Developing a performance persona osteopathy for singers

Osteopath and  former West  EndOsteopathy1536x1024 performer,  Jennie Morton,  talks about the most common issue she treats in singers. The cause of a hoarse voice may arise from an unexpected source. The Osteopathic philosophy views the body as a completely integrated system  and Osteopathic  treatment  is  aimed   at  facilitating  the  body’s   self-healing mechanisms through the use of manual therapy. As Osteopaths, we do not  separate the mind  and body  – they  are interdependent  systems –  and in  my work  with treating singers, I feel this is nowhere more apparent than in the manifestation of vocal  issues. The  voice is  an organic  instrument and  a vital part of our means  of  expression, whether  we  are professional  voice  users or  not,  and therefore treatment  must encompass  both the  physical and  emotional states in order to find resolution. The majority of issues I see with singers fall into the broad category of Muscle Tension  Dysphonia  (MTD).  This  is  where  increased  tension  in  the   vocal musculature  leads  to a  variety  of symptoms  which  can include  breathiness, hoarseness,  pitch changes,  breaks, weakness  etc., and  can manifest  with or without pain or discomfort. Usually there is no frank damage to the cords themselves, although this can be a sequela in extreme cases. So what can lead  to this muscle tension? If we look  at where the vocal apparatus sits in the context of the whole body, then we can start  to understand this better. The vocal  apparatus is  made up  of the  larynx (housing  the vocal cords), the thyroid and cricoid cartilages and the hyoid bone, which serves as an attachment point for many of the extrinsic muscles associated with phonation. The hyoid  is a unique bone in the body in  that it does not articulate (join with)  any other bone – it is literally suspended in space by the sling of muscles that surrounds it.   Osteopathic Coupled with its location at the front of the neck (one the most mobile areas of the body), it  is therefore very  reflective of any  postural asymmetries coming from structures below. Humans are programmed  by nature always to keep the  eyes level: this is  a  primitive survival  mechanism  that allows  us  to judge  distances  more accurately – useful when being approached by a predator! If we take the  example of someone with a dropped arch on one foot, this will pull the corresponding leg downwards leading  to a  sideways tilt  at the  pelvis, which  could potentially begin a ‘list’ in  the spine. The body  will then set up  a compensatory pattern where muscles will correct alternatively  right and left in a  ‘zig-zag’ fashion up the back until the final point of correction at the top of the neck to  bring the eyes  level. This  will result  in an  asymmetrical pull  through the hyoid muscles leading to imbalance and potentially to vocal strain. Neutral pelvic positioning is also key to optimal respiratory mechanics via  the abdominal and  respiratory muscles.  Sub-optimal pelvic  alignment can  serve to tighten or  slacken the  surrounding muscles,  which may  affect our  ability to receive a sufficient  in-breath. This will  then lead to  a lack of  sub-glottal pressure which, when aiming for higher  pitches or greater volume, may lead  the singer to overuse the muscles above the hyoid to achieve this. This can lead to tension and strain of the vocal muscles and the symptoms of MTD. ACUPUNCTURE Any singer who has experienced vocal issues will know that it can be a very stressful situation. Anxiety has its own postural  pattern that includes shoulder and neck  tension and high, shallow breathing.  This will also adversely affect sub-glottal pressure  and vocal muscle tension –  the more we worry,  the worse  it gets!  So stress-management  is also  a central part of regaining the voice. To summarise, the majority  of vocal issues I  see usually have their  origin in postural alignment, leading to inefficient  muscle use and strain. Vocal  issues are often put down to ‘poor technique’. but it is my belief that  many such technical problems arise because  the singer finds himself  or herself  fighting their  own anatomy.  Once an optimal neutral posture is  found and  the muscle  function is  better understood,  much of this strain disappears. Losing  one’s voice is  a loss of  self, so vocal  issues can often lead to  the voice becoming  ‘dissociated’ from the  rest of the  body. By working from the feet up, we can  reintegrate the voice into the body and  allow for the freedom of expression, which serves as the inspiration for all singers.

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