Let’s talk about the chin tuck.

Not Chin Tuck Against Resistance (CTAR)—we’ll save that for another post—but the classic, compensatory strategy: “Just tuck your chin when you swallow.”

We’ve taught this one so well that nurses, respiratory therapists, and even Aunt Carol down the hall feel confident recommending it to every person who coughs with water or says they have trouble swallowing that one pill.

At some point, the chin tuck became the holy grail of swallowing strategies—right up there with diet modifications and thickened liquids. But should it be?

Let’s unpack it.

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What Is the Chin Tuck Supposed to Do?

The goal of the chin tuck is to change the physiology of the swallow.
According to Logemann (1993) and others, the chin tuck can:

• Widen the vallecular space
• Push the tongue base posteriorly
• Improve epiglottic inversion
• Narrow the entrance to the airway

Sounds great, right?

These changes can help reduce laryngeal penetration and aspiration, especially in patients with delayed swallow initiation or poor airway protection.

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When It Goes Wrong…

But here’s the thing: it doesn’t always work.

In fact, sometimes the chin tuck can make things worse.

I’ve had patients do just fine with thin liquids… until we tried a chin tuck. Suddenly? Aspirating.

One study (Robbins & Hind, 2008) compared:

• Thin liquids + chin tuck
• Nectar-thick liquids
• Honey-thick liquids

The chin tuck group actually had more aspiration events than those on thickened liquids. BUT—thickened liquids had more adverse effects, including:

• Dehydration
• Urinary tract infections
• Fever

So basically: chin tuck might not prevent aspiration, and thickened liquids come with their own bag of tricks.

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What Does the Research Say?

• Robbins et al. (2005) and Shaker et al. (2002) found the chin tuck was effective in 72% of patients studied.
• BUT—there’s a caveat. The strategy may be contraindicated in patients with weak pharyngeal contraction, as it can further reduce pharyngeal pressure and duration.

In other words, the chin tuck is not your one-size-fits-all solution. It has to match the physiology.

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When You May NOT Want To Use a Chin Tuck

• Poor pharyngeal constriction
• Reduced hyolaryngeal elevation
• Excessive residue in the pyriform sinuses
• Difficulty following multi-step directions
• When instrumentation shows it increases aspiration

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When Might It Help?

• Delayed pharyngeal swallow
• Reduced tongue base retraction
• Vallecular residue (but check first!)
• If it’s been confirmed via MBSS or FEES that it improves airway protection

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A PSA to All SLPs (and Anyone Handing Out Swallowing Advice):

“Don’t assume the chin tuck will always work—because it won’t.”

What works for Tom may absolutely backfire for Rick. That’s why your best friend in dysphagia therapy is the instrumental assessment. Use MBSS or FEES to trial and verify that a chin tuck actually does what you think it’s doing.

If it helps, great! If it doesn’t? Time to move on to other strategies (and possibly a referral to you-know-who).

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Final Thought

The chin tuck isn’t useless. But it’s not the miracle fix it’s often made out to be. Like all compensatory strategies, it works when it’s the right fit for the patient’s physiology.

So let’s stop handing it out like Halloween candy and start using it like the powerful, but patient-specific, tool that it is.

Are you ready for a deeper dive with even more resources available? Join the Dysphagia Skills Accelerator today. You will get so many great tools with new tools being added all the time! Click here to join now!

Have you ever wanted a way to create a more standardized protocol for your Clinical Swallow Evaluation?   Do you often forget or leave out parts of the CSE, you know, the parts that are important for your Plan of Care?  You probably need the Clinical Dysphagia Assessment Toolkit if you answered yes.   You can get your copy here.  

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References:

• Robbins, J., & Hind, J. A. (2008). Dysphagia research: evidence and clinical relevance. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 17(1), 2-6.
• Robbins, J., Gensler, G., Hind, J., Logemann, J., Lindblad, A., Brandt, D., … & Miller Gardner, P. (2005). Comparison of 2 interventions for liquid aspiration on pneumonia incidence: a randomized trial. Annals of Internal Medicine, 141(7), 509–517.
• Robbins, J., Butler, S. G., Daniels, S. K., Gross, R. D., Langmore, S., Lazarus, C. L., … & Rosenbek, J. (2008). Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. Journal of Speech, Language, and Hearing Research, 51(1), S276-S300.
• Shaker, R., et al. (2002). Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology, 122(5), 1314-1321.
• Logemann, J. A. (1993). Evaluation and Treatment of Swallowing Disorders. PRO-ED.
• Robbins, J., Nicosia, M., Hind, J. A., Gill, G. D., Blanco, R., & Logemann, J. (2002). Defining physical properties of fluids for dysphagia evaluation and treatment. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 11(2), 16-19.
• Robbins, J., Butler, S. G., Daniels, S. K., Gross, R. D., Langmore, S., Lazarus, C. L., … & Rosenbek, J. (2008). Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. Journal of Speech, Language, and Hearing Research, 51(1), S276-S300.