Masako Maneuver

How To Do The Masako Maneuver

  1. Sit up straight
  2. Gather saliva in your mouth
  3. Stick out your tongue and hold it gently between your teeth
    • Relax your eyes and cheeks
  4. While holding your tongue between your teeth, swallow
  5. Repeat to fatigue (or in sets of 5-10 swallows, as appropriate)

A patient should not do this exercise with food or liquid; only their saliva.

For premade dysphagia handouts and treatment guides, check out The Adult Speech Therapy Starter Pack!

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About The Masako Maneuver

masako maneuver

The Masako maneuver (also known as Masako exercise or tongue-hold swallow) is a swallowing exercise. Its goal is to improve the movement and strength of the posterior pharyngeal wall.

In keeping the tongue between the teeth, this exercise aims to create more space in the throat. This causes the pharyngeal wall to compensate by performing larger movements when swallowing.

Masako Maneuver Contraindications

The Masako maneuver may be contraindicated for those with decreased hyoid displacement and/or poor pharyngeal motility. A patient should not do this exercise with food or liquid; only their saliva.

When To Use The Masako Maneuver

masako exercise

Use the Masako Maneuver with the following signs of dysphagia:

  • If a modified barium swallow study demonstrates:
    • Decreased tongue-base retraction
    • Residue in the pharynx
    • Decreased hyolaryngeal elevation
  • Pharyngeal weakness
  • Wet voice/gurgle after swallow or wet vocal quality

This exercise can be a bit tricky, so we recommended using it with patients with normal cognition to mild cognitive deficits.


  • American Speech-Language-Hearing Association. (n.d.). Adult Dysphagia. (Practice Portal). Retrieved Feb, 15, 2023, from
  • Masako, F., Logemann, J. A. (1996). Effect of a Tongue-Holding Maneuver on Posterior Pharyngeal Wall Movement During Deglutition. American Journal of Speech-Language Pathology. 5(1), 23-30.
  • (n.d.). Masako Maneuver. Medbridge. Retrieved February 15, 2023, from
  • Umay, E., Eyigor, S., Ertekin, C. et al. Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part II: Rehabilitation. Dysphagia 36, 800–820 (2021).

Patient Handouts

For evidence-based patient handouts, worksheets, templates, and much more, check out The Adult Speech Therapy Starter Pack!

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