Swallowing Problems in Adults: Exercises and Dysphagia Care in London & Essex
“Why does food feel as though it is sticking in my throat?” and “Are there exercises I can do to improve my swallowing?” are common questions from adults experiencing swallowing difficulties.
For patients across London, East London, Brentwood and Essex, the important first step is understanding why swallowing has changed. Exercises can be helpful for some forms of dysphagia, but the right exercise depends on which part of the swallowing mechanism is affected. Mr Gaurav Kumar, Consultant ENT Surgeon, assesses adults with throat, voice and swallowing symptoms and works alongside speech and language therapy and other specialities where required.
The NHS advises that dysphagia should be medically assessed because treatment depends on its cause and severity.
What is dysphagia?
Dysphagia is the medical term for difficulty swallowing.
You might notice problems swallowing food, liquids, tablets or even saliva. Some people feel their swallow doesn't start properly. Others cough during meals or feel food gets stuck after they swallow.
Problems can arise in two broad areas.
Oropharyngeal dysphagia involves moving food or drink from the mouth through the throat. People may cough, choke, need repeated swallows or develop a wet or gurgly voice after drinking.
Oesophageal dysphagia occurs farther down the food pipe. A person may swallow normally at first but then feel food sticking lower in the neck or chest.
The distinction matters because investigations and treatment may involve ENT, speech and language therapy, gastroenterology, neurology or several specialists together.
What symptoms can swallowing problems cause?
Symptoms can include:
- coughing or choking when eating or drinking
- needing several attempts to swallow
- food apparently sticking in the throat
- difficulty swallowing tablets
- a wet or gurgling voice after drinking
- unexplained changes to eating habits
- unusually long mealtimes
- avoiding certain textures
- regurgitation of food
- recurrent chest infections
- unintended weight loss or dehydration.
NICE includes coughing or choking around swallowing, a sensation of obstruction, painful or difficult swallowing, regurgitation and unexplained weight loss among indicators that should prompt consideration of specialist swallowing assessment.
Why might an adult develop dysphagia?
There is no single cause.
Swallowing can be affected by neurological conditions such as stroke or Parkinson's disease; weakness or coordination problems affecting the swallowing muscles; structural narrowing; previous head and neck treatment; inflammation; some oesophageal disorders; or abnormalities involving the throat and larynx.
Occasionally an obstructing lesion needs to be excluded.
This is why searching online for an exercise should not replace establishing the diagnosis.
Can swallowing exercises actually help?
They can help selected patients, particularly when an assessment identifies a specific weakness or movement that therapy aims to improve.
A 2025 systematic review evaluated interventions including the Mendelsohn manoeuvre, Shaker exercise, effortful swallowing and postural techniques. Many studies reported beneficial effects, but substantial variation remained across patient groups, treatment programmes, and outcome measures. The authors therefore regarded the overall evidence as encouraging but still preliminary.
A separate network meta-analysis of 25 randomised trials involving more than 1,000 adults also found evidence that several swallowing-rehabilitation approaches can improve swallowing outcomes in selected patients. Again, treatment must match the underlying impairment.
The Mendelsohn manoeuvre
During a normal swallow, the larynx or voice box rises.
The Mendelsohn manoeuvre involves deliberately prolonging this elevated position during part of the swallow. It may be prescribed to work on aspects of laryngeal elevation and opening at the upper end of the oesophagus.
It sounds simple, but technique matters.
Current NHS patient guidance states that the Mendelsohn manoeuvre should be completed only if a speech and language therapist recommends it. The therapist may also advise whether to practise it with saliva only or in another way.
The Shaker or head-lift exercise
The Shaker exercise is designed to work muscles involved in lifting the structures beneath the chin and helping the upper oesophageal opening during swallowing.
Traditionally, it is performed lying down, lifting the head toward the toes without lifting the shoulders.
It can be physically demanding. Research has reported neck fatigue and temporary discomfort in some patients, and modified exercises may sometimes be preferable.
An SLT should decide whether this is appropriate and what frequency or modification suits the individual.
Chin tuck and other swallowing postures
Patients sometimes find online advice telling everyone with dysphagia to “put your chin down when you swallow”.
This should not be treated as a universal rule.
Changing the head or neck position changes the geometry of the swallowing pathway. That may make swallowing safer for one particular impairment while being unnecessary or potentially unhelpful for another.
A swallowing therapist may trial chin-down positioning, head rotation or another posture during assessment to see whether it genuinely improves that patient's swallow.
Why a swallowing assessment is important
The purpose of assessment is not simply to confirm that swallowing feels difficult. It is to determine where the problem occurs and why.
An ENT assessment may include examination of the mouth, throat and neck and, where appropriate, flexible nasendoscopy. A thin flexible camera is passed through the nose to examine the throat, voice box and surrounding structures.
Speech and language therapists can perform a detailed clinical swallowing assessment.
Further investigations may include:
Sometimes neurological assessment, imaging or other tests are needed.
What can I safely do at home?
While waiting for assessment, concentrate on sensible measures rather than experimenting with multiple swallowing manoeuvres.
Sit upright and give meals your full attention. Eat slowly and avoid rushing. Good dental and mouth care is particularly important.
If a particular food repeatedly causes difficulty, do not repeatedly force it down.
However, you should not automatically thicken drinks, substantially alter your diet, perform swallowing exercises with food, or adopt a specific swallowing posture simply because you have seen it online. These measures should ideally follow an individual swallowing assessment.
The NHS similarly explains that changes in food consistency and swallowing therapy are selected according to the cause and severity of dysphagia.
When is specialist treatment needed?
Treatment is determined by the cause.
Some people benefit mainly from swallowing rehabilitation with an SLT. Others require nutritional input, treatment for an underlying neurological disorder or management of an identified throat or oesophageal problem.
Selected structural problems can require a procedure. Depending on the diagnosis, options might include treating oesophageal narrowing, managing a pharyngeal pouch, or another intervention directed at the underlying abnormality.
Surgery is therefore not a treatment for “dysphagia” itself. It is used when investigation identifies a condition for which a procedure is appropriate.
When should swallowing difficulty be investigated promptly?
New or progressive dysphagia should not simply be attributed to ageing or reflux without appropriate assessment.
Seek medical assessment particularly if swallowing difficulty is persistent or worsening, or occurs together with:
- unexplained weight loss
- a persistent hoarse voice
- persistent one-sided throat pain
- a new or enlarging neck lump
- pain when swallowing
- recurrent chest infections
- coughing or choking repeatedly when eating
- blood in vomit or coughed-up blood.
NICE currently recommends referral on a suspected cancer pathway for adults presenting with dysphagia when considering possible oesophageal or stomach cancer. This does not mean that most people with swallowing difficulty have cancer; it means the symptom merits appropriate investigation rather than prolonged self-treatment.
When is swallowing difficulty an emergency?
Call 999 if someone is choking and cannot breathe, speak or cough effectively, or if swallowing difficulty develops with signs of a stroke such as sudden facial weakness, arm weakness or speech disturbance.
Urgent medical assessment is also needed if someone cannot swallow their saliva, has major breathing difficulty or has a food bolus completely stuck and cannot swallow normally.
For urgent symptoms that are not immediately life-threatening, NHS 111 can help direct you to the appropriate service.
Private adult ENT assessment in London and Essex
An ENT consultation may be useful when swallowing symptoms appear to arise from the throat or larynx, particularly where there is associated hoarseness, throat discomfort, coughing, choking or a sensation of food sticking in the upper throat.
Patients attending from London, East London, Brentwood, Romford, Redbridge, Ilford, Woodford, Chelmsford and surrounding Essex areas can be assessed to determine whether investigation should focus on ENT, speech and language therapy, gastroenterology or another speciality.
The aim is not simply to prescribe an exercise. It is to understand the reason swallowing has changed and select the safest next step.
Conclusion
Swallowing exercises such as the Mendelsohn manoeuvre and Shaker or head-lift exercise are established parts of dysphagia rehabilitation and can be useful for appropriately selected patients.
They are not universal treatments.
The safest approach is to identify the type and cause of dysphagia first and then use an individual rehabilitation programme where appropriate.
If swallowing is becoming progressively harder, food repeatedly sticks, you frequently cough or choke during meals, or you have weight loss, persistent hoarseness, throat pain or a neck lump, arrange medical assessment rather than relying on exercises alone.
1. Can swallowing exercises cure dysphagia?
No single exercise treats every type of dysphagia. Exercises may improve specific swallowing impairments, but a speech and language therapist should first identify the cause and ideally select the programme.
2. What is the Mendelsohn manoeuvre?
It is a swallowing exercise that deliberately prolongs laryngeal elevation during part of the swallow. NHS guidance advises performing it only when an SLT recommends it.
3. What is the Shaker exercise for dysphagia?
The Shaker or head-lift exercise works the muscles involved in lifting the larynx and opening the upper oesophageal region. It is physically demanding and may not be appropriate for every patient.
4. Should I tuck my chin when swallowing?
Not automatically. Chin tuck is a compensatory technique that helps some swallowing patterns but not others. Ideally, it should be tested during an individual swallowing assessment.
5. Why does food feel stuck in my throat?
Possible causes range from poor coordination of the throat muscles to structural narrowing or oesophageal conditions. Persistent or progressive symptoms need assessment, not diagnosis from symptoms alone.
6. Which doctor should I see for difficulty swallowing?
Symptoms centred in the throat, particularly with hoarseness, choking or throat discomfort, may warrant ENT assessment. Other presentations may require speech and language therapy, gastroenterology or neurology.
7. When should dysphagia worry me?
Progressive swallowing difficulty, weight loss, recurrent choking, persistent hoarseness, pain on swallowing, blood or an unexplained neck lump should prompt medical assessment. NICE recommends a suspected-cancer pathway referral for dysphagia where upper gastrointestinal malignancy needs exclusion.
8. Can I learn swallowing exercises from YouTube?
Videos can help demonstrate an exercise after it has been recommended for you, but they cannot determine whether the exercise is appropriate for your swallowing problem.
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