Skip to main content

The Effects of Different Exercise Trainings on Suprahyoid Muscle Activation, Tongue Pressure Force and Dysphagia Limit in Healthy Subjects


Suprahyoid muscle activation and tongue pressure force play a critical role for swallowing function. In addition, dysphagia limit is one of most important factors indicating swallowing efficiency. The purpose of this study was to compare the effects of 8-week training sessions of three different exercises including chin tuck against resistance (CTAR), Shaker exercises and chin tuck exercise with theraband on suprahyoid muscle activity, anterior tongue pressure and dysphagia limit in healthy subjects. Thirty-six healthy volunteers aged between 18 and 40 years who scored below 3 points from Turkish version of Eating Assessment Tool (T-EAT-10) were included in the study, and all participants were divided into three groups randomly. Maximal suprahyoid muscle activations and dysphagia limit of participants were assessed by superficial electromyography. CTAR and chin tuck exercise with theraband increased the maximum suprahyoid muscle activation (p1 = 0.004, p2 = 0.018), whereas Shaker exercise did not increase maximal suprahyoid muscle activation (p = 0.507) after exercise training. CTAR and chin tuck exercise with theraband increased tongue pressure (p1 = 0.045, p2 = 0.041), while Shaker exercise did not increase anterior tongue pressure (p = 0.248). There was no statistically significant difference in dysphagia limits in three groups between before and after exercise training (p > 0.05). As a result, although CTAR seems to be the most effective exercise in most parameters, chin tuck exercise with theraband can also be used as an alternative to CTAR to improve suprahyoid muscle activity and tongue pressure.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. Macht M, White SD, Moss M. Swallowing dysfunction after critical illness. Chest. 2014;146(6):1681–9.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Molfenter SM, Steele CM. Physiological variability in the deglutition literature: hyoid and laryngeal kinematics. Dysphagia. 2011;26(1):67–74.

    Article  PubMed  Google Scholar 

  3. Shaker R, Easterling C, Kern M, Nitschke T, Massey B, Daniels S, Grande B, Kazandjian M, Dikeman K. Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology. 2002;122(5):1314–21.

    Article  Google Scholar 

  4. Yoon WL, Khoo JK, Rickard Liow SJ. Chin tuck against resistance (CTAR): new method for enhancing suprahyoid muscle activity using a Shaker-type exercise. Dysphagia. 2014;29(2):243–8.

    Article  PubMed  Google Scholar 

  5. Sze WP, Yoon WL, Escoffier N, Rickard Liow SJ. Evaluating the training effects of two swallowing rehabilitation therapies using surface electromyography—chin tuck against resistance (CTAR) exercise and the Shaker exercise. Dysphagia. 2016;31(2):195–205.

    Article  PubMed  Google Scholar 

  6. Page PA, Lamberth J, Abadie B, Boling R, Collins R, Linton R. Posterior rotator cuff strengthening using theraband(r) in a functional diagonal pattern in collegiate baseball pitchers. J Athl Train. 1993;28(4):346–54.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Demir N, Serel Arslan S, Inal O, Karaduman AA. Reliability and validity of the Turkish Eating Assessment Tool (T-EAT-10). Dysphagia. 2016;31(5):644–9.

    Article  PubMed  Google Scholar 

  8. Yoshida M, Groher ME, Crary MA, Mann GC, Akagawa Y. Comparison of surface electromyographic (sEMG) activity of submental muscles between the head lift and tongue press exercises as a therapeutic exercise for pharyngeal dysphagia. Gerodontology. 2007;24(2):111–6.

    Article  PubMed  Google Scholar 

  9. Ertekin C, Aydogdu I, Yuceyar N. Piecemeal deglutition and dysphagia limit in normal subjects and in patients with swallowing disorders. J Neurol Neurosurg Psychiatry. 1996;61(5):491–6.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. Hewitt A, Hind J, Kays S, Nicosia M, Doyle J, Tompkins W, Gangnon R, Robbins J. Standardized instrument for lingual pressure measurement. Dysphagia. 2008;23(1):16–25.

    Article  PubMed  Google Scholar 

  11. Stierwalt JA, Youmans SR. Tongue measures in individuals with normal and impaired swallowing. Am J Speech Lang Pathol. 2007;16(2):148–56.

    Article  PubMed  Google Scholar 

  12. Watts CR. Measurement of hyolaryngeal muscle activation using surface electromyography for comparison of two rehabilitative dysphagia exercises. Arch Phys Med Rehabil. 2013;94(12):2542–8.

    Article  PubMed  Google Scholar 

  13. Gao J, Zhang HJ (2017) Effects of chin tuck against resistance exercise versus Shaker exercise on dysphagia and psychological state after cerebral infarction. Eur J Phys Rehabil Med 53(3):426–432.

  14. Easterling C, Grande B, Kern M, Sears K, Shaker R. Attaining and maintaining isometric and isokinetic goals of the Shaker exercise. Dysphagia. 2005;20(2):133–8.

    Article  PubMed  Google Scholar 

  15. Huelke DF, Nusholtz GS. Cervical spine biomechanics: a review of the literature. J Orthop Res. 1986;4(2):232–45.

    CAS  Article  PubMed  Google Scholar 

  16. Falla DL, Jull GA, Hodges PW (2004) Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test. Spine (Phila Pa 1976) 29(19):2108–2114

  17. Mayoux-Benhamou MA, Revel M, Vallee C, Roudier R, Barbet JP, Bargy F. Longus colli has a postural function on cervical curvature. Surg Radiol Anat. 1994;16(4):367–71.

    CAS  Article  Google Scholar 

  18. Koskimies K, Sutinen P, Aalto H, Starck J, Toppila E, Hirvonen T, Kaksonen R, Ishizaki H, Alaranta H, Pyykko I. Postural stability, neck proprioception and tension neck. Acta Otolaryngol Suppl. 1997;529:95–7.

    CAS  Article  Google Scholar 

  19. Santuz A, Akay T, Mayer WP, Wells TL, Schroll A, Arampatzis A. Modular organization of murine locomotor pattern in the presence and absence of sensory feedback from muscle spindles. J Physiol. 2019.

    Article  PubMed  Google Scholar 

  20. Herzog W, ter Keurs HE. Force–length relation of in-vivo human rectus femoris muscles. Pflugers Arch. 1988;411(6):642–7.

    CAS  Article  Google Scholar 

  21. ter Keurs HE, Iwazumi T, Pollack GH. The sarcomere length–tension relation in skeletal muscle. J Gen Physiol. 1978;72(4):565–92.

    Article  PubMed  Google Scholar 

  22. Ertekin C, Aydogdu I, Yuceyar N, Tarlaci S, Kiylioglu N, Pehlivan M, Celebi G. Electrodiagnostic methods for neurogenic dysphagia. Electroencephalogr Clin Neurophysiol. 1998;109(4):331–40.

    CAS  Article  Google Scholar 

  23. Belo LR, Gomes NA, Coriolano M, de Souza ES, Moura DA, Asano AG, Lins OG. The relationship between limit of dysphagia and average volume per swallow in patients with Parkinson’s disease. Dysphagia. 2014;29(4):419–24.

    Article  PubMed  Google Scholar 

  24. Buchholz DW, Bosma JF, Donner MW. Adaptation, compensation, and decompensation of the pharyngeal swallow. Gastrointest Radiol. 1985;10(3):235–9.

    CAS  Article  Google Scholar 

  25. Selcuk B, Uysal H, Aydogdu I, Akyuz M, Ertekin C. Effect of temperature on electrophysiological parameters of swallowing. J Rehabil Res Dev. 2007;44(3):373–80.

    Article  Google Scholar 

  26. Ertekin C, Kiylioglu N, Tarlaci S, Keskin A, Aydogdu I. Effect of mucosal anaesthesia on oropharyngeal swallowing. Neurogastroenterol Motil. 2000;12(6):567–72.

    CAS  Article  Google Scholar 

  27. Ertekin C, Keskin A, Kiylioglu N, Kirazli Y, On AY, Tarlaci S, Aydogdu I. The effect of head and neck positions on oropharyngeal swallowing: a clinical and electrophysiologic study. Arch Phys Med Rehabil. 2001;82(9):1255–60.

    CAS  Article  Google Scholar 

  28. Oh JC, Kwon JS. Effects of resistive jaw-opening exercise with elastic bands on suprahyoid muscle activation in normal subjects. Folia Phoniatr Logop. 2018;70(3–4):101–8.

    Article  PubMed  Google Scholar 

  29. Oh JC. A pilot study of the head extension swallowing exercise: new method for strengthening swallowing-related muscle activity. Dysphagia. 2016;31(5):680–6.

    Article  PubMed  Google Scholar 

  30. Palmer PM, Jaffe DM, McCulloch TM, Finnegan EM, Van Daele DJ, Luschei ES. Quantitative contributions of the muscles of the tongue, floor-of-mouth, jaw, and velum to tongue-to-palate pressure generation. J Speech Lang Hear Res. 2008;51(4):828–35.

    Article  PubMed  Google Scholar 

  31. Pearson WG Jr, Langmore SE, Yu LB, Zumwalt AC. Structural analysis of muscles elevating the hyolaryngeal complex. Dysphagia. 2012;27(4):445–51.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Wakabayashi H, Matsushima M, Momosaki R, Yoshida S, Mutai R, Yodoshi T, Murayama S, Hayashi T, Horiguchi R, Ichikawa H. The effects of resistance training of swallowing muscles on dysphagia in older people: a cluster, randomized, controlled trial. Nutrition. 2018;48:111–6.

    Article  PubMed  Google Scholar 

  33. Pearson WG Jr, Hindson DF, Langmore SE, Zumwalt AC. Evaluating swallowing muscles essential for hyolaryngeal elevation by using muscle functional magnetic resonance imaging. Int J Radiat Oncol Biol Phys. 2013;85(3):735–40.

    Article  PubMed  Google Scholar 

  34. Castell JA, Castell DO, Schultz AR, Georgeson S. Effect of head position on the dynamics of the upper esophageal sphincter and pharynx. Dysphagia. 1993;8(1):1–6.

    CAS  Article  Google Scholar 

Download references


No funding.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Hasan Erkan Kılınç.

Ethics declarations

Conflict of interest

There is no conflict of interest.

Ethical Approval

All procedures performed in the study involving human participants were in accordance with the Ethical Standards of the Institutional Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

All participants signed an informed consent form.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kılınç, H.E., Arslan, S.S., Demir, N. et al. The Effects of Different Exercise Trainings on Suprahyoid Muscle Activation, Tongue Pressure Force and Dysphagia Limit in Healthy Subjects. Dysphagia 35, 717–724 (2020).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Deglutition
  • Deglutition disorders
  • Exercise training
  • Electromyography