Take a good look at the tongue attachment now. Sometimes the little clip 
of the anterior tongue tie is not enough to give the baby good tongue 
function, and a little deeper snip will help. There's a lot more to 
tongue and jaw anatomy than just the length and extent of the lingual 
frenulum, unfortunately.
Sometimes exercises do work, even in cases where the baby would benefit 
from frenotomy/ more extensive frenotomy. Which one to offer is 
determined by exactly what the baby is doing with the tongue that is 
painful to mom. This can be determined by looking at mom's nipples, 
asking mom for a complete description of what she feels, and doing a 
digital suck assessment while realizing that since the breast (latched 
to correctly) is larger than the typical woman's finger, elevation 
restrictions may matter a tiny bit less if the baby can latch well. 
Unfortunately what we know about tt is that it causes a shallower latch. 
(confirmed by D. Ramsay's ultrasound work).

That said, the most common compensation for tongue tie is anterior 
tongue retraction and posterior elevation. Fingerfeeding with pressure 
on the posterior tongue any time the baby retracts and elevates can help 
some of them stop doing this. (Just my own clinical experience, no 
controlled studies yet, sorry). Other things work for other compensations.
Catherine Watson Genna, IBCLC  NYC

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