You’ve all heard of the head lift exercise (AKA the Shaker) that targets the suprahyoid muscles. It involves the patient lying down on a flat surface and repeatedly raising and lowering their head, as well as doing sustained head lifts. It can be difficult and uncomfortable for patients with complex health or mobility issues. What to do?

Enter the recline exercise! It’s like the head lift, but patients can do it while reclining. No need to get horizontal!

To do the recline exercise, your patient can be seated in an office chair (head completely unuspported) with a pillow behind their lower back so their hips and trunk are at a 135° angle. The exercise itself involves reclining and lifting their head from an angled position while seated. This approach still activates the suprahyoids since the patient’s head is suspended and supported by their neck muscles, but it is easier to do.
 

But wait, if the recline is easier than the head lift, then do patients get the same benefit?
 

“…choosing appropriate swallowing exercises [is] a difficult but important task that must balance efficacy with ease of use to maximize likelihood of adherence.”

 

– Larsen et al., 2021

In this study, Larsen and colleagues compared suprahyoid muscle activation between the recline exercise and the traditional head lift using surface electromyography. They also tracked perceived exertion and whether the patients could complete their set of exercises. The patients enrolled in this study had head and neck cancer and were at least 6-months post-radiation treatment. 
 

So, what did they find? 

• There was nearly double the muscle activation during the head lift exercise than the recline exercise. 
• The head lift exercise was perceived to be more difficult than the recline exercise.  Of note: Half of the head lift group needed modifications like bending their knees to relieve pressure from the lower back or placing a pillow under the lower back.
• Most patients in this study were able to complete all the exercises (recline and head lift), but two (out of eight) had difficulty. Both of those patients could sustain the recline exercise position longer than the head lift exercise, which supports the idea that the recline is easier. 

Ok, but what does this mean for you?

• The recline exercise may be a more comfortable alternative that still activates the suprahyoid muscles. Patients may be able to strengthen their suprahyoids by doing more repetitions to fatigue their muscles.
• A good idea from the authors is to start patients with the recline exercise to build up strength and then transition to the more challenging head lift exercise. 
• An important caveat is that this study did not include functional outcomes, and the recline exercise has not been used in a clinical study of patients with dysphagia. So, until there is some research showing improvement in swallowing function, it’s best to use the recline with the goal of transitioning to the head lift exercise.  

Larsen, A. M., Wolford, L. L., & Brobeck, T. C. (2021). A comparison of the head lift exercise and recline exercise in patients with chronic head and neck cancer post-radiation. Supportive Care in Cancer. https://doi.org/10.1007/s00520-020-05925-9 [open access]