Hyoid Exercises: What They Are and How to Do Them Safely

Hyoid exercises are a family of movements designed to strengthen the small muscles attached to the hyoid bone, a horseshoe-shaped structure in the front of your neck that plays a central role in swallowing. These exercises were originally developed for people with dysphagia (difficulty swallowing), and the research behind them comes almost entirely from swallowing rehabilitation. The most studied versions include the Shaker head-lift, chin tuck against resistance, the Mendelsohn maneuver, and tongue-press exercises, each targeting the hyoid muscles from a slightly different angle. Doing them safely depends on choosing the right exercise for your situation and, in most cases, working with a speech-language pathologist or similar clinician rather than experimenting on your own.

What the Hyoid Bone Actually Does

The hyoid sits just above the Adam’s apple, and unlike almost every other bone in your body, it doesn’t directly connect to another bone. Instead, it’s suspended by a web of muscles and ligaments that pull it in different directions. During a normal swallow, these muscles yank the hyoid up and forward in a quick, coordinated sequence. That movement lifts the larynx, helps seal off the airway so food doesn’t go down the wrong pipe, and tugs open the upper esophageal sphincter so the food bolus can pass through into the esophagus.

The muscles responsible for this are called the suprahyoid muscles, and they sit between the hyoid bone and your jaw, tongue, and skull. Research using imaging and structural analysis has shown that different muscles in this group have distinct jobs: the geniohyoid, which runs from the chin to the hyoid, has the greatest potential to pull the hyoid forward, while the mylohyoid, a flat sheet forming the floor of the mouth, is best suited for pulling it upward.¹ A CT-based study confirmed this division of labor during actual swallowing, finding that the stylohyoid, posterior digastric, and mylohyoid initiate the swallowing reflex and drive upward hyoid movement, while the geniohyoid is the key muscle for forward motion.² When any of these muscles weaken, the hyoid doesn’t move far enough or fast enough, and swallowing becomes less safe.

When Hyoid Exercises Are Prescribed

The most common reason someone ends up doing hyoid exercises is dysphagia following a stroke, head and neck cancer treatment, or age-related muscle decline. After a stroke, weakened neural signaling can reduce how far the hyoid travels during a swallow, leaving the airway partially unprotected and food or liquid at risk of entering the lungs. Radiation therapy for head and neck cancers directly damages the suprahyoid muscles themselves. Research has shown that radiation dose to the geniohyoid muscle is significantly associated with impaired hyoid movement and increased aspiration risk, establishing a direct link between muscle damage and swallowing failure.³

In older adults, sarcopenia (the gradual loss of muscle mass with age) affects the suprahyoid muscles just as it affects the rest of the body. The swallowing reflex slows, the hyoid doesn’t travel as far, and the upper esophageal sphincter doesn’t open as widely. Hyoid exercises aim to reverse or slow these changes. They’re also occasionally explored for obstructive sleep apnea, though that application is more peripheral to the core evidence base.

The Shaker Exercise (Head-Lift)

The Shaker exercise is the oldest and most widely studied hyoid exercise. You lie flat on your back without a pillow, then lift only your head high enough to look at your toes while keeping your shoulders on the ground. The original protocol involves both sustained holds (isometric) and repeated lifts (isokinetic). A typical session calls for three one-minute holds with a one-minute rest between each, followed by 30 consecutive head lifts.

The foundational study behind this exercise showed striking results in a specific population: tube-fed patients with dysphagia caused by poor upper esophageal sphincter opening. After six weeks of the exercise, all 11 patients in the treatment group showed significant improvement in sphincter opening and forward laryngeal movement, and all were able to resume eating by mouth. A sham-exercise control group showed no change.⁴ Those results generated enormous enthusiasm, but it’s worth noting that the study was small and focused on a very particular type of swallowing problem.

Later research has been more sobering. A randomized controlled trial of the Shaker exercise in patients treated for head and neck cancer found that despite high adherence to the training program, there were no statistically significant differences in objectively measured swallowing function between the exercise group and controls.⁵ This doesn’t mean the exercise is useless, but it suggests the benefits may be strongest for the specific swallowing impairment it was designed around, rather than being a universal fix for all types of dysphagia.

Chin Tuck Against Resistance

One practical problem with the Shaker exercise is that many of the people who need it most, particularly older adults and post-stroke patients, find it physically difficult. Holding your head up while lying flat demands a lot of neck effort, and the muscles doing much of that heavy lifting are the sternocleidomastoid muscles on the sides of the neck, not the suprahyoid muscles you’re actually trying to train.

Chin tuck against resistance, or CTAR, was developed as an alternative. You sit upright and press your chin down against something that pushes back, like a rubber ball or an inflatable device held against your chest. The exercise has both isometric (sustained press) and isokinetic (repeated press-and-release) versions, mirroring the Shaker protocol.

Electromyography studies comparing the two exercises found that CTAR produced equal or greater activation of the suprahyoid muscles while significantly reducing activation of the sternocleidomastoid muscles. Participants also reported that it felt less strenuous, even though the target muscles were working harder.⁶ A separate analysis confirmed these findings, concluding that CTAR was more specific in targeting the suprahyoid muscles than the Shaker exercise and that it was sufficiently intense to produce muscular fatigue in the right muscle group.⁷

A study of adults aged 65 to 90 tested whether different instructional methods changed how well people performed CTAR. Video-only instructions, video plus verbal coaching, and video plus biofeedback all resulted in similar muscle activation on average, though the biofeedback group performed more consistently, with less variation between individuals.⁸ The practical takeaway is that most people can learn CTAR from a video demonstration, though biofeedback can help if performance consistency matters.

The Mendelsohn Maneuver

Unlike the Shaker and CTAR, which are pure strength exercises, the Mendelsohn maneuver is a swallowing technique that doubles as a training tool. The idea is simple: when you swallow, your Adam’s apple rises. In the Mendelsohn maneuver, you deliberately hold it at its highest point for several seconds before letting it drop. This extends the window during which the hyoid is elevated and the airway is protected.

Three-dimensional CT analysis of the maneuver in healthy volunteers showed that it produces several distinct changes in swallowing mechanics. The hyoid bone reached a significantly higher position at maximum displacement, and the duration of pharyngeal closure was significantly longer than during a normal swallow.⁹ In post-stroke patients, practicing the maneuver as a rehabilitative exercise over two weeks led to significant changes in the duration of both superior and anterior hyoid movement.¹⁰ Other research in stroke patients has found that it positively affects the duration of upper esophageal sphincter opening, the same bottleneck the Shaker exercise targets.¹¹

The Mendelsohn maneuver is harder to learn than the head-lift or chin-tuck exercises because the feedback is internal. You have to feel your larynx rise and then consciously hold it, which requires a degree of body awareness that some patients struggle with. Clinicians typically teach it by having you place your fingers on your throat so you can feel the movement, then practice holding it while swallowing small sips of water.

Tongue-Press Exercises

An indirect but effective route to the suprahyoid muscles runs through the tongue. The geniohyoid muscle attaches to both the chin and the hyoid bone, and it sits right next to the genioglossus, which is a primary tongue muscle. When you press your tongue hard against the roof of your mouth, you recruit the suprahyoid muscles as part of the effort.

An eight-week tongue-strengthening program in healthy young adults found that the geniohyoid muscle increased significantly in cross-sectional area, growing from an average of about 2.3 to 2.6 square centimeters. Maximum tongue pressure also jumped substantially.¹² In elderly participants, tongue-pressure resistance training led to significantly greater anterior and superior hyoid movement during swallowing, with large effect sizes for both directions.¹³ These exercises typically use a small device you press your tongue against, with resistance set as a percentage of your maximum tongue pressure, but even pressing your tongue firmly against the hard palate without a device engages the same muscle groups.

Rapid Jaw-Opening and Other Variations

Researchers have explored several other ways to train the suprahyoid muscles. One approach involves rapid, maximum jaw-opening movements, targeting the fast-twitch fibers in the suprahyoid group. A protocol tested in older adults used three sets of 20 rapid jaw-opening repetitions with 10-second rests between sets, performed twice daily for four weeks.¹⁴ The rationale is that swallowing is a fast movement, and traditional slow-strength exercises like the Shaker may not adequately train the speed component.

A head-extension swallowing exercise, in which you tilt your head back and then swallow, has also been studied. One trial used 20-minute sessions twice weekly for eight weeks in healthy elderly individuals.¹⁵ The logic is that extending the head stretches the suprahyoid muscles, so swallowing in that position forces them to work harder against gravity.

Expiratory muscle strength training, or EMST, takes yet another indirect path. Using a handheld device that requires forceful exhalation, you recruit the submental muscle complex (which overlaps heavily with the suprahyoid group) in a way that electromyography shows actually produces longer-duration, higher-amplitude muscle activation than swallowing itself.¹⁶ EMST was originally developed for respiratory strengthening, but its crossover effects on swallowing muscles have attracted interest as a supplementary tool.

Safety Considerations

Hyoid exercises are generally low-risk, but “generally low-risk” and “safe for everyone to try unsupervised” are very different statements. The most important safety concern is that these exercises exist in a clinical context. If you have trouble swallowing, the cause matters enormously. Dysphagia from weak suprahyoid muscles responds to suprahyoid strengthening; dysphagia from a structural obstruction, a neurological condition affecting the brainstem, or severe tissue fibrosis from radiation may not, and doing exercises without a proper assessment could delay appropriate treatment.

For the Shaker exercise specifically, neck strain and discomfort are the most common complaints. Because you’re holding your head up from a supine position, the sternocleidomastoid and other neck muscles take on a heavy load. People with cervical spine problems, recent neck surgery, or significant neck pain should avoid it or discuss alternatives with their clinician. CTAR avoids much of this problem because the seated position keeps the neck in a more neutral alignment, and electromyography confirms that the sternocleidomastoid is significantly less activated during CTAR than during the Shaker exercise.⁷

The Mendelsohn maneuver involves actual swallowing, so there’s a small risk of aspiration if performed incorrectly or in someone with severe dysphagia. Clinicians typically assess swallowing function with imaging (often a videofluoroscopic swallow study) before prescribing maneuvers that involve taking anything by mouth.¹⁷ Tongue-press exercises and jaw-opening exercises carry minimal direct risk, though overdoing any repetitive movement can cause muscle soreness or temporomandibular joint (TMJ) discomfort in the case of jaw exercises.

What a Typical Protocol Looks Like

There is no single standardized protocol, which is one of the frustrations of this field. Different studies have used different dosing schedules, and no large trial has compared dosing head-to-head. That said, some patterns emerge from the research.

For the Shaker exercise, the original study used three sustained 60-second head lifts followed by 30 consecutive lifts, performed three times daily for six weeks. For CTAR, studies have generally mirrored that structure but adapted it for the chin-tuck movement. Tongue-press programs have used protocols of roughly 30 presses per session, three sessions per day, three days per week, for eight weeks, with resistance set at 60 to 80 percent of maximum tongue pressure.¹² The rapid jaw-opening exercise used a lighter schedule of three sets of 20 repetitions, twice daily, for four weeks.¹⁴

Most protocols run for four to eight weeks before reassessing. Measurable changes in muscle activity and hyoid displacement tend to appear within two to four weeks, though meaningful changes in swallowing safety and efficiency can take longer. If you’re working with a clinician, expect periodic reassessments, often using imaging, to track whether the exercises are translating into actual improvements in swallowing function.

Oropharyngeal Exercises and Sleep Apnea

The hyoid bone also plays a role in keeping the upper airway open during sleep. In people with obstructive sleep apnea, the airway collapses repeatedly during the night, and the position and muscular support of the hyoid are part of the structural picture. This has led researchers to test whether oropharyngeal exercises, a broader category that includes tongue, palate, and throat exercises alongside more targeted hyoid work, can reduce sleep apnea severity.

A Cochrane systematic review of myofunctional therapy for obstructive sleep apnea found that in adults, compared to sham therapy, the exercises may result in a large reduction in the apnea-hypopnea index, the main measure of sleep apnea severity. The evidence was graded as low-certainty, but the direction of benefit was consistent.¹⁸ A separate trial focused on patients with moderate sleep apnea found that upper airway exercises led to significant improvements in daytime sleepiness, oxygen desaturation, and snoring, with the majority of moderate-severity patients shifting to mild classification.¹⁹

These exercise programs are not identical to the dysphagia-focused hyoid exercises described earlier. They tend to include a wider mix of movements: tongue curls, palate stretches, cheek exercises, and breathing drills alongside chin tucks and swallowing maneuvers. But there is significant overlap in the muscles involved, and the hyoid’s dual role in both swallowing and airway maintenance makes it a natural crossover target.

Hyoid Position, Voice, and Surgical Recovery

Beyond swallowing and breathing, the hyoid bone sits at the anatomical crossroads of voice production. The larynx hangs from the hyoid, and changes in hyoid position directly affect vocal pitch and resonance. Research tracking patients after thyroid surgery found that fundamental vocal frequency dropped significantly, and hyoid movement patterns during certain vowel sounds changed measurably in the days following surgery.²⁰ The voice changes were tied to altered hyoid displacement, not just laryngeal nerve effects, suggesting the soft tissue disruption around the hyoid itself contributed to post-surgical voice problems.

Singers and voice professionals have long been aware that hyoid tension affects vocal quality, and some vocal coaching programs include exercises aimed at releasing or repositioning the hyoid. These tend to be gentler than dysphagia rehabilitation exercises and focus more on relaxation and mobility than on strengthening. Laryngeal massage, which involves manual manipulation of the muscles around the hyoid and thyroid cartilage, is used by some voice therapists for patients with muscle tension dysphonia. The evidence base here is thinner than for swallowing rehabilitation, but the anatomical logic is sound: a hyoid bone that can move freely in all directions is one that can support a wider range of vocal tasks.

From an evolutionary perspective, the hyoid’s position in the human neck is unusual. In other primates, the hyoid sits higher and is more tightly linked to the skull base. During human evolution, the hyoid descended within the neck, a change thought to be connected to the development of speech. That descent gave us an expanded vocal tract but also created the vulnerability that makes us uniquely prone to choking and aspiration among mammals. The exercises described throughout this article are, in a sense, compensating for a trade-off our species made long ago: a hyoid bone optimized for speech rather than for safe swallowing.