Have you ever thought about your tongue in terms of balance and posture? Most of us associate balance with our inner ear, eyes, or feet, but it turns out the tongue, jaw, and their associated nerves may play a role in how we stand and move. While the research in this area is still in its infancy, some intriguing studies suggest that tongue position and stimulation might influence postural stability and balance.

In this article, we’ll dive into the anatomy and physiology of the tongue and jaw, explore the current state of research linking these structures to balance, and introduce you to the mind-blowing world of sensory substitution with devices like the BrainPort.

Before you dive in, I strongly encourage you to check out my article on the Three Bodily Balance Systems if you are unfamiliar with your body's mechanisms of balance.

Anatomy and Physiology of the Tongue, Jaw, and Associated Nerves

The tongue is an incredible organ. It’s not only vital for eating, speaking, and swallowing but also plays a potential role in balance and posture through its connections to various nerves and muscles. Understanding the anatomy and physiology of the tongue, jaw, and associated nerves gives us a clearer picture of why some researchers believe these structures may influence postural control.

1. The Tongue's Anatomy and Muscle Structure

The tongue is a “muscular hydrostat”, meaning it’s made up of muscles that can move independently of a skeletal structure just like an octopus arm. (1) These muscles fall into two main categories: intrinsic and extrinsic muscles.

• Intrinsic muscles are located entirely within the tongue and are responsible for shaping it during activities like speech or swallowing. These muscles allow the tongue to change shape: thinning, thickening, lengthening, or shortening.

• Extrinsic muscles, on the other hand, connect the tongue to various structures in the head and neck, such as the jaw (mandible), hyoid bone, and styloid process. These muscles are responsible for larger movements of the tongue, such as sticking it out, pulling it back, or moving it from side to side. Key extrinsic muscles include:

• Genioglossus (moves the tongue forward)

• Hyoglossus (pulls the tongue downward)

• Styloglossus (retracts the tongue)

• Palatoglossus (elevates the back of the tongue)

These muscles work in tandem to execute complex movements, but their connection to the skeletal system through the jaw can be particularly relevant to posture. (2)

2. The Jaw and Its Role in Head Posture

The jaw (or mandible) plays a critical role in maintaining head posture. (3) Since the tongue is anchored to the jaw, its position can indirectly affect how the head and neck align. (4) Poor jaw alignment or habitual mouth positioning may lead to subtle shifts in head posture, which could impact the body’s balance mechanisms. The temporomandibular joint (TMJ), where the jaw meets the skull, acts as a hinge that controls jaw movement and could influence overall postural alignment.

Research suggests that improper tongue and jaw positioning (for example, letting the tongue rest at the bottom of the mouth or clenching the jaw) may negatively affect the body’s sense of balance to a small degree. (5, 6) The hyoid bone, located in the throat and connected to the tongue, also plays a role in this system, acting almost like a “floating” anchor that coordinates with the jaw, neck, and skull.

3. Cranial Nerves and Their Connection to the Tongue

The tongue is innervated by several cranial nerves (nerves of the head) that are vital to its function. (7) These nerves relay sensory and motor information to the brain, but they also have secondary roles in proprioception and spatial awareness.

• Hypoglossal nerve (Cranial Nerve XII): This is the primary motor nerve that controls most of the tongue’s movements. It’s responsible for allowing the tongue to shift and adjust, which may indirectly affect oral posture and, in turn, contribute to head and neck alignment.

• Glossopharyngeal nerve (Cranial Nerve IX): This nerve provides sensory input from the back of the tongue, particularly for taste and sensation. It also has a role in swallowing and saliva secretion, all of which are coordinated processes that could indirectly influence body posture.

• Trigeminal nerve (Cranial Nerve V): While the trigeminal nerve is primarily associated with facial sensation and chewing, it also innervates parts of the jaw. Because of its role in jaw movement, dysfunction in the trigeminal nerve can potentially alter oral posture which might influence balance through changes in head and neck alignment.

4. The Vestibular System and Proprioception

While the tongue itself isn’t part of the vestibular system (the sensory system responsible for balance in the ear), it is closely tied to the proprioceptive system, which helps the body understand its position in space. (8, 9) Proprioception is essentially the body’s internal GPS, providing constant feedback to the brain about where different body parts are and how they are moving.

The tongue, due to its rich network of nerves and constant activity, may provide sensory information that the brain integrates into its overall sense of spatial awareness. (10, 11) Tiny adjustments in tongue and jaw position may play a subtle role in maintaining balance, especially when it comes to head posture, which directly affects balance.

5. Neuroplasticity and Balance

Neuroplasticity refers to the brain’s ability to reorganize itself by forming new nerve connections. (12, 13) This ability is key to why tongue stimulation may be linked to balance. The brain is capable of adapting to new sensory input and using that information in novel ways, or rather ways we wouldn’t normally expect. In individuals with vestibular disorders, for example, the brain may learn to use signals from the tongue (through devices like the BrainPort) as a substitute for the balance signals that are normally processed through the ears.

Neuroplasticity is particularly important when discussing tongue stimulation for balance because it explains how the brain can “rewire” itself to integrate new sources of information to help maintain posture and equilibrium.

What the Research Says (So Far) About the Tongue and Balance

Despite the complex anatomy and the potential links between the tongue and balance, research in this field remains thin. There are only a handful of studies that examine how the tongue might influence postural stability, and most are in early stages of exploration.

Tongue and Jaw Position’s Relation to Postural Stability

A key study conducted by Alghadir, Zafar, and Iqbal examined the effect of tongue position on postural stability in healthy young males. (14) The researchers discovered that maintaining different tongue positions (such as pressing the tongue against the roof of the mouth) had a significant effect on balance while standing still. When participants held their tongues against the roof of their mouths, they demonstrated improved postural stability, as measured by sway velocity and center of pressure movements. This suggests that tongue positioning might influence balance by helping to stabilize the head and neck, which are critical for maintaining equilibrium .

Bordoni et al. offered another perspective by looking at the anatomical relationships between the tongue, jaw, and overall body system. (2) While this study didn't focus directly on balance, it highlighted the deep connections between the tongue, jaw, and cervical spine. These interconnections suggest that changes in tongue posture, jaw alignment, and muscle activity might influence head posture and, by extension, balance. This anatomical framework provides a potential basis for why some studies show tongue stimulation or positioning can affect balance .

Electrical Tongue Stimulation and Balance

An intriguing study by Vuillerme et al. explored the role of sensory supplementation from the tongue in improving balance control. (15) In this study, electrotactile biofeedback via the tongue was used to provide information about head position in subjects with balance disorders. The researchers found that participants could use this feedback to improve their postural stability, especially when visual cues were removed. This suggests that the tongue, with its rich sensory capabilities, can act as a substitute for more traditional balance systems (like the vestibular system) when they’re compromised .

The concept of using tongue stimulation for balance has garnered considerable attention, especially in the form of the BrainPort technology. Wildenberg et al. investigated the effects of electrical tongue stimulation on the brain and found that it could induce sustained neuromodulation in cortical and subcortical areas involved in balance and spatial awareness. (16) Their findings showed that the brain is highly adaptable and can learn to integrate sensory signals from the tongue to aid in balance when vestibular function is impaired .

While these studies offer intriguing insights, it's important to consider the limitations. Many of the studies had small sample sizes or were conducted on specific groups, such as healthy young males or individuals with vestibular disorders. As a result, it’s difficult to generalize these findings to larger populations or those with different health conditions. Additionally, most of the current research is still in its early stages, meaning that while there are promising indications, much remains speculative.

Given the limited scope of research, it’s clear that while there may be an association between tongue position and balance, the current understanding is far from definitive. At best, we can say that there are interesting hints that the tongue plays some role in postural stability, but more studies are needed to confirm how significant this relationship is.

The BrainPort: Tongue Stimulation for Balance

One of the most exciting developments in this emerging field is the use of tongue-based sensory substitution devices, particularly the BrainPort mentioned above. This device is originally intended for those with blindness to help with “seeing” the world around them. The second generation device, the BrainPort Balance Plus, was designed to send electrotactile stimulation to the tongue, which sends sensory signals to the brain to compensate for impaired balance. Essentially, the BrainPort Balance Plus turns the tongue into a balance sensor.

Research led by Danilov et al. has shown promising results using the BrainPort with individuals who suffer from balance disorders due to vestibular loss (issues with the inner ear). (17) In these cases, individuals wear a small device that translates head/body movements into tactile feedback on the tongue, which the brain learns to interpret as information about body position. This can help people regain their sense of balance when other systems fail.

• One study found that individuals using the BrainPort could significantly improve their balance over time. The sustained cortical and subcortical neuromodulation induced by tongue stimulation appeared to promote neuroplasticity, meaning the brain adapted to use this new sensory input for balance control . (16)

What makes BrainPort fascinating is its use of the tongue as a substitute pathway for balance information. When the vestibular system is damaged, the brain is no longer able to receive the usual signals that help control balance. The BrainPort device takes advantage of the tongue’s sensitivity, sending electrical signals through its nerve endings to the brain. Thanks to the brain’s neuroplasticity, the ability to adapt and rewire neural pathways, users can retrain their brain to interpret these tongue-based signals as balance-related information, effectively ‘feeling’ balance through their tongues.

While the BrainPort is still a relatively new technology, it demonstrates the potential of the tongue as an alternative pathway for balance-related sensory information. As more studies are conducted, this may pave the way for further exploration of how the tongue and balance are connected in both healthy and impaired individuals.

Where Does This Leave Us?

At this point, we’re still in the early days of fully understanding the tongue’s role in balance. Research has shown that the tongue is intricately connected to systems that manage posture and stability, but much of this research is exploratory or focused on specific cases like vestibular loss.

• What we know so far:

• The tongue and jaw have deep anatomical and neural connections with systems that can be directly and indirectly involved in posture and balance.

• Changing tongue position can affect postural stability in controlled environments.

• Sensory substitution devices like the BrainPort offer exciting possibilities for people with balance disorders, using tongue stimulation to regain stability.

• What we don’t yet know:

• The full extent of how the tongue affects balance in everyday life for the general population.

• Whether these findings can be generalized to different age groups, health conditions, or more complex balance scenarios.

Final Thoughts: A Growing Field with Big Potential

So, while the research on the tongue and balance connection is still thin, it’s a fascinating area with real-world applications, particularly in the field of sensory substitution for balance disorders. The anatomical and physiological links between the tongue, jaw, and posture give researchers a lot of exciting questions to explore in the years to come.

As with many emerging fields, we won’t have all the answers anytime soon, but the studies conducted so far open the door to new ways of thinking about how our bodies maintain stability. Devices like the BrainPort give us a glimpse into the potential of tongue stimulation to assist with balance. As research grows, we’ll likely uncover even more about how this overlooked part of the body fits into the full picture of balance. Advances in technology and a deeper understanding of neuroplasticity are just beginning to scratch the surface of how the tongue and jaw might play a role in balance. Could we one day harness the sensory power of the tongue to help individuals with balance disorders on a wider scale? Only time, and further research, will tell, but the potential is certainly there.

If you're interested in improving your own balance or optimizing your overall wellness as you age, check out this presentation where I lay out my method for tackling all aspects of healthy aging!