared tension, we will want to treat both sides, with whatever break duration for the patient inbetween. Additionally, this is often when I would want to check the maxillary joint line for height disparity (with L raised, R low being most common, and the reverse being more of an issue when present) and address that with a cranial skill set, and any internal maxillary motility or mobility work, viscerocranial junctions etc. It's likely if we're here for the TVP, some of these points will warrant care if you have the skill set to do so, and a general cranial check afterwards (with emphasis on temporal and maxillary bones), as well as the trigeminal nerve, branches of which innervate the TVP.
On the neuro side for those who have that skill set, I will, after the above, want to approach positive and negative ear pressure, general audio input, vestibulocochlear nerves, sinus pressure, and potentially vestibular stimuli if needed.
On the whole I don't run into the need to work on this often, but when it's needed it can be a seriously powerful target for resolving symptoms and potentially preventing that patient from having damage to the ear apparatus. If you work with a population which is more prone to these issues, I would encourage you to study further into other eustachian and oral muscles in when and why you may want to approach those as well, but I find the TVP the most frequent, impactful, and necessary target for oral soft tissue work within our scope. Also while I mentioned several other treatment options and skill sets to assist this overall situation, the simple two minutes or so of soft tissue work on the TVP is the most important part most of the time, so don't skip over this for the sake of not having cranial, nerve, or Neuro based skillsets.