Looking for a simple but effective exercise to strengthen the entire swallowing mechanism using resistance?

So was I.

Over the years, I’ve tried many different exercises with my patients. One of my go-to favorites—though it earns me a few side-eyes from coworkers—is an unusual yet highly effective technique I call:

Pudding with a Straw

Yes, it’s exactly what it sounds like.

The patient drinks pudding through a straw.

They usually look at me like I’ve lost my mind… until they try it.

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Why It Works: The Evidence

Let’s break it down based on what the literature tells us:

• Straw use increases labial activation
  (Clark, 2003)
• Thicker, heavier boluses increase oral and pharyngeal activity
  (Robbins et al., 2008)
• Effortful swallow increases sensory input and muscle contraction
  (Wheeler-Hegland et al., 2008; Park et al., 2012)

Swallowing is a sub-maximal event. But when we intentionally ask for effort—swallow hard, swallow fast—we recruit more muscle fibers and strengthen the entire mechanism.

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Putting It All Together

When I try this myself (yes, I test these things), I feel it immediately:

• Lips purse with resistance.
• Tongue retracts and tightens.
• Jaw contracts for stability.

Add a cocktail straw (think coffee stirrer, not smoothie straw), and the challenge is on. The thicker the bolus, the greater the resistance. Add an effortful swallow cue, and now I’ve engaged nearly every component of the swallow—from labial seal to tongue base retraction and pharyngeal strength.

This is a functional, whole-system exercise rooted in neuroplasticity and task-specific training.

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Why Not Just Use a Device?

Because sometimes, pudding and a straw are all you need.

Sure, there are high-tech tools and devices. But this exercise:

• Requires no expensive equipment
• Can be easily modified
• Is engaging and task-specific
• Applies principles of resistance, salience, specificity, and repetition

We talk about treating the whole swallowing system—not just one phase in isolation. This exercise honors that.

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Patient Modifications

Not every patient can start with pudding and a cocktail straw.

That’s okay.

Here’s how I modify:

Straw Options (easiest to hardest):

• Smoothie straw (large diameter)
• Standard drinking straw
• Cocktail straw (smallest diameter)

Straw Length:
Shorter = easier (cut straws in half or thirds)

Bolus Options (thinner to thicker):

• Thickened liquid
• Applesauce
• Yogurt (no fruit)
• Pudding (varied by brand/temperature)

Pro Tip: Snack Pack chocolate pudding is often thinner than vanilla. Room temperature pudding is easier than cold.

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What’s the Goal?

You won’t see “drink pudding through a straw” in my goals.

Instead, I target:

• Labial seal
• Tongue base retraction
• Pharyngeal contraction
• Lingual strengthening
• Effortful swallow with resistance

I may time the task, track progress, and layer in surface EMG or e-stim for feedback. But the core goal is function.

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Progress and Documentation

Track patient time to complete the task. As strength improves, time should decrease.

Document like this:

“Patient completed effortful swallows using a weighted bolus and straw-based resistance for labial, lingual, and pharyngeal strengthening.”

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Just Try It

Don’t believe me? Try it yourself.

Start with vanilla pudding and a cocktail straw. Swallow hard and fast. Feel the engagement from lips to larynx. Now imagine the benefit for your patient.

Do you want to incorporate this exercise with your patients?   Download your free guide here.

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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Let’s Get Functional

This isn’t about busywork.

It’s about targeted, evidence-based therapy that works.

So next time you need a full-system exercise that’s low-cost and high-impact, reach for the pudding.

And don’t forget your straw.

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References (APA Style)

Burkhead, L. M., Sapienza, C. M., & Rosenbek, J. C. (2007). Strength-training exercise in dysphagia rehabilitation: Principles, procedures and directions for future research. Dysphagia, 22(3), 251–265.

Burkhead, L. M. (2009). Applications of exercise science in dysphagia rehabilitation. Perspectives on Swallowing and Swallowing Disorders, 18(2), 43–48.

Clark, H. M. (2003). Neuromuscular treatments for speech and swallowing: A tutorial. American Journal of Speech-Language Pathology, 12(4), 400–415.

Clark, H. M. (2005). Therapeutic exercise in dysphagia management: Philosophies, practices and challenges. Perspectives in Swallowing and Swallowing Disorders, 14(2), 24–27.

Lazarus, C., Logemann, J. A., Huang, C. F., & Rademaker, A. W. (2003). Effects of two types of tongue strengthening exercises in young normals. Folia Phoniatrica et Logopaedica, 55(4), 199–205.

Park, J. W., Kim, Y., Oh, J. C., & Lee, H. J. (2012). Effortful swallow training combined with electrical stimulation in post-stroke dysphagia: A randomized controlled study. Dysphagia, 27(4), 521–527.

Robbins, J. A., Gangnon, R. E., Theis, S. M., Kays, S. A., Hewitt, A. L., & Hind, J. A. (2005). The effects of lingual exercise on swallowing in older adults. Journal of the American Geriatrics Society, 53(9), 1483–1489.

Robbins, J. A., Butler, S. G., Daniels, S. K., Diez Gross, R., Langmore, S., Lazarus, C. L., et al. (2008). Swallowing and dysphagia rehabilitation: Translating principles of neural plasticity into clinically oriented evidence. Journal of Speech, Language, and Hearing Research, 51, S276–S300.

Wheeler-Hegland, K. M., Rosenbek, J. C., & Sapienza, C. M. (2008). Submental sEMG and hyoid movement during Mendelsohn maneuver, effortful swallow, and expiratory muscle strength training. Journal of Speech, Language, and Hearing Research, 51(5), 1072–1087.