Swallowing Exercises — What Caregivers Should Know

Oropharyngeal swallowing exercises are clinician-directed techniques that may support swallowing muscle function in selected patients with dysphagia. This page is educational information for caregivers and care-home staff — it is not a self-treatment guide. All exercises described here must be prescribed and supervised by a qualified Speech-Language Therapist (SLT).

Why Swallowing is Muscular

Swallowing is a coordinated neuromuscular action involving over 30 muscles. The tongue shapes and propels the food bolus; the soft palate closes the nasopharynx to prevent nasal regurgitation; the pharyngeal constrictor muscles drive the bolus downward; and the larynx elevates while the upper oesophageal sphincter relaxes to protect the airway. Age-related muscle decline (sarcopenia), neurological conditions, and structural changes can weaken any of these components, resulting in dysphagia. Targeted exercise may help maintain or partially rehabilitate muscle strength and coordination in appropriate candidates — a determination that belongs to the treating SLT.

Three Named Exercises (Educational Overview)

• Shaker Exercise (Head-Raise Exercise)

  Originally described by Reza Shaker, this exercise targets the suprahyoid muscles that elevate the larynx and open the upper oesophageal sphincter during swallowing. The patient lies flat, lifts only the head to look at the toes while keeping shoulders on the surface, holds, then lowers. Sustained and repetitive variants exist. The intended effect is to strengthen the muscles that widen the upper oesophageal inlet, which may reduce residue in the pharynx after swallowing. It must not be performed by patients with cervical spine pathology or significant cardiovascular conditions without medical clearance.

• Mendelsohn Manoeuvre

  The Mendelsohn manoeuvre involves consciously prolonging laryngeal elevation at the peak of a swallow, which in turn prolongs upper oesophageal sphincter opening. The patient swallows while deliberately holding the larynx at its highest point for several seconds before letting it descend. This technique requires the patient to have sufficient cognitive ability and voluntary motor control to follow verbal instructions. It is used as both a compensatory strategy during meals and as a therapeutic exercise in an SLT programme.

• Masako Manoeuvre (Tongue-Hold Exercise)

  The Masako manoeuvre asks the patient to hold the tongue tip gently between the front teeth while swallowing. The resistance placed on the tongue base during the swallow may strengthen posterior tongue-base retraction — the movement that drives the bolus into the pharynx. It is typically used as a therapeutic exercise rather than a mealtime compensatory strategy, as holding the tongue during food intake affects bolus control. Patients with dentition problems or oral sensitivity issues may not tolerate this manoeuvre.

When to Refer to a Speech-Language Therapist

Early referral supports better outcomes. The following signs may indicate swallowing difficulty and warrant an SLT assessment. This list is for awareness — it is not diagnostic criteria:

• Coughing or choking during or after meals
• Wet or gurgly voice quality after eating or drinking
• Unexplained weight loss, dehydration, or reduced appetite
• Recurrent chest infections or unexplained pneumonia
• Difficulty managing saliva or excessive drooling
• Prolonged mealtimes (over 30 minutes) or meal refusal
• Food or liquid coming back through the nose
• Complaints of food sticking in the throat or chest

Related resources:

• IDDSI Framework

  The global standard for texture-modified food and thickened drinks — how levels are defined and tested.

• Family Caregiver Guide

  Practical mealtime support for families caring for loved ones with swallowing difficulties.

• Healthcare Professionals

  Clinical resources, product datasheets, and RCHE training information for SLTs and dietitians.