New physiotherapy technique that improves your singing voice

New physiotherapy technique that improves your singing voice


I first came across the concept of “voice physio” a few months ago while talking to one of our vocal coaches, Philly Lopez who was raving about the effect a session had had on her (already impressive) voice. On further investigation I found that one London based physiotherapy practice, PhysioEd Medical Ltd, had developed a highly specialised treatment routine for singers. When visiting the practice I was greeted with a wall of files relating to all the big West End shows and it soon became clear that the practice is the “go to” place for many singing, acting and dancing stars of the West End.

I asked Andrew Pilcher, who is a Christian and a physiotherapist who works at PhysioEd, to share more. Andrew recently gave a brief talk at Worship Central on the physiotherapy for the voice (and, we understand, was highly sought after late into the evening from the various professional singers at the event). Andrew is part of Holy Trinity Brompton (home of the Alpha Course) and, together with his wife  Lara Bianca Pilcher, a musical theatre performer, produce shows and events, and run a regular gathering for  believers who are professional singers and performers in the arts, music and entertainment industries.

Here’s Andrew’s article:

Have you heard about singers getting huskiness, losing parts of their vocal range or even losing their voice? Have you ever had a feeling of tight muscles in your throat? Do you get pain when singing or find your voice tires quickly?

These are all symptoms I help and treat as a physiotherapist and can make a substantial difference to your singing health. I have been fortunate to work alongside a physiotherapist who has pioneered this form of physiotherapy, and has been involved in the research which validates this type of intervention.

Principally our work involves manual therapy techniques to the throat, including direct soft tissue release and stretching of the laryngeal muscles. Laryngeal muscle tension builds up very easily and from many different causes. I will advise you through this article of the many different ways to keep your voice healthy and how to keep muscle tension to a minimum.

Firstly you must understand your larynx is mobile. The vocal folds are encased within the thyroid and cricoid cartilages and are mostly soft tissue. Vocal output involves very fast vibrating vocal folds as air passes them. To sing you need an environment that is quite mobile as the thyroid cartilage needs to tilt on the cricoid cartilage easily to change pitch. However the muscles of the larynx often become tight and restrict larynx mobility which in turn affects your singing. Reasons for this may include a combination of factors including technical issues, neck problems or tension, posture, jaw problems, tongue root tension, poor dietary habits and poor support mechanisms. You might gawk at that list of factors but from celebrity performers to training singers all professional and amateur voice users can be affected by them and we see this type of presentation in clinic regularly.

A reliable singing technique is often not stressed enough and sometimes even belittled within the performance world. There are teachers and coaches around that can see and hear so much in us, and can point out strengths and weaknesses. This is astounding. From a physiotherapy perspective we can provide a fantastic environment for you to use your voice however working with someone to point out problem areas and help you achieve new strategies and develop your voice is the key to maintaining a healthy voice. We strongly recommend regular singing lessons and technical appraisal, both someone successful on the charts and busy touring the world right through to the weekend amateur.

Neck tension and posture control is a huge issue. If you’ve had a neck injury or longstanding pain or just get tight muscles in your upper back when standing or sitting, this is bound to be reflected in your laryngeal muscles. Each presentation at the clinic is individual however we will identify any key muscular or joint issues and treat these appropriately. If these problems aren’t addressed it may potentially be the cause of persistent voice problems. Some general advice would be to stretch tight muscles in your neck through recognised stretching techniques, or better yet see a professional who can help you identify which particular muscles are tight and help show you how to stretch them effectively. If poor posture has already affected your laryngeal muscles and made them tight then you may well be a candidate for a laryngeal manual therapy session

Posture affects everything. Our position when adopting static postures like standing, sitting and working, all influence the various muscles and joints of the body and the load they’re under. Our

posture while we do more dynamic activities is also crucial. How we lift weights or exercise and of course what positions we sing in affect our muscle control and their behaviour. This is another key element of how muscle tension can affect laryngeal control. A perceptive vocal coach or physiotherapist can help you correct placement here or show you why you might have difficulty correcting posture. Something to consider, is whether you feel different singing standing or sitting. This might help you determine if some minor adjustments to your posture could help.

The jaw is a complex area and often problematic. Symptoms can include clicking, pain or tension when chewing or singing and headaches. Restriction in jaw motion from muscle tension will affect vocal placement and dexterity, tongue root tension levels and laryngeal mobility. You will naturally compensate to get the sound you want which will potentially lead to problems with jaw movements and larynx control. As it is so complicated it’s probably best to consult us at the clinic, a jaw specialist or a physiotherapist working in this area if you have these symptoms.

Tongue root tension is a widely accepted challenge for most singers. The tongue is a muscle that obviously helps us chew food, but is also important with vocal placement. It attaches into key areas in the throat including the larynx, the, jaw, and even the deep parts of the vertebrae. There are specific treatment techniques, tongue stretches and exercises to loosen tension, but the issue of why it’s tight is key. If you can identify and address this, you will have improved vocal control and performance. Posture plays a part, as does isolated jaw issues however most tongue root problems come down to technique and placement.

Diet is one I’m sure you’ll say “now hold on a second, this guy has gone on and on about the physical aspects of the voice but diet … Really?!?!”

Well, yes. Acid reflux and what we term silent reflux plays a part in the voice. The key is you don’t have to feel burning up your throat or a sensation of rising fluid to have it. If morning croakiness or huskiness, or increased phlegm is present, this may well be you. Tomatoes, chilli, and citrus all can bring about more acidity. Eating late, less than 3 hours before you go to bed is a big one, making the stomach process food (an acidic state) as you lye down to sleep. Many times performers have looked at us, with confusion saying it really did work – simply cutting out tomatoes!

Finally I want to talk about support. How you support your voice provides the life and depth of your sound production. Put simply, if you don’t have appropriate support you will inevitably just use your throat muscles. Conversely too much support is equally problematic. Both scenarios simply overload the laryngeal muscles, restricting their ability to change length which in turn affects your laryngeal mobility and your voicing potential. My mentor, and the physiotherapist who helped pioneer vocal physiotherapy, undertook the research looking quantitatively at abdominal musculature and voicing to prove this point. The conclusion was that abdominal activity levels dictate laryngeal muscle tension levels and therefore it was critical to get this balance right for a healthy and mobile larynx. Between a good voice coach and within our clinic there are amazing tools to help you find appropriate support strategies for a healthy and reliable voice.

To conclude, this is a taste of the problems, solutions and challenges in developing vocal control. I would implore you to see your voice as an instrument that needs strengthening, developing, and maintaining all your life. There are people to help you with this. We would love to see you in London.

Andrew Pilcher
BSc (Physiotherapy)
57 Harley Street
London W1G 8QS