Exercises and Postures to Help with Swallowing Problems: Basic Swallow Therapy for Dysphagia

There are three fundamental exercises and two basic postures that swallow therapists use to help a patient overcome swallowing difficulties as part of a comprehensive treatment plan.

The swallowing exercises are performed in order to strengthen the swallowing muscles to more effectively swallow without problems. Just like any other muscle in the body, targeted exercise will make a muscle stronger and more efficient.

Positioning maneuvers are to help with swallow, but is more geared towards helping to close off the airway thereby minimizing risk of aspiration.

The first technique is the Masako maneuver, which improves the function of the back of the throat during swallowing. For this exercise, the tongue is stuck out and placed between the teeth. Then you swallow while keeping your tongue held between the teeth the entire time. Perform 10 times, three times a day.

The second exercise is the Mendelsohn Maneuver which is a bit more difficult. When you swallow normally, the Adam's apple or your larynx moves upward. You can feel this movement by feeling for the notch on the top part of your voicebox and then swallowing. So when food or liquids go down with a swallow, the voicebox moves upward, and then back down as the swallow is completed.

With the Mendelsohn maneuver, you squeeze the throat muscles as tightly together as possible the moment the voicebox raises to its highest level during a swallow. The tongue is pressed tightly against the roof of the mouth. Hold this position for 3-5 seconds before relaxing. When holding the throat in this tightly squeezed position, you are holding your breath which is what naturally occurs during a swallow. This exercise just accentuates and strengthens that natural breath holding during swallow. Perform 5-10 Mendelsohn maneuvers three times a day.

The third strengthening exercise is to help with the swallow timing. Called a supraglottic swallow, there are 3 steps. First hold your breath. Step 2, swallow. Finally step 3, cough after the swallow is completed.

Now let’s talk about the 2 positioning maneuvers to help with swallow. Remember, these maneuvers help to close the airway to prevent aspiration of food or liquids. With both positions, remember to ALWAYS sit upright when you eat. It's very important to make sure that the person with the swallowing disorder is sitting up at 90 degrees every single time they swallow anything. It’s easier to do this in a chair, but if they happen to be in a bed, make sure to still sit up in the bed at 90 degrees or as far as they can go.

The first and most common position technique is called a chin tuck. Right before initiating a swallow, tuck the chin down to the chest. Once the head is down, swallow hard and fast, keeping the head all the way down the entire time. Once the swallow has been completed, then bring the head back up. By bringing the chin down to the chest, it helps to protect the airway as it opens the throat up in a way that makes it easier to swallow without aspiration. For some patients, this is the only they are able to swallow safely.

The second positioning maneuver helps mostly with people who have had a stroke that affects one side of their throat and vocal cords. For example, if someone had a stroke on the left side of the body, it is common to also have issues with the left side of the throat and voicebox. In this situation, swallowing should occur with the head turned towards the affected side…. the side that is not working.

When swallowing in this position, food and liquids preferentially goes down the opposite good side as the head turn essentially narrows closed the bad side of the throat.

Beyond, these basic swallowing strategies to help improve swallow, be sure to always use small sips or bites at a time. Perform 1 or more dry swallows after each bite or sip. After taking a bite of solid foods, chase it down with a sip of liquids. With liquids, hold it in the mouth for 2-3 seconds before attempting to swallow.

Be sure to work with a qualified speech language pathologist to further optimize and improve any persistent problems.

• Masako Maneuver (0:37)
• Mendelsohn Maneuver (1:04)
• Supraglottic Swallow (2:24)
• Chin Tuck (3:17)
• Head Turn Swallow (3:56)
• General Tips (4:29)

Video created by Dr. Christopher Chang:
https://www.FauquierENT.net

Actress:
Janine Collins
https://www.JanineCollins.com

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