Monday, September 5, 2016

In honor of Labor Day! (I know, wrong kind of labor) Strengthen your Pelvic Floor Muscles for a Stronger, Healthier Voice: A look at the anatomy, biomechanics and exercises to get you singing at your best!







Exercises to promote awareness, flexibility and strength of the pelvic floor

  • *  Sit on a hard surface and make sure you are sitting on your sit bones or ischial tuberosities. Find a neutral pelvis by gently rocking the pelvis back and forth and side to side. Once you have found neutral, inhale through your nose and feel the body expand to breathe into the lateral ribcage, back and pelvic floor (downward). Inspiratory diaphragm also moves downward as you inhale. As you exhale on a "hum" feel and encourage the pelvic floor to move up and inward, toward your head.  Release pelvic floor at the end of the utterance.  Your breath should return automatically.  Repeat.

  • *  Lean forward with your elbows on your knees and repeat the inhalation/exhalation exercise. Feel the deeper course of the inspiratory diaphragm and the pelvic floor expansion in this position and the upward and inward motion of the pelvic floor on the exhalation/ hum. Repeat with different h-syllables, e.g., /ha/, /he/, /hi/, /ho/, /hu/.

  • *  Move into child's pose making sure you are not tucking your pelvis first before you stretch your torso forward and away from your hips. Inhale and exhale, noticing your breath and with an increased awareness of the pelvic floor. Perform a lift followed by a release of the pelvic floor muscles. Repeat 10 times. This is an agility exercises and will help you have more control of engaging and releasing PFM.

  • *  While in child's pose, transition to lifting the pelvic floor and sustaining that lift.  Increase progressively, releasing the pelvic floor musculature for equal counts after each lift/sustain.  Work up to 10 counts each of lift/sustain and release.  This is an endurance exercise and will translate to the pelvic floor musculature strengthening.  A strong pelvic floor can engage and support phonation through a long spoken or sung phrase easily. E.g., lift 1, release 1; lift 12, release 12; lift 123, release 123, etc.

  • *  Repeat the process with your favorite sung vowels.

    * Inhale and on your exhale slowly stand. Feet stay hip distance apart and pelvis restores to neutral as your body straightens. Release your knees as you inhale and go into a feet parallel plié.  Inspiratory and pelvic diaphragms move downward. Lift pelvic floor upward as you exhale and slowly stand. Couple this with sustained speech or singing in place of exhaling air. 



  • The role of the pelvic floor: considerations in voice production



    Breathing
    • *  The inspiratory diaphragm works in a symbiotic, phase-locked relationship with the pelvic floor (pelvic diaphragm).
    • *  As the inspiratory diaphragm courses downward during inhalation, so does the pelvic floor and the larynx
    • *  If the pelvic floor is not released, it compromises the inhalation by limiting the course of the inspiratory diaphragm
      *  The pelvic floor descends and expands as the vocal folds open during inhalation



  • Phonation

    *  The pelvic floor and transverse abdominis co-contract during forced expiration/phonation.

    *  Support must come from dynamic, coordinated musculature of the pelvic floor and transverse abdominis.
    *  Inhalation expansion ends at pelvic floor and support for forced exhalation and phonation begins at pelvic floor. 



    Physical Considerations

    • *  Globally, alignment of the body is impacted by the pelvis
    • *  The jaw mimics the pelvis; too much tension in the jaw can obstruct the pelvic floor
    • *  Pelvic floor, inspiratory diaphragm, 1st rib, glottis and soft palate need to be stacked
      above one another in alignment
    • *  Because of the central position of the pelvis, small shifts can result in big changes, e.g., a
      big twist in the neck
    • *  Pelvic floor supports almost every movement we make
    • *  Knee and feet movements are connected to pelvic floor; if the pelvic floor is balanced, so then are the feet
    • *  Tension in the upper body can obstruct pelvic floor function
    • *  A tight pelvic floor can lead to constipation; vice versa
    • *  A weak pelvic floor can lead to urogenital dysfunction
    • *  Glottic insufficiency can lead to pelvic floor dysfunction
    • *  Of note, hormone receptors are identical in larynx and urogenital region (Abitbol)
    • *  Wearing high heels can obstruct pelvic floor function 

    • References

      1. Austin, S. (2013). Building strong voices -12 different ways, part III. Journal of Singing. 69(5): 603-613.

      2. Bedekar, N. (2012). Pelvic floor muscles activation during singing: A pilot study. Journal of Association Chartered Physiotherapists in Women’s Health. 110:27-32

      3. Bo, K., Sherburn, M., Allen, T.J. (2003). Transabdominal measurement of PFM activity when activated directly or via a transversus abdominis muscle contraction.. Neuourology and Urodynamics. 22(6) 582-588. 

      4. Boones, D.R. (1988). Respiratory training in voice therapy. Journal of Voice 2(1) 20-25. 

      5. Critchley, D. (2002). Instructing pelvic floor contraction facilitates transverse abdominis thickness increase during low-abdominal hollowing. Physiotherapy Research International, 7(2), 65-75.

      6. Deeter, A. W. (2005). Overlooked and Undermining: A Look into Some of the Causes, Effects, and Preventatives to the Dysfunctions Generated by Excessive Tension. Journal of Singing, 62(1), 27-31.

      7. Doscher, B. (1988). The functional unity of the singing voice. Metucher, NJ. Scarecrow Press: 57. 

      8. Franklin, E. (2003). Pelvic power, mind and body exercise for strength, flexibility and balance. Heightstown, NJ: Princeton Book Company.

      9. Gómez Vilda, P., Belmonte Useros, E., Rodellar Biarge, M., Nieto Lluis, V., Álvarez Marquina, A., & Mazaira Fernández, L. M. (2013). Biomechanical evaluation of the singing voice. Journal of Voice. 

      10. Griffin, B., Woo, P., Colton, R., Casper, J., Brewer, D. (1995). Physiological characteristics of the supported singing voice: a preliminary study. Journal of Voice 9(1) 45-56

      11. Han, D., Ha, M. (2015). Effect of PFM exercises on pulmonary function. Journal of Physical Therapy Science. 27: 3233-3235

      12. Hardy, L. (1958). The physiology of breathing. (1958). The Bulletin (NATS). Dec 12-14. 

      13. Hawkins, C. (2007). The mechanics of breathing as applied to different vocal tasks. Communication Voice. 8(1)

      14. Hodges, P.W., Gandevia, S.C. (2002). Postural activity of the diaphragm is reduced in humans when respiratory demand increases. Journal of Physiology. 89: 967-976

      15. Hodges, P.W., Sapsford, R., Pengel, L.H.M. (2007). Postural and respiratory function of the pelvic floor muscles. Neurology and Urodynamics. 20:362-371

      16. Holmes, L. (2006). A conversation with Patricia Craig. Journal of Singing. May/June 62(5) 579-585

      17. Hixon, T.J. (1979). Respiratory function in speech and singing: myth and reality. Transcripts from 8th Symposium.

      18. Leanderson, R. (1987). Discussion: Pitch, abduction quotient, breathing. Journal of Voice (3): 273

      19. Leanderson, R., Sundberg, J. (1988). Breathing for singing. Journal of Voice. 2(1): 2-12. 

      20. Leanderson, R., Sundberg, J., Von Euler, C. (1987). Breathing muscles activity and subglottal pressure dynamics in singing and speech. Journal of Voice. 1(3) 258-261.

      21. Leanderson, R., Sundberg, J., Von Euler, C. (1989). Effects of diaphragm activity on phonation during singing. 13th symposium part I. New York.

      22. Macdonald, I., Rubin, J.S., Blake, E., Hirani, S., Epstein, R. (2012). An investigation of abdominal muscles recruitment for sustained phonation in 25 healthy singers. Journal of Voice. 26(6): 815-e9.

      23. MacRae, T. (1948).Breathing and its effect on singing. NATS

      24. McCarther, S. (2014). Being careful with cueing, part 1: the pelvis head and neck. Journal of Singing. 71(1): 17-25

      25. Melton, J. (2009). Essay The Technical Core: An Inside View. Voice and Speech Review, 6(1), 431-435.

      26. Miller, R. (1983) The misuses and “scientific information” in the teaching of singing. Sotto Voce Jan/Feb 28-29. 

      27. Moliterno, M. (2008). Yoga voice: balancing the instrument. Journal of Singing. 65(1) 45-52. 

      28. Nelson, S., Blades, E. (2005) Singing with your whole self: The feldenkrais method and voice. Journal of Singing. Nov/Dec. 

      29. Neumann, P., Gill, V. (2002). Pelvic floor and abdominal muscles interactions and EMG activity and intra-abdominal pressure. International Urogyneocology Journal. 2(13): 125-132.

      30. Park, H. K. (2014). The Effects of Pelvic Floor Muscle Contraction on Pulmonary Function and Diapharagm Activity. Department of Physical Therapy, Graduate School, Silla University.

      31. Park, H., & Han, D. (2015). The effect of the correlation between the contraction of the pelvic floor muscles and diaphragmatic motion during breathing. Journal of physical therapy science, 27(7), 2113.

      32. Rubin, J.S., Macdonald, I., Blake, E. (2011). The putative involvement of the trans-abdominal muscles in dysphonia: A preliminary study and thoughts. Journal of Voice. 25(2) 218-222

      33. Rubin, J., Matheison, L., Blake, E. (2004). Posture and voice. Journal of Singing. Jan/Feb 271-275.

      34. Sapsford, R. (2004). Rehabilitation of PFM using trunk stabilization. Manual Therapy. 9: 3-12.

      35. Sapsford, R. R., Hodges, P. W., Richardson, C. A., Cooper, D. H., Markwell, S. J., & Jull, G. A. (2001). Coactivation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourology and urodynamics, 20(1), 31-42.

      36. Sapsford, R., Hodges, P., & Smith, M. (2010). Systematic review: Abdominal or pelvic floor muscle training. Neurourology and urodynamics, 29(5), 800-801.

      37. Schulte, H.K. (1984). Efficient of professional singing in terms of energy ratio. Folia Phonitrica. 36(6) 267-272

      38. Schutte, H. K., & Miller, R. (1984). Breath management in repeated vocal onset. Folia Phoniatrica et Logopaedica, 36(5), 225-232.

      39. Smith, E.C. (1970). An electromyographic investigation of the relationship between abdominal muscular effort and rate of vocal vibrato. NATS  May/June 2-17. 

      40. Smith, M. D., Coppieters, M. W., & Hodges, P. W. (2007). Postural response of the pelvic floor and abdominal muscles in women with and without incontinence. Neurourology and urodynamics, 26(3), 377-385.

      41. Sonhinen, A., Lakkanen, A., Karma, K., Hume, P. (2004). Evaluation of support in singing. Journal of Voice. 19(2) 223-237. 

      42. Spillane, K.W. (1989) Breath support directives used by singing teachers: A delphi study. NATS Jan/Feb 9-22. 

      43. Tajiri, K., Huo, H., Maruyama, H. (2014). Effects of co-contraction of both transverse abdominal muscles and pelvic floor muscles exercise for stress urinary incontinence: A randomized controlled trial. Journal of Physical Therapy Science. 26: 1161-1163

      44. Tahan, N., Bandpei, M.A.M. (2011). Co-activation of abdominal and pelvic floor muscles: a systematic review of the literature. Journal of  Mazandaran University of Medical Sciences 

      45. Tahan, N., Rasouli, O., Arab, A. M., Khademi, K., & Samani, E. N. (2014). Reliability of the ultrasound measurements of abdominal muscles activity when activated with and without pelvic floor muscles contraction. Journal of back and musculoskeletal rehabilitation, 27(3), 339-347.

      46. Talasz, H., Kalchschmid, E., Kofler, M., & Lechleitner, M. (2012). Effects of multidimensional pelvic floor muscle training in healthy young women. Archives of gynecology and obstetrics, 285(3), 709-715.

      47. Talasz, H., Kofler, M., Kalchschmid, E., Pretterklieber, M., & Lechleitner, M. (2009). Breathing with the pelvic floor? Correlation of pelvic floor muscle function and expiratory flows in healthy young nulliparous women. International urogynecology journal, 21(4), 475-481.

      48. Talasz H, Kofler, M. (2011). Phase-locked parallel movement of diaphragm and pelvic floor during breathing and coughing. Urogynecology Journal 22:61-68. 

      49. Talasz, H., Kremser, C., Kofler, M., Kalchschmid, E., Lechleitner, M., & Rudisch, A. (2012). Proof of concept: differential effects of Valsalva and straining maneuvers on the pelvic floor. European Journal of Obstetrics & Gynecology and Reproductive Biology, 164(2), 227-233.

      50. Thorpe, C.W., Cala, S.J., Chapman, J., Davis, P.J. (2001). Patterns of breath support in projection of the singing voice. Journal of Voice. 15(1) 86-104

      51. Titze, I. (1986). Some notes on breath control during singing. NATS. 43(2) Jan/Feb 28.

      52. Watson, P.J., Hixon, T.J. (1985). Respiratory kinematics in classical (opera) singers. Journal of Speech and Hearing Research. 104-122. 

      53. White, R.C. (1988). On the teaching of breathing for the singing voice. Journal of Voice. 2(1) 26-29

      54. Zivkovic, V., Lazovic, M., Vlajkovic, M., Slavkovic, A., Dimitrijevic, L., Stankovic, I., & Vacic, N. (2012). Diaphragmatic breathing exercises and pelvic floor retraining in children with dysfunctional voiding. European journal of physical and rehabilitation medicine, 48(3), 413-421.

      55. Richardson, C. A., Hodges, P., & Hides, J. A. (2004). Therapeutic exercise for lumbopelvic stabilization: a motor control approach for the treatment and prevention of low back pain. Churchill Livingstone.










Sunday, June 12, 2016

Inhalation Phonation for the Singing Voice







Use of Inhalation Phonation in treating Muscle Tension Dysphonia (MTD) in Singers





                    Extreme muscle tension dysphonia (MTD) during phonation



Muscle tension dysphonia (MTD) is characterized by excessive muscle recruitment resulting in incorrect vibratory patterns of vocal folds and an alteration in voice production. It is the technical term for stressful or strenuous overuse of the voice, resulting in vocal dysfunction. Over time, untreated MTD results in worsening of symptoms, including loss of vocal range and pain when singing/performing, as well as development of benign vocal fold lesions, vocal fold tear, or vocal fold hemorrhage.





Physical Correlates of Muscle Tension Dysphonia:

▪ Increased compression of ventricular folds

▪ Increases tension in the thyroarytenoid muscle

▪ Imbalance of intrinsic and extrinsic laryngeal musculature

▪ Increased compression of true vocal folds during phonation

▪ Restriction of Cricothyroid joint

▪ Imbalances in surrounding musculature, e.g, scalenes, SCM, masseter, etc

▪ Elevation of larynx high in neck, disturbing pharyngeal space/resonance

▪ Narrowing of pharyngeal cavity

▪ Restricts the movement of the laryngeal cartilages (altering vocal range)

▪ Global tension in head and neck musculature

▪ Decreased mouth opening

▪ Depressed sternum, rounded shoulders, forward head position

▪ Tongue and jaw tension

▪ Decrease in power

▪ Fatigue



Etiology of MTD typically seen in singers :


▪ As a response to a weakness (paresis) of the vocal folds (SLNp)

▪ As a response to changes on the vibratory edges of the vocal folds (e.g., swelling or masses resulting in insufficient glottic closure)

▪ As a response to insufficient breath management for singing voice

▪ As a result of the lack of or sub-optimal vocal training (effortful production)

▪ In response to irritation from an infection or reflux

▪ Because of improper postural alignment (including shoe choice)

▪ Singing without feedback (poor monitors when singing amplified)

▪ Stress (work, relationship, loss)

▪ As a result of mood issues such as anxiety and depression

▪ Physical weakness from an eating disorder

▪ Pelvic floor dysfunction



Inhalation















When we inhale, the vocal folds open and the muscular architecture in the supraglottic tract expands and opens.

This action results in:

*ventricular distention/widening

*pharyngeal widening

*descent of laryngeal carriage

*velar ascent



Inhalation Phonation (IP)

▪ Production of voice during inspiration in paradox to normal voice production

▪ Deliberate sound production on ingressive airflow

▪ Otherwise known as “Reverse Phonation” or “Ingressive Voice Production”



Rationale for use of IP with Singers

▪ Organic in nature, e.g., naturally occurs in laughing, crying and gasp

▪ Maintains open posture of inhalation during phonation

▪ Assists in vocal fold entrainment through Bernouli Effect in reverse

▪ Ventricular compression abates eliminating pressed phonation

▪ Promotes inverse mucosal wave /improved vibratory characteristics of vfs

▪ Improves physiological control of vocal folds

▪ Promotes a more symmetrical pattern of vocal fold contact

▪ Models appropriate physiology for restructuring muscle tension

▪ Trains coordination of inspiratory diaphragm and pelvic floor musculature

▪ Contracts cricothryoid muscles resulting in stretching of vocal folds

▪ Increases fundamental frequency (for restructuring inappropriately low Fo)

▪ Naturally lowers larynx

▪ Increases airflow associated with phonation

▪ Can produce on specific pitches and pulse mode of phonation

▪ Promotes a global improvement of the vocal fold signal and sensations



Using Inhalation Phonation in Singers

▪ Begin with training inhalation phonation in isolation

▪ Sometimes need to start with phonation and move to IP (Eeyore)

▪ Best to do IP immediately followed by voice on the exhalation

▪ Once IP is achieved in speaking voice, move to sung vowels

▪ If singer is not able to produce IP with pitch, use speaking voice IP

▪ Nasal inhalation/reverse hum is a good starting place

▪ Use hierarchy of sounds, e.g., vowel, syllable, word, partial phrase
▪ Important to cue relaxed inhalation

▪ Cue release of pelvic floor/lower abdominal musculature

▪ Can be used on specific pitches and pulse mode of phonation

▪ With advanced students, can use inhalation straw phonation



Singing Voice Exercises


▪ IP vowel followed immediately by descending 5-note scale

▪ Alternating IP/EP on descending 3- or 5-note scale

▪ Alternating IP/EP on ascending 3- or 5-note scale

▪ Increase range of exercise and extent of IP

▪ Add an /h/ or /m/to the vowels to move to syllable level

▪ IP on 1st word of phrase, EP on entire phrase (chanting)

▪ IP on 1st word of a phrase of a song, EP on remainder of phrase

▪ Extend IP to multiple words, EP on remainder of phrase

▪ IP before sung phrase, EP entire phrase

▪ IP as a pre-phonatory gesture without sound but with benefit of IP


Other Rationale for using Inhalation Phonation



▪ Pre-phonatory gesture to restructure narrowed pharynx

▪ Restoring vocal function with vocal fold paresis (SLNp)

▪ Improving vf entrainment with benign vocal fold lesions

▪ Post-op restoration of vibratory characteristic of vfs

▪ Cueing or training abdominal/pelvic floor musculature

▪ Optimizing vocal technique in healthy singers

▪ Diagnosing location and presence of lesions w/strobe exam

▪ Restoring true vf phonation in pts w/ventricular phonation

▪ Increasing ease in phonation w/ pts with SD

▪ Improving vibratory characteristics of vfs w/pts w/ vf scar

▪ Decreasing pressed phonation









References

(1) Finger, L.S., Cielo, CA. (2007). Reverse phonation-physiologic and clinical aspects of this speech voice therapy modality. Rev Bras Otorrinolaringol 73(2): 271-7.

(2) Orlikoff, R.F., Baken, R.J., Kraus, D.H. (1997). Acoustic and physical characteristics of inspiratory phonation. J Acoust Soc America, 102(3): 1838-1845.

(3) Robb, M.P., Chen, Y., Gilbert, H.R., Leiman, J.W. (2001). Acoustic comparison of vowel articulation in normal and reverse phonation. JSHR 44, 118-127.

(4) Shulman, S. (2000) Symptom modification for abductor spasmodic dysphonia: Inhalation phonation. In J.C. Stemple (eds). Voice Therapy: Clinical Studies (2nd ed). San Diego, CA: Singular Publishing Group.

(5) Colton, R.H., Casper, J.E., Leonard, R. (2006). Understanding Voice Problems: A Physiological Perspective for Diagnosis and Treatment (3rd ed.) Baltimore, MD: Williams & Wilkins.

(6) Tomlinson, C.A., Archer, K.R. (2014). Manual Therapy and Exercises to Improve Outcomes in Patients with Muscle Tension Dysphonia. Physical Therapy.

(7) Kelly, C., Fisher, K. Stroboscopic and acoustic measures of inspiratory phonation. (1999). J of Voice 13(3): 389-402.

(8) Wattremez, A., Delpech, C., DeBrugiere, C., Chevaillier, G. (2011). Reverse phonation: Pathological and therapeutic aspects. Study of a clinical case. Revue de laryngologie-otologie-rinologie.

(9) Lopes, M.V., Behlau, M., DoBrasil, O.O.C., Andrade, D. (1999). The use of inspiratory phonation to characterize laryngeal benign lesions. Revista Brasileira de Otorinolaringologia.

(10) Zimmer, V., Cielo, C.A., Finger, L.S. (2010). Spectrography of acoustic vocal modifications produced by reverse phonation. Revisit CEFAC, Jul-Aug 12(4): 535-542.

(11) Finger, L.S., Cielo, C.A. (2008). Acoustic vocal modifications produced by reverse phonation. Revista da Sociedade Brasileira de Fono.

(12) Behlau, M. (2000). The use of inspiratory phonation to characterize laryngeal benign lesions. Rev Bras Otolaringol Jan.

(13) Vanhecke, F., Lebacq, J., Manfredi, C., Raes, G-W., DeJonckere, P.H. (2016) Physiology and Acoustics of Inspiratory Phonation. J of Voice (In Press).

(14) Moerman, M., Vanhecke, F., Van Assche, L., Vercruysse, J., Daemers, K, Leman, M. (2016). Vocal Tract Morphology in Inhaling Singing: An MRI-Based Study. J of Voice (In Press).

(15) Goff-Fynn, J., Carroll, L.M. (2012). Collaboration and Conquest: MTD as viewed by voice teacher (Singing Voice Specialist) and Speech-Language Pathologist, J of Voice 27(3): 391e9-e14.










                   Copyright © 2016, Kate A. Emerich

Wednesday, September 2, 2015

Kate Emerich, bio


 


Kate A. Emerich, B.M., M.S., CCC-SLP, owner, Vocal Essentials LLC has specialized in care of the professional voice as both a Voice Pathologist and a Singing Voice Specialist for 25 years.  She is also a Voice Instructor (previously at The University of Denver, Lamont School of Music and National Theatre Conservatory (NTC) and is a professional singer. Prior to starting her own practice she worked as a Voice Pathologist, Singing Voice Specialist and Researcher with Robert T. Sataloff, M.D., D.M.A., FACS and Ingo R. Titze Ph.D. at the National Center for Voice and Speech. She holds an undergraduate degree in Vocal Performance and a graduate degree in Communicative Disorders, both from from the University of Wisconsin-Madison.  Kate has written numerous articles and book chapters on professional voice topics and has served on the editorial board of the Journal of Voice for 20 years.  She continues to be an active independent researcher on the biomechanics of breathing and phonation.






Monday, November 17, 2014

Keeping your Voice Healthy through the Holidays

It was an early winter last week thanks to an Arctic air mass moving into Colorado.  I definitely wasn't prepared for January temperatures with snow in mid-November.  I don't think anyone was.  The early cold reminded me of COLD/FLU season.  Yes, it's time.  Time to get your immune system game on, especially if you are a singer.  This is a busy, busy time for singers and there isn't time for getting sick with all our concerting, cavorting and caroling we have to do.  Even more importantly, by being vigilant in your own health care, you can prevent a Superior Laryngeal Nerve paresis, a nerve injury consequence commonly seen with upper respiratory viruses.

How?  Don't get sick!

Top 10 List:  Ways to stay Healthy and have a Strong Voice through the Holidays:

10.  Rest.  Often.  Shoot for 8 hours of sleep.  Nap if you are tired.  In general, listen to your body.

9.  Limit your alcohol/caffeine consumption.  Alcohol and caffeine are diuretics and actually remove moisture from your tissues.  Singing with dry mucosa increases your risk for a phonotraumatic injury from coughing, sneezing or loud talking/singing.  Dry mucosa in your nasal passages also traps bacteria and viruses and increases your chances of becoming sick.

8.  Consume a balanced diet filled with nutrient-dense foods.  This will fuel your body adequately and help boost your immunity.  Often times this requires planning and preparation.  Dedicate a night (I choose Sunday evenings) to prepare healthy foods you can take with you on the go through the following week.  Berries, veggies and lean proteins are great choices.

7.  Exercise.  Often when we are busy, exercise falls to the bottom of the list of priorities.  However, managing our stress is extremely important in maintaining a healthy immune system, and exercise is an effective way of doing so.  My favorites?  Pilates, Yoga, swimming and walking.  A good goal in general is to get the body moving every day for at least 20-30 minutes.

6.  Drink (green) tea.  There is something really lovely about sipping warm liquids.  The warmth of the liquids as you swallow them actually relaxes the neck muscles and the larynx while you help to systemically hydrate.  The antioxidants in green tea (catechins) help prevent cell damage and boost your immune system, so it makes an excellent choice.  If you are not a green tea fan, try my trick of adding a bag of green tea with a bag of your favorite herbal tea in your mug.  Then all you taste is your favorite herbal tea!

5.  Warm-up and Cool-down.  Make time for vocalizing and releasing muscle tension in and around the vocal mechanism before and after performing.  Get your body moving and energized with your vocalizations to tune into your pelvic floor support (core) so you make sure your breath management is optimal for singing.  After performing, do gentle lip trill descending slides, humming and massaging to release any tension you may have added during singing.  At least 10 minutes prior to and after singing is best.

4.  Steam inhalation.  In addition to systemic hydration, inhaling steam is the only other way to add moisture to the vocal fold tissue.  All singers can benefit from regular "steaming".  The easiest way to do this is to own a Personal Steam Inhaler and use that.  Old school boiling water and steaming hot water from a bowl with a towel over the head works, too.  Bonus steaming happens in a hot shower.  Because the steam dissipates quickly, steaming 2-3 times a day is helpful in keeping the vocal folds plump and effortlessly vibrating.

3.  Vocal rest.  Vocal naps are really important if you are doing a lot of singing/performing.  Even 10 minutes of vocal rest per hour allows for some vocal fold tissue recovery.  If your voice is tired....zip it!  If your speaking voice is hoarse...zip it.  If you aren't getting paid to sing/speak...zip it.  When you are speaking, make sure your technique is commensurate with your singing voice.

2.  Follow optimal vocal hygiene.  Drink half of your body weight in ounces of water or herbal tea. Replace throat clearing and coughing with a silent cough or burst of air past the vocal folds to remove mucus.  Breathe in through your nose if you are outdoors and it is cold/dry to add a filter/moisture to the air you breathe.  Take your vitamins but avoid too much vitamin C (1,000 mg or more) as it can dry your vocal folds and cause gas!  A regular probiotic will keep your gut healthy and your immune system working at its best.  Only use Tylenol for aches/pains.  Remember that Advil, aspirin or any NSAID changes the way your platelets work and increase your risk for a vocal fold hemorrhage.

1.  Practice Universal Precautions.  Wash your hands often with warm, soapy water for as long as it takes to silently sing the "Alphabet Song".  Use a paper towel to turn off the faucet and open the bathroom door after you've dried your hands.  Wave "hello" instead of shaking people's hands. Avoid touching elevator buttons (use a key) or handrails in heavily populated places.  Have your favorite immune booster on hand to take the second you start to feel sick and until your symptoms abate.  My favorites over-the-counter remedies are Sambucus (elderberry) lozenges or syrup and ColdSnap, a concoction of Chinese herbs designed to boost and support immune system function. However, always best to consult your primary care physician and/or laryngologist for what is best for you.

Tuesday, September 16, 2014

A Celebration of Life and Longevity of the Larynx: Magda Olivero

I am writing this blog as yet another tribute to a great. I had not intended to write anything but pedagogical and vocal pathology wisdom for this blog, but I cannot fight the spontaneous momentum when I feel it.  Magda Olivero died at 104 in Milan, Italy last week.  She was one of the last, great opera singers of her time.  Maybe of all time.  She had a uniquely fast vibrato reminiscent of the old black and white movie singers, yet sang with such depth, such immense passion that one couldn't help but be totally taken in.  Listening to an NPR story, it turns out she was one of my favorite opera singers....Renèe Fleming...favorite opera singers.  She even took a few voice lessons from Magda.  What thrills and inspires me about this legendary diva is that she made her Metropolitan Opera debut at age 65  Yes...no typo there.  6-5.  So maybe there's still hope for me!  Ha!  I digress.  She was still performing concerts in her 90s.  I just love it!  And do you know what this opera great attested to her vocal longevity?  Iron-clad technique!  So, all you students of mine who roll your eyes as I teach you about your instrument, the biomechanics behind it, and spend years on breath management, pure vowels, resonance and the like.  It is worth it!  Sing on, diva, sing on.  May we all take the time to get to know you through your recordings and honor you through diligent, disciplined technical work and, in my opinion, passionate, visceral and genuine performances.

Washington Post article (click to go to article)


Tuesday, August 12, 2014

Remembering Robin Williams

When it comes to thinking outside the box, Robin Williams was a master.  He was brilliant.  He brought to us an unbridled energy in his comedy, acting, and voice work.  He was the spokes model for "bring it".   He was a whirling dervish performing stand-up and riveting, quiet and wise in his portrayal of dramatic characters.  He made us laugh so hard we couldn't breathe and he made us cry and believe and wonder.  He was a genius and a genie.  His voice is etched in our hearts and our minds and we will always remember and laugh and cry.

From the movie "Dead Poets Society"

"Boys, you must strive to find your own voice. Because the longer you wait to begin, the less likely you are to find it at all. "

"No matter what anybody tells you....words and ideas can change the world."


O Captain, my Captain, you have changed the world.  Rest in peace.