Strengthening the Upper Esophageal Sphincter (UES): Exercises for Speech-Language Pathologists

As speech-language pathologists (SLPs), we play a vital role in helping individuals overcome challenges related to swallowing difficulties, known as dysphagia. One key aspect of swallowing function is the coordination and strength of the upper esophageal sphincter (UES), a muscular valve that controls the passage of food and liquids from the throat into the esophagus. Strengthening exercises targeted at the UES can be instrumental in improving swallowing function and enhancing our ability to support clients with dysphagia effectively.

In this blog, we'll explore some of the best exercises for strengthening the esophagus UES. These exercises aim to optimize the coordination and muscle tone of the UES, ultimately facilitating safer and more efficient swallowing function for our clients.

Understanding the Upper Esophageal Sphincter (UES):

Before delving into the exercises, it's essential to grasp the role of the UES in the swallowing process. The UES serves as a barrier between the throat (pharynx) and the esophagus, remaining closed at rest to prevent food and liquids from entering the airway. During swallowing, the UES briefly opens to allow the passage of the bolus into the esophagus before returning to its closed position. The hyo-laryngeal complex of muscles helps to pull the UES open during the swallow. The following exercises can help to strengthen the hyo-laryngeal elevation (HLE) muscles.

Best Exercises for Esophageal UES Opening:

1. Chin Tuck Against Resistance (CTAR):

• Sit or stand comfortably with your spine in alignment.

• Place two fingers (fist, ball, towel, or a PhagiaFlex device) under your chin, applying gentle resistance as you attempt to tuck your chin towards your chest.

• Hold the chin tuck position against the resistance for 3-5 seconds, then release.

• Repeat this exercise for until the muscles under your chin are fatigued, gradually increasing the resistance as tolerated over time.

• CTAR strengthens the muscles responsible for UES opening while also promoting proper head and neck alignment during swallowing, which can aid in reducing the risk of aspiration and improved esophagus UES opening.

2. Shaker Exercise:

- Lie flat on your back and raise your head slightly off the ground.

- Gently lift your head up, then lower it back down.

- Repeat this motion for 30 seconds to 1 minute, aiming for 3-5 repetitions.

- The Shaker exercise targets the suprahyoid muscles, which play a crucial role in elevating the larynx and opening the UES during swallowing.

3. Mendelsohn Maneuver:

- Swallow normally, then as you feel the swallow reaching its peak, hold the contraction of the swallowing muscles.

- Focus on consciously elevating and prolonging the elevation of the larynx for 2-3 seconds before allowing it to return to its resting position.

- Aim to perform 5-10 repetitions of the Mendelsohn maneuver during each meal or swallowing exercise session.

- This maneuver strengthens the muscles involved in UES opening and promotes greater awareness and control over swallowing function.

4. Effortful Swallow:

- Take a small sip of water or a designated swallow-safe liquid.

- Swallow the liquid while exerting maximal effort, as if you're trying to swallow a large pill.

- Repeat this exercise 5-10 times during each meal or swallowing exercise session.

- The effortful swallow increases the force of the swallow, thereby enhancing UES opening and clearance of the bolus from the pharynx.

5. Tongue Base Retraction:

- Place the tip of your tongue against the roof of your mouth, just behind your front teeth.

- With the tip of your tongue in this position, retract the back of your tongue towards the back of your throat.

- Hold this position for 5-10 seconds, then relax.

- Aim for 2-3 sets of 5-10 repetitions.

- This exercise targets the base of the tongue and the pharyngeal muscles, promoting improved esophagus UES opening and bolus propulsion during swallowing.

Integrating UES Exercises into Clinical Practice:

As SLPs, incorporating these UES strengthening exercises into our clinical practice can enhance our ability to address swallowing difficulties effectively. By guiding clients through targeted exercises and providing personalized strategies for improving UES function, we can empower individuals to achieve safer and more efficient swallowing outcomes.

Conclusion:

Strengthening the upper esophageal sphincter (UES) is a crucial aspect of dysphagia management, and as speech-language pathologists, we are uniquely positioned to facilitate this process. By integrating targeted exercises into our clinical practice and collaborating closely with clients to optimize swallowing function, we can make significant strides in enhancing their quality of life and promoting safe and enjoyable eating and drinking experiences.

Remember, if you are a dysphagia patient, always consult with a qualified healthcare professional before initiating any new exercise regimen, especially if you have underlying medical conditions.

With dedication, consistency, and expert guidance we, as speech language pathologists, can leverage the power of UES strengthening exercises to transform swallowing function and improve the lives of those we serve.

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