Why singers should think like swimmers to beat muscle tension dysphonia

Nearly every singer has muscle tension dysphonia (MTD). Pause for a moment and think about the fact that nearly everyone reading this article will have a condition almost none have heard of. We fear nodules and polyps and scour the internet for ways to assure ourselves we don’t have these dreaded conditions, yet the most common condition, MTD, is rarely discussed.

What if I told you that nearly every swimmer at the Rio Olympics had tightness and pain in their lower back muscles? Would you suggest they rush to the doctor, convinced they had torn their rotator cuff?

The analogy here is that the swimmer, pushing their arms and upper backs to an athletic extreme, will fatigue. Such extreme use causes inflammation in their shoulder joints, which alters their stroke. This will cause tension in their back muscles, due to the unusual pattern of muscle activation while swimming. For example, swimmers are supposed to use their shoulder and upper back muscles, but when pushed in competition, they engage some lower back muscles. After the race, these muscles can ache. When faced with the achy muscles, we do not usually fear injury in the swimmer. Instead, we understand that athletic excess can cause muscle engagement that allows for a greater outcome (i.e. faster, stronger, longer). Singers are not given the same allowance.

Typically, singers face scenarios when they have to push. Examples include long gigs (the equivalent of swimming a longer race at the Olympics), singing while sick (akin to an athlete swimming with mild shoulder joint inflammation), or working to develop a new part of their range (like training to swim faster). The push causes compensatory muscles to kick in. These muscles can ache because they are performing a task to which they are unaccustomed. As voice use continues, this becomes pain. This is referred to as muscle tension dysphonia. It is the finding, during a voice exam, of excessive use of muscles that are not typically used for voice production. For the singer, these patterns can develop during times of stress (singing while sick, for example) and become hard to undo.

Just as an Olympic swimmer needs help to undo stress and tension, so too does the professional singer.



Treatments for MTD vary according to whether or not there are any other findings. Some MTD develops as a compensation for laryngitis and must be treated by identifying the cause of laryngitis. At other times, MTD develops as a strictly muscular condition, in which case therapy may be needed to release the muscles that are tight. While pain does not indicate a vocal cord injury, it does suggest MTD. However, MTD can be caused by vocal cord damage. Before treatment begins, it is important to rule this out. Just like the swimmer needs to rule out a rotator cuff injury before beginning therapy, the singer needs to undergo a strobe to determine if an injury is present. Once

Before treatment begins, it is important to rule this out. Just like the swimmer needs to rule out a rotator cuff injury before beginning therapy, the singer needs to undergo a strobe to determine if an injury is present. Once accurate diagnosis is established, treatment can begin and is usually successful within one to two sessions.


Dr. Reena Gupta is the Director of the Division of Voice and Laryngology at the Osborne Head and Neck Institute (LA, California). She is a laryngologist/voice specialist who has devoted her career to caring for professional voice users. Dr. Gupta’s desire to care for voice patients stems from her passion for the vocal arts. She began singing in elementary school and continued through college and medical school, while pursuing her love for the art of medicine. She completed residency at New York University School of Medicine in Head and Neck Surgery and the prestigious fellowship in Laryngology and Care of the Professional Voice at Drexel University College of Medicine. Dr. Gupta strongly believes in advocating for performers and designs treatment plans that enable her patients to thrive in their careers. ohniww.org


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