No pain, no gain: Laryngeal massage for voice tension

Laryngeal Massage

Some singers are evangelical about the benefits of laryngeal massage to relieve vocal strain and tension. CLARISSA LAND investigates if this hands-on approach lives up to the hype.

At 21, fresh-faced and fresh out of university, I immediately began fronting a function band. I had no monitoring, no vocal training, no technique and no idea. After a few months, I began to lose my voice rather a lot. I was husky all day, every day. Initially delighted, I told anyone who asked that I was “a jazz singer, daahling”. But when Billie Holiday became Bonnie Tyler, I lived in perpetual fear of losing my voice permanently and, subsequently, my career and only income. I trundled off to my GP.

After an agonising six months, my ENT (Ear, Nose and Throat) referral arrived. I ventured to a rusty trailer opposite a Gala Bingo in a dodgy car park, soaking in the glamour. After a brusque welcome from a gruff ENT doctor, I hoarsely recounted my woes. He proceeded to insert a tube up my nose and down my throat and, with scant regard for tact, inform me I had vocal nodules. With that bombshell, he showed me the (very flimsy) door.

“Wait!” I cried, close to tears, “What kind of nodules are they? What should I do? Do I have to stop singing?”. Helpful to a fault, he grunted that this wasn’t his area and that I should find a singing teacher. Undeterred, I solicited his expert advice on how best to protect my precious and delicate hearing from loud drum kits and PA systems. Wordlessly, he pulled from a drawer a pair of industrial ear protectors, as modelled by that guy outside your window in the hi-vis jacket operating a pneumatic drill. Visualising myself wearing these on stage with a slinky red dress and stilettos, I concluded I’d exhausted him of all constructive knowledge. Moping out the door to catch a bus and weep some more, I resigned myself to figuring out a silent, penniless future.

Fast forward several years, I am sitting in a sunny room on a comfy sofa in London’s Harley Street, feeling trepidatious. I have an appointment with Ed Blake, founder of Physio Ed Medical Ltd, the UK’s leading clinic for vocal physiotherapy. The receptionist’s shelves are awash with files labelled like an A to Z of West End shows, TV shows and theatre schools. Mercifully, I haven’t had any voice problems in years: I’m just here for some maintenance and a nice larynx massage. Lah-di-dah, you think. You are wrong. You were misled by the word “massage”.

I recently discovered laryngeal manipulation therapy at a vocal coaches’ conference, during a seminar by Physio Ed Medical Ltd. I’d never heard of it. However, it instantly transpired that some singers in the room were devotees, equal parts evangelical and hysterical. “It’s euphoric! It’s horrific! You MUST go!” sang a chorus.

The woman in front excitedly whipped round to describe how the magic treatment had freed her whole voice, eradicating all tension and elevating her to the dizzying heights of vocal nirvana. But, she warned me, one pays a grave price: one must endure pain more brutal than the pangs of hell. Yikes. Another singer chimed in with a charming addendum: the procedure dredges up painful childhood memories and reopens old wounds from family conflict leading to uncontrollably sobbing throughout. How cathartic. Over lunch, yet more vocalists adamantly proclaimed that laryngeal massage is essential maintenance for all self-respecting professional singers. I later reflect on all this when Blake tells me singers are neurotic and musical theatre students frequently compare the procedure’s pain to childbirth, despite having given birth to exactly no children at all. “They love the drama,” he quips, in his Aussie twang.

So, naturally, curiosity got the better of me. Here’s the lowdown.

Who is Physio Ed Medical Ltd?

Physio Ed Medical Ltd is a boutique physiotherapy clinic for the entertainment industry, with a huge focus on voice. They look after big TV shows like Strictly Come Dancing, tour with global pop bands and facilitate a never-ending kick line of West End luvvies in hitting notes only dogs can hear for eight shows a week. Normal physiotherapists may stare at you vacantly at the mention of laryngeal manual therapy, but Physio Ed Medical Ltd is known for it.

What is laryngeal manipulation therapy?

It’s a manual (hands, yo) therapy to restore normal biomechanics to a mechanism at the mercy of others. More accurately, it’s a heavy-duty throat and neck massage and forceful kneading of your Adam’s Apple, to restore your voice box (larynx) to its factory settings.

Why would I let anyone do that me?

The larynx is naturally a very mobile structure, moving up and down whenever you swallow and change pitch. The muscles that control the movement of your vocal cords are particularly vulnerable to tension. Tension restricts movement in muscles causing clamping. Tight muscles cause the larynx to rest in an abnormally high position. This leads to poor muscle coordination and poor performance but can cause structural pathology such as nodules. When tight muscles are released, range comes back, the tone becomes clear again, and vocal fatigue disappears.

Tension results from poor technique, but also belting, alignment issues, heavy mic packs, costumes, raked stages, high heels, bad posture from phones and laptops, spasms associated with acid reflux, working shifts in noisy bars to pay your musical theatre tuition, and even which side you chew on.

Who is laryngeal massage it for?

Singers with voice problems, such as lost resonance or breathiness. You might be referred by your ENT, speech therapist or singing teacher. Or book your own appointment and tell him I sent you.

Who is it not for?

Me apparently. Blake doesn’t see much benefit to singers such as myself who have no symptoms, nor much point in maintenance generally. If an athlete aces a 400m sprint, he says, should they have regular deep tissue massage on their leg muscles to keep everything tip-top? Or should they leave everything alone, in case they upset the perfect balance? Either is fine, he says.

How often and how much?

On average, you’ll need two to three sessions, depending on the severity of your symptoms. A standard 30-minute appointment is £60, but for students or Equity and Musicians’ Union members, it’s £45.

Is it worse than labour?

No. Though I currently have no experience in that department either, thankfully.

I sit on the bed, looking at the ceiling with my mouth wide open. Blake stands behind me and expertly pulls his hand down the front of my neck. I lie down and Blake bends my head one way and the other, pushing hard beneath my jaw and behind my ears. Occasionally, I am required to stick out my tongue and make some strange noises. Five minutes later, I can’t tell if my voice is any more resonant though Blake comments on a change, but my jaw feels wobbly, as though it’s hang-ing by thread.

Is it pleasant? Far from it. It’s minor strangulation, except voluntary and with health benefits. At most, however, I would term the experience mildly uncomfortable. I can breathe well enough, I’m in no real physical pain and I’m perfectly calm throughout. In fact, I even remember laughing a little. Sure, I can think of myriad ways I’d rather spend my time, but if I ever had voice problems again I would walk through fire. This would be a walk in the park. And I can promise not a single traumatic memory came to the fore. In Blake’s words, “We try to steer clear of psychology with singers – I run late enough as it is.”

How soon will you see results from a laryngeal massage treatment?

Rapidly. According to Blake, if it’s going to work, it should be relatively instantaneous. Like taking the handbrake off a high-performance Ferrari, your voice should quickly accelerate.

N.B. If you haven’t been to see an ENT (Blake is very strict on this), you must show significant improvement within two treatment sessions or they won’t treat you any further until you do.

Ed Blake, Physiotherapist and Director of Physio Ed Medical
Ed Blake, Physiotherapist and Director of Physio Ed Medical, London
Ed Blake’s Top Tips for avoiding vocal muscle tension
  • Be the smart singer. Be aware of what you’re trying to do. Body awareness is important.
  • Do cool down (sirens are your friend)
  • Do educate yourself
  • Do be aware of posture and too much air pushing through.
  • Don’t push too much air
  • Don’t hang on your head when using your devices.


Clarissa Land is a London-based singer and songwriter currently recording her debut solo album. She sings, tours and records with major artists, most recently Crystal Fighters. She also has a busy teaching practice, where she provides vocal coaching to a wide range of singers; from the novice singer, all the way through to bands signed to major labels.