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Schemmann H.1, Grafe M.2,3, Zalpour C.1
1University of Applied Sciences Osnabrueck, Institute for Applied Physiotherapy and Osteopathy (INAP/O), Osnabrueck, Germany, 2Martin-Luther-University, Institute of Health and Nursing Sciences, Halle-Wittenberg, Germany, 3University of Applied Sciences Muenster, Faculty of Health, Muenster, Germany
Background: Professional voice users have high demands regarding voice quality and vocal load. Professional singers and actors are known to have the highest vocal demands among professional voice users. Thus, are at greater risk of developing a voice disorder which may affect their livelihood. Functional voice disorders are caused by inadequate voice use. Risk factors such as poor posture, poor breathing patterns, and stress-related factors can contribute to excessive phonatory effort resulting in muscle tension dysphonia (MTD). Given the various risk factors, the management of MTD requires a multidisciplinary approach.
Purpose: This study reviewed the literature on MTD and highlights how physiotherapy can contribute to the management of this problem in professional voice users.
Methods: A literature review regarding physiotherapy management of MTD was conducted. A retrospective review of patient notes from a special physiotherapeutical outpatient clinic for vocalists was performed and the assessment and treatment process documented for one patient.
Results: The case study refers to a 32-year-old professional male classical singer who presented with a tight feeling in his throat and difficulties singing, especially high pitches and long musical phrases. He was assessed by an Ear, Nose and Throat (ENT) surgeon to have MTD without organic changes or current infection. In the physiotherapeutical outpatient clinic the singer underwent the following assessments:
Self-perceived voice quality using the Singing Voice Handicap Index (SVHI); observation of posture in standing at rest and while singing; palpation of muscle tension of the neck and laryngeal area; observation of breathing pattern at rest and during singing, and observation and palpation of the larynx.
Based on current evidence, anatomical considerations and the clinical reasoning process, the singer was assessed to have upper crossed syndrome, a sternal breathing pattern, and restricted larynx mobility, especially downwards. He received 10 treatment sessions which included: specific postural advice and retraining; strength exercises for the weak muscles like deep neck flexors and stretching exercises for the shortened muscles like suboccipital muscles; manual therapy to the larynx; specific breathing retraining; coaching strategies regarding stress management and vocal hygiene.
Reassessment demonstrated: an improved self-perceived voice quality (lower SVHI score); improved standing posture at rest and while singing, and the ability to use different breathing patterns during singing; palpation revealed reduced muscle tension in the neck and laryngeal area. The singer reported less tension in the throat and more ease while letting the larynx move downwards.
Conclusion(s): The case study demonstrated the unique contribution of physiotherapy in the management of MTD in a professional singer. There is little evidence for physiotherapy in functional voice disorders in professional voice users. Therefore, further research is necessary including prospective randomized controlled studies to establish what techniques or combinations of techniques mentioned above are effective in the management of this problem, or to investigate the relationship between body motion and muscle activity as well as the quality of voice.
Implications: This case study demonstrates that physiotherapy, especially posture and breathing retraining and manual therapy can be a valuable component in the multidisciplinary approach to functional voice disorders in professional voice users.
Funding acknowledgements: This work was unfunded.
Topic: Professional practice: other
Ethics approval: No ethics were approved, because it was a retrospective review. The patient consented to scientific usage of his data.
All authors, affiliations and abstracts have been published as submitted.
