Hyoid Exercises for Better Swallowing and Speech

Swallowing and speaking rely on a complex interplay of muscles, including those connected to the hyoid bone. Weakness or lack of coordination in these muscles due to aging, injury, or medical conditions can cause dysphagia (trouble swallowing) or speech impairments. Strengthening these muscles improves both functions, making daily activities like eating and communicating easier.

Specific exercises enhance the hyoid’s movement and stability, improving muscle coordination. Speech-language pathologists or healthcare providers often recommend these exercises for individuals experiencing swallowing or articulation difficulties.

Anatomy Of The Hyoid

The hyoid bone is unique in that it does not directly connect to any other bone. Suspended in the anterior neck at the level of the third cervical vertebra (C3), it serves as an anchor for muscles involved in swallowing, speech, and airway protection. Its horseshoe shape includes a central body, two greater horns, and two lesser horns, which provide attachment sites for ligaments and muscles that facilitate mobility. This mobility allows the hyoid to elevate, depress, and shift forward and backward, coordinating complex oropharyngeal functions.

Encased within a network of suprahyoid and infrahyoid muscles, the hyoid plays a central role in swallowing and phonation. The suprahyoid muscles—including the digastric, mylohyoid, geniohyoid, and stylohyoid—elevate the hyoid during swallowing, moving the larynx upward and forward to protect the airway. The infrahyoid muscles—sternohyoid, omohyoid, thyrohyoid, and sternothyroid—lower the hyoid after swallowing, returning it to its resting position. This interplay ensures food and liquid move safely into the esophagus while also adjusting laryngeal tension for vocal modulation.

The hyoid also plays a role in airway maintenance. Studies published in The Laryngoscope show that a lower-set hyoid increases the risk of airway obstruction in conditions like obstructive sleep apnea (OSA). Variations in hyoid morphology also affect vocal range and resonance, particularly in professional voice users such as singers and public speakers.

Muscles That Assist Hyoid Movement

The hyoid’s mobility depends on two groups of muscles: the suprahyoid muscles, which lift the hyoid and contribute to airway protection during swallowing, and the infrahyoid muscles, which lower the hyoid and reset its position. Their coordination ensures efficient swallowing and clear speech articulation.

The suprahyoid group includes the digastric, mylohyoid, geniohyoid, and stylohyoid muscles. The digastric, with anterior and posterior bellies, pulls the hyoid upward and forward, aiding in laryngeal elevation. The mylohyoid forms the floor of the mouth and supports hyoid elevation, while the geniohyoid moves the hyoid forward. The stylohyoid, originating from the styloid process of the temporal bone, stabilizes the hyoid during speech and swallowing.

The infrahyoid muscles—sternohyoid, omohyoid, thyrohyoid, and sternothyroid—counterbalance these movements. The sternohyoid depresses the hyoid after elevation, while the omohyoid provides additional downward force and stabilization. The thyrohyoid brings the hyoid closer to the larynx, affecting speech modulation, while the sternothyroid lowers the larynx, influencing vocal tone and resonance.

Coordination With Swallowing And Speech

The hyoid’s movement is essential for both swallowing and speech, requiring precise muscle coordination. During swallowing, the hyoid elevates and moves forward, facilitating laryngeal elevation and epiglottic closure to prevent aspiration. The suprahyoid muscles initiate this movement, while the infrahyoid muscles return the hyoid to its resting position after the bolus passes through the oropharynx. Disruptions in this sequence, such as delayed hyoid elevation or weak muscle contractions, can lead to dysphagia and increase the risk of choking or aspiration pneumonia.

Speech production also depends on hyoid positioning, as it influences laryngeal stability and vocal modulation. When the hyoid elevates, it alters vocal cord tension, affecting pitch and resonance. In tonal languages like Mandarin, where precise pitch control is necessary, the hyoid’s role becomes even more pronounced. Additionally, articulation of certain phonemes, particularly those requiring tongue elevation, depends on the hyoid’s ability to provide a stable base for lingual movement.

Neurological conditions such as Parkinson’s disease and amyotrophic lateral sclerosis (ALS) highlight the importance of hyoid coordination. Parkinson’s disease can cause delayed or diminished hyoid elevation, prolonging swallowing and increasing aspiration risk. ALS weakens the suprahyoid and infrahyoid muscles, leading to progressive dysarthria and dysphagia. Speech-language pathologists assess hyoid movement using videofluoroscopic swallow studies (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES) to determine impairment and guide therapy.

Types Of Hyoid Exercises

Targeted exercises strengthen and improve the coordination of muscles controlling hyoid movement, benefiting swallowing and speech. These exercises are commonly prescribed for individuals with dysphagia, speech difficulties, or weakened musculature due to aging or neurological conditions.

Head Lift

The head lift exercise, also known as the Shaker exercise, strengthens the suprahyoid muscles responsible for elevating the hyoid and larynx. Lying flat on their back, an individual lifts their head while keeping their shoulders on the ground, looking toward their toes. Holding this position for a few seconds before lowering the head back down builds endurance and strength.

Research published in Dysphagia shows that the head lift exercise increases anterior hyoid movement and improves upper esophageal sphincter opening, which is crucial for efficient swallowing. It is particularly beneficial for individuals recovering from stroke or those with weakened suprahyoid muscles due to aging.

Tongue-Hold Maneuver

The tongue-hold maneuver, or Masako maneuver, strengthens pharyngeal muscles and improves swallowing coordination. An individual places the tip of their tongue between their teeth and holds it while swallowing, forcing the pharyngeal muscles to work harder.

Studies in The American Journal of Speech-Language Pathology indicate that this maneuver increases posterior pharyngeal wall movement, aiding bolus propulsion. It is particularly useful for individuals with reduced tongue strength or difficulty clearing food from the pharynx.

Effortful Swallow

The effortful swallow exercise enhances muscle strength and coordination by increasing the force of contraction. An individual consciously swallows with as much effort as possible, engaging the suprahyoid and pharyngeal muscles more intensely than a normal swallow.

Research in The Journal of Speech, Language, and Hearing Research shows that the effortful swallow improves bolus clearance and increases hyoid elevation. It is especially beneficial for individuals with weak pharyngeal contraction, helping reduce food residue and lowering aspiration risk.

Shaker Exercise

The Shaker exercise strengthens the suprahyoid muscles, particularly for individuals with reduced upper esophageal sphincter opening. It includes an isometric phase, where the head is lifted and held, and an isotonic phase, where the head is repeatedly lifted and lowered.

Clinical research in The Annals of Otology, Rhinology & Laryngology demonstrates that this exercise improves anterior hyoid movement and esophageal sphincter function, reducing post-swallow residue. It is especially beneficial for individuals with dysphagia following head and neck surgery or those with weakened suprahyoid muscles due to neurological conditions.

Posture And Alignment Guidance

Proper head, neck, and shoulder positioning optimizes hyoid movement during swallowing and speech. Poor posture, such as forward head positioning from prolonged electronic device use, increases tension in the infrahyoid muscles, restricting hyoid elevation. Maintaining a neutral cervical spine position, with ears aligned with the shoulders, supports efficient hyoid function.

Posture also affects airway patency and vocal projection. Singers and public speakers adopt an upright stance to maximize hyoid mobility and laryngeal control. Research in The Journal of Voice shows that poor posture reduces vocal intensity and increases phonatory effort. Simple adjustments, such as keeping the chin slightly tucked and avoiding excessive neck extension, enhance swallowing safety and vocal clarity.

Additional Techniques Involving The Tongue

The tongue directly influences hyoid positioning, so strengthening lingual muscles further supports swallowing and speech. Weak tongue musculature can decrease hyoid movement, prolonging food transit and increasing residue accumulation.

Tongue resistance exercises, such as pressing the tongue against the roof of the mouth or a depressor, build muscular endurance. Studies in Clinical Dysphagia show that tongue resistance training improves hyoid elevation and pharyngeal constriction. Another effective technique is the lingual sweep, moving the tongue in controlled motions along the inner cheeks and teeth to enhance agility and pressure generation during swallowing. Incorporating these tongue-focused techniques alongside hyoid exercises improves eating and speaking efficiency.