Critical Safety Notice

Consult a certified speech-language pathologist (SLP) before attempting any swallowing exercise described on this page.

Swallowing exercises are not appropriate for every patient. The wrong exercise performed in the wrong clinical context — for example, Shaker exercises in a patient with cervical spine problems — can cause harm. This page is for educational understanding only. It cannot substitute for an individual swallowing assessment and a personalised therapy programme.

To find a registered SLP in Hong Kong, search the Hong Kong Association of Speech-Language Pathologists (HKSLTA) directory at hkslta.org.hk.

The Science Behind Swallowing Rehabilitation

Swallowing is a complex reflex involving more than 30 muscles coordinated by the brainstem and cerebral cortex. When these muscles are weakened or dyscoordinated — by stroke, neurological disease or head and neck cancer treatment — targeted exercises can help by:

• Strengthening oral and pharyngeal muscles involved in swallowing
• Improving laryngeal elevation (critical for opening the upper oesophageal sphincter)
• Increasing active swallowing force, reducing food residue
• Retraining swallowing patterns through neuroplasticity

Important: The degree of improvement varies with the patient’s condition, exercise frequency and duration. Some exercises have strong evidence bases; others have mixed research findings. Your SLP will select the most appropriate exercises based on your individual assessment results.

Key Swallowing Exercises

1. Shaker Exercise (Head Lift Exercise)

Target muscles and swallowing phase: Suprahyoid muscles and laryngeal elevators. Primarily improves the pharyngeal swallowing phase — enhances laryngeal elevation, promotes opening of the upper oesophageal sphincter (UOS), reduces pharyngeal residue and aspiration risk.

How to perform:

1. Lie flat on a bed or the floor (supine), shoulders flat and not raised
2. Slowly lift the head as if trying to look at your toes, keeping the shoulders flat on the surface
3. Isometric (static) holds: Hold the head-raised position for 60 seconds, repeat 3 times
4. Isotonic (dynamic) repetitions: Raise and lower the head repeatedly, 30 times
5. Both components are required; perform 3 sets per day

Frequency: 3 sessions daily for 6 weeks (original research protocol)

Who should NOT perform this without SLP supervision:

• Patients with cervical spine conditions (cervical stenosis, cervical injury) — head lifting places significant stress on the cervical spine
• Patients who have recently undergone head or neck surgery
• Patients with severe cardiopulmonary conditions (the exercise can affect blood pressure and heart rate)
• Very frail or severely malnourished patients

Most relevant in Hong Kong for: Post-stroke pharyngeal dysphagia; dysphagia following head and neck cancer radiotherapy (begin only after completing treatment)

2. Masako Manoeuvre (Tongue-Hold Swallow)

Target muscles and swallowing phase: Pharyngeal constrictor muscles, particularly the posterior pharyngeal wall. Improves pharyngeal wall contraction and the efficiency of bolus propulsion through the pharynx.

How to perform:

1. Gently hold the tip of the tongue between your front teeth (light grip, not hard biting)
2. With the tongue tip held, perform a dry swallow (saliva only, no food or drink)
3. You will feel the swallowing action in the throat
4. Perform 10 repetitions per session, 3 sessions daily

Critical note: The Masako Manoeuvre is a training exercise — it should NOT be used during actual eating. Applying it at mealtimes increases aspiration risk because the tongue’s mobility is restricted, impairing its normal role in propelling the food bolus.

Who should NOT perform without SLP supervision: Patients with severely impaired oral sensation; patients with oral wounds or ulcers

3. Mendelsohn Manoeuvre (Laryngeal Hold)

Target: Training the patient to voluntarily extend the duration of laryngeal elevation, thereby prolonging the opening of the upper oesophageal sphincter — allowing more time for the bolus to pass through safely.

How to perform:

1. Perform a normal dry swallow
2. As you swallow, feel the larynx (Adam’s apple) rise
3. When the larynx reaches its highest point, deliberately hold it there for 2–3 seconds using muscular effort
4. Then allow the larynx to descend to complete the swallow
5. Perform 10 repetitions per session, 2–3 sessions daily

Confirmation: You can lightly place fingertips beside the Adam’s apple to feel the rise and hold. If you cannot feel or reproduce this, ask your SLP to demonstrate and guide you in person.

Who should NOT perform without SLP supervision: Patients with significantly impaired cognition (this exercise requires sustained intentional effort); patients with severe muscle weakness

4. Effortful Swallow

Target muscles and swallowing phase: All swallowing musculature, with emphasis on increasing tongue base contact with the posterior pharyngeal wall — reducing food residue in the vallecular space.

How to perform:

1. Perform a dry swallow (or swallow a small amount of food/liquid)
2. As you swallow, squeeze all the throat muscles as hard as possible — feel the tongue base pressing forcefully backwards
3. The sensation should be noticeably different from a relaxed swallow
4. Perform 10 repetitions per session, 3 sessions daily

HK application note: The effortful swallow is the exercise most readily applicable as a real-time compensatory strategy during actual meals. Some SLPs recommend using it at every mealtime following assessment. Whether it is safe and appropriate to use during eating must be determined by individual SLP assessment.

5. Supraglottic Swallow

Target: Voluntarily closing the vocal cords before and during the swallow, preventing food from entering the airway. Used for patients with reduced glottic closure function.

How to perform:

1. Inhale and hold your breath (breath-hold state after inhaling)
2. While holding your breath, place food in the mouth and swallow
3. Immediately after swallowing, cough once deliberately (to clear any material near the vocal cords)
4. Only then breathe again

Important caution: This technique involves breath-holding and deliberate coughing. It requires good respiratory control and adequate cough force. Patients with respiratory conditions (e.g., COPD) must exercise particular caution and must only use this technique after SLP assessment and instruction.

6. Tongue Strengthening Exercises

Target muscles: Tongue musculature in all directions, improving oral-phase bolus control and propulsion efficiency.

Resistance exercise using a tongue depressor (壓舌板):

1. Place a tongue depressor (available from pharmacies) on the tip of the tongue, pressing lightly downward
2. Push the tongue tip upward against the depressor’s resistance, hold 5 seconds
3. Repeat 10 times; repeat on each side of the tongue

Tongue range-of-motion exercises:

• Tongue protrusion (extend as far forward as possible): hold 5 seconds, repeat 10 times
• Tongue to left and right corners of the mouth: 10 times each
• Tongue to upper and lower lip: 10 times each

Purchasing tongue depressors in Hong Kong: Available at most pharmacies. Approximate price: HKD $10–20 per pack of approximately 50.

7. Lip Exercises

Target muscles: Orbicularis oris and surrounding facial muscles, improving oral containment — preventing food and liquid from leaking out of the mouth.

Basic exercises:

• Tight lip seal (without clenching teeth), hold 5 seconds, repeat 10 times
• Exaggerated lip protrusion (“oo” shape), hold 5 seconds, repeat 10 times
• Broad smile with teeth showing, hold 5 seconds, repeat 10 times

Why Unsupervised Home Exercises Without SLP Guidance Can Be Dangerous

Finding a Certified SLP in Hong Kong

In Hong Kong, speech-language pathologists complete degree training at a recognised institution and are typically members of the Hong Kong Association of Speech-Language Pathologists (HKSLTA).

How to search:

• Use the HKSLTA member directory at hkslta.org.hk
• Ask your attending doctor or ward nurse to refer to public hospital outpatient speech therapy
• Contact NGOs listed in related articles to ask whether swallowing assessment services are available

Public vs. private SLP:

• Public (HA): approximately HKD $80 per visit, but waiting times can range from weeks to months
• Private: approximately HKD $800–$2,500 per session, typically available within days to weeks

Frequently Asked Questions

Q: If a patient is doing swallowing exercises, when can they stop?

A: The duration of swallowing rehabilitation and when to reduce or stop depends on regular SLP reassessment. Generally, frequency is reduced after swallowing function has stabilised and treatment goals are achieved. Do not stop independently.

Q: Can swallowing exercises prevent dysphagia from developing?

A: Some exercises — particularly tongue and lip strengthening — may help maintain swallowing-related muscle function in the earlier stages of certain neurological conditions such as Parkinson’s disease. However, the evidence base for purely preventive exercise programmes remains limited. Consult an SLP about whether this approach is appropriate for the individual.

Q: Is some neck or muscle soreness after exercises normal?

A: Mild muscle soreness (similar to general exercise-related aching) can occur after some exercises. However, neck pain, headache or any severe pain is not normal — stop immediately and inform your SLP.

Information on this page is for educational purposes only and does not constitute medical advice. Swallowing exercises must be performed under the assessment and guidance of a speech-language pathologist. Do not start any swallowing exercise programme independently.