Simple Exercises Instead of Having Esophagus Stretched or Dilated

Esophageal stretching or dilating is a procedure that is done when the Upper Esophageal Sphincter (UES) is not opening well, due to radiation treatment, muscle weakness, or other causes. When the UES does not open well, it makes it difficult to get foods to "go down" and can create a clogged or backed up pipe type of problem, frequently even resulting in vomiting during meals. There are simple exercises which have been shown to be effective in improving UES opening without having esophagus stretched or dilated.

The Shaker exercise was developed by Reza Shaker, MD, who is a Gastro-Interologist. He developed this exercise to improve Upper Esophageal Sphincter (UES) opening through exercises instead of a surgical procedure. This exercise has been tested in well known, well accepted research studies and shown to be very effective.

All speech language pathologists learn about this exercise in graduate school as they are learning to help people with swallowing disorders. Yet, for some reason, speech language pathologists rarely ever receive referrals from physicians to treat this disorder with simple exercises. Instead, patients are usually referred to have their esophagus stretched or dilated, to get temporary relief, over and over, until they are told it can't be done anymore and then they are left to suffer with this disorder. They are never sent to the speech language pathologist, even when they have nothing else to offer them! Perhaps the referring physicians just don't know about the Shaker exercise. Is that possible?

In recent years, there have been new developments, making the Shaker exercise even easier to do and maybe even slightly more effective. Modern research has determined that this exercise, which is normally done by lying in a supine position and lifting your head up and down, can also be done sitting upright with resistance under your chin as you nod your head up and down. This is called the Chin Tuck Against Resistance (CTAR) exercise. There are other exercises also which target the suprahyoid muscles, which can be helpful for this disorder. The suprahyoid muscles lift the larynx up and forward during the swallow, which is the movement that pulls the esophagus open. When the movement is stronger due to stronger suprahyoid muscles, the esophagus will open much better, in most cases. Simple exercises may well be equally effective, if not more effective in the long run, than esophageal stretching or esophageal dilating.

About the Author: Jolie Parker, MSCCC-SLP is a speech language pathologist who works with patients who have difficulty swallowing or a swallowing disorder, which is called dysphagia. She has over 20 years experience as a speech language pathologist and is a co-inventor of the ISO-CTAR Throat Exercise Device, which is an exercise tool designed to help patients improve swallow function by doing the Shaker exercise in the upright position, which is also called the Chin Tuck Against Resistance (CTAR) exercise. The device can also be used to complete the Jaw Opening Against Resistance (JOAR) exercise, which is another evidence based dysphagia exercise. 

 

 

Cricopharyngeal Dysphagia: Alternative to having esophagus stretched or dilated

I have come across many patients over the years who were not referred to me for this problem, but were referred for some other reason, who say they have had temporary relief from having the esophagus stretched or dilated, to help the UES open better, but they have to continue to have this done every year or so, and it can only be done so many times. Then, after that the physician has no other recommendations for them, no hope whatsoever!They suffer terribly with this condition, which causes great difficulty in getting food down and frequently even vomiting during meals. Some of them suffered for many years before I met them!

I've been able to completely correct this problem every single time, using the Shaker exercise, CTAR, JOAR, and lingual exercises that target the suprahyoid muscles. Full disclosure: I also use the CTAR/JOAR device I co-invented (alternativespeech.com). My patients are always extremely appreciative, but also very angry that their doctors never told them this could be fixed with exercises!

The Shaker exercise was invented by a GI, and is well documented to improve UES opening. So, surely the GI doctors know about this exercise, right? All SLPs learn about this exercise in graduate school. So, why are these patients not being referred to SLPs for this problem????

There seems to be a huge disconnect somewhere on this issue, between physicians and speech therapists, which is causing a lot of people to have completely needless, horrible suffering. Why is this happening, and what can we do to fix it???

About the Author: Jolie Parker, MSCCC-SLP is a speech language pathologist who works with patients who have difficulty swallowing or a swallowing disorder, which is called dysphagia. She has over 20 years experience as a speech language pathologist and is a co-inventor of the ISO-CTAR Throat Exercise Device, which is an exercise tool designed to help patients improve swallow function by doing the Shaker exercise in the upright position, which is also called the Chin Tuck Against Resistance (CTAR) exercise. The device can also be used to complete the Jaw Opening Against Resistance (JOAR) exercise, which is another evidence based dysphagia exercise.