VOCAL HEALTHKeeping your Voice

Shining!
Terri Metcalf-Peterson MA/MM/DMA(ABD)
terri.metcalf-peterson@utahtech.edu 303-619-4224

Your Voice is a fascinating sound-making instrument, that is part of your physical physiology. Compared to
other musical and sound making instruments the vocal mechanism is a fraction of the size in relation to the
volume and variety of timbres it can produce. In maintaining overall wellness, we must recognize that the
voice is connected to our over-all physiology and deserves the same care. It only takes the common cold to
realize how your voice can be affected and since you only have one of these organs, caring for the voice is
imperative. This handout is intended primarily for singers and teachers of singing but also has relevance for
anyone who may speak or need to project their voice.

Preparation of the Body

The voice is dependent on the same respiratory system we need to sustain life. We inhale to take in air or
oxygen, and exhale to expel carbon monoxide. These muscles work naturally and involuntarily with the
help of our diaphragm muscle. When we vocalize or sing we often need more air to create the
necessary length of phrase or volume. Breathing deeply requires intention. Our rib cage must expand
more, with the viscera and muscles moving out of the way to take in the breath. The rib cage moves
like a spring and sometimes lacks mobility from daily shallow breathing. Stretching these muscles will
allow our respiration to be fuller and more responsive for the potential air we need to sing or vocalize.
Employ simple exercises to stretch the circumference of our rib cage. Many good stretches and breathing
exercises come from Yoga practices such as “Cat and Cow”, “Childs Pose”, and “Forward Bend”.
Intentionally coordinating breathing with physical movement also connects our mind with our body.
Many other core twisting and stretching while breathing exercises exist. Instructors and the internet
can provide a lot of these.

Alignment
Since the vocal tract includes the lungs trachea, and head cavities, the position of the head in relationship to
the body makes a difference. A head protruded forward, or slumped shoulders can not only
compromise breathing, but can cause undue tension. The neck, that houses our wind pipe and vocal
folds is closely connected to the same muscles that hold the head up. The more aligned the head is to
the rest of the body, the less you are working against the forces of gravity with unneeded tension
allowing your voice to work more efficiently.
Check your posture before you sing. This should include the position of your head with the rest of your body.
Always have a mirror handy so that what you are seeing is matching what you are feeling.
Coordinating Movement while stretching helps as well. It’s proven that emotional stress is often held in
our neck and shoulder muscles without our knowing. Alexander technique teaches us to be more
kinesthetically aware of our body without necessarily seeing it.

Warming up:
Recognizing the Physics: Air pressure vs Air Flow.
A fundamental aspect of vocalizing includes the simple physics of air pressure and airflow. You can make
sound with a blown-up balloon by manipulating top allowing the pressurized air to escape. The
difference in singing and speaking is how air is pressurized. We create air pressure all the time…for
 instance when we clear our throat we are instinctively protecting our airway. We create a pressurized
puff of air to blow off anything that could be threatening our airway. If you were to put your hand on
your abdomen, you would feel the abdomen lower and expand as you quickly inhale, and then
tightening a split second before the air “puff” effect happens at your vocal cords. This same connection
is often called breath support. We often think that the heavy lifting happens at the site of the vibration,
and then ask too much of those smaller muscles in resisting the air pressure. Laughter, when
employed naturally, clearly employs the same core muscles. You feel it in your core first, and the
gurgling sound happens as a natural extension.

Occlusion
Optimal vocalizing has a balance of air pressure and air flow that will maximize the sound quality, and volume.
Jumping right into the climax of an aria before your vocalism is ready, will not only be uncomfortable,
but might cause shock to the cords. Your vocal folds can share the load of pressure by a second
resistance, or what is called occlusion. A sustained lip trill, or raspberry buzz with the tongue out can
create a second resistance providing a less sudden stress on the cords. Blowing through various sizes
of straws can achieve occlusion as well. There is an added benefit of occlusion. In singing most air
pressure is subglottic or coming beneath the vocal folds. By adding occlusion with the mouth and straw
you are adding a balancing supraglottic pressure from the mouth cavity down to the cords. This can
help stabilize and balance the two sides vocal folds as they vibrate. For this reason, occlusion
exercises are often used at therapy for vocal issues.

Phonation
After you’ve gradually asked the vocal cords to vibrate with occlusion, then you can give it full responsibility.
Teachers will have various warm-up exercises to access the full potential of acoustical resonance,
consistency though-out your high, middle, and low registers of the voice. Generally, starting with a
more air flow until the cords are fully engaged is a gentler way of starting your vocal warm-up. It may
seem like more of a sigh using a vowel. Adding occlusive consonants that allow more air flow like “ss”,
“zz”, “vv”, “mm”, “th”, and “ff”, can aid in balancing air flow. Then you can use more plosive consonants
like “pp’s”, “tt’s”, and “dd’s”. Glottal starts of sounds with the cords coming together first, like when
saying “uh oh” can also engage your cords. Many popular singing styles begin with a hard onset with a
growl or “fry”. Over-use of this technique asks a lot of your vocal cords and could lead to vocal issues.
Moderation and awareness, will help you manage your voice.

Maximizing Acoustical Properties: Resonance

As stated before, the mechanism and size of the singing voice is relatively small compared to other
instruments with the same amplitude. So that means that there is something more going on that
amplifies the voice so that it can be heard over and orchestra or a crowded room. A singer usually
seeks to develop and internalize an understanding of how to access the resonating cavities…or
amplifiers of the vocal tract to its greatest potential. Teachers and vocal practitioners will help you feel
and employ these resonators through various exercises. It’s important to realize that our own ears
don’t give us the same feedback compared to how it is heard in the room by others. Have you ever
heard yourself talk on a recording and not recognize your own voice? Recordings are honest in
replicating your sound and how it is heard by others, but often an experienced teacher or coach provide
the best feedback. The greatest singers consult with their vocal mentors regularly.

The Singing Voice vs. the Speaking Voice

Sometimes we forget that the speaking voice is the same voice used to sing. We have different centers of the
brain. The left brain controls the verbal center, and the right brain controls the emotional, spatial
center. Perhaps that is why we differentiate between the two acts so much. However, if we can use
 both centers simultaneously in producing sounds, then we communicate a clearer message and
expression through music and word. Vocal therapies for singers now include speaking therapies, and
therapies for speakers now include singing therapies. Music Therapy is now an accepted discipline in
treating much more than vocal issues. Vocal exercises illustrate how a natural speaking voice can tap
into our most optimal singing voice, such as speaking the words of a song on a well-produced pitch
before singing it.

Hydration
Studies currently show that adequately hydrating your body is crucial to good singing. The vocal fold and
mechanisms of the voice are made of ligaments, and muscle tissue. Since the mechanism is so small,
a variation in fluid content can easily affect its ability to make sound. Not enough hydration can lead to
hoarseness and thinner less resilient tissues. If the tissues have too much fluid as with inflammation
and edema, the vocal fold structure is also compromised. If hydration is not optimal, then we may
inadvertently employ movements to compensate for any ineffectiveness we may feel during phonation,
and if over-used, these movements become dysfunctional over time and can lead to vocal issues.
Rules for Hydration:
 At least 8 cups of water a day
 Drink water gradually, and allow enough time to absorb water before vocalizing especially for
performances (at least 8 hours before)
 Avoid too many caffeinated drinks. These often act as diuretics, and you will need to replace lost fluid.
 Carbonated drinks -avoid due to water retention and edema.

Nutrition
As the saying goes, “We are what we eat”, so since our body is the musical instrument, then it stands to
reason that what we take into our bodies will affect how healthy our body is and its ability to perform.
Nutrition and calorie intake should be determined by what is optimal based on your weight, height, and
age. Literature on nutrition and optimal diets abound, but generally include more fruits and vegetables,
protein, and less fatty, over-processed foods and sugar. There are many opinions of foods to avoid for
vocalists. Here are a few:
 Dairy products: Generally, dairy products produce more mucous in order to digest…Mucous glands are
located in the vicinity of your vocal tract as mucous helps break down and digest food. If too much
mucous interferes with phonation, then reevaluate your intake of dairy products.
 Salt: Too much salt can cause water retention…decide if that can cause interference
 Spicy, Acidic food: Spicy food is probably more of a danger if you experience acid reflux.
 At the very least avoid eating spicy foods too late in the evening before you sleep.
Vitamins. Take them. Too much of our food lack all the vitamins and minerals we need. Find a good multi-
vitamin.

Rest, Relaxation, Fitness

Sleep. Studies show that a crucial determinant of working at our physical mental best is by getting enough
sleep. For most, that means at least 6-8 hours of restful sleep and it’s not just the number of attempted
hours of sleep, it’s the phase of deep sleep, or what’s called REM’s. Our brains are our core operating
system the greatest benefactor of restful sleep. Sleep “resets” our brains to function properly.

Stressing and Tensing vs. Relaxing and Responding. More studies are surfacing on how emotional stress can
affect our performance. A build-up of stress can cause inhibiting sympathetic tensions that compromise
our ability to perform. There are many life factors that can cause stress, but performance anxiety itself
is a common problem for many vocalists. A certain amount of stress causes us to be alert and ready,
but too much stress can be debilitating if not managed. Managing and/or redirecting stress starts with
 awareness. Also, we should remember that stress often originates from the non-rational part of our
brain…the “fight of flight” instinctive response meant to protect us from danger and vulnerability, and it’s
difficult to control…only through practice within a performance context.

Unwanted tensions result from our inability to relax. Sometimes we just need help, such as a paying for a
massage, but if we can figure out how to relax consciously and on our own, then we will be able to
manage tension in the moment.
 Breathing: Intentional Deep breathing and focusing on the breath in the moment is a way to lower
your heart rate. For instance, simple inhaling on a slow count of “1,2,3,4,” and then holding the
breath for a count of “1,2,3,4,” followed by exhaling on the same count. Doing these 3 times, will
lower your heart rate, and slow down the flow of adrenaline.
 Stretching: Stretching the body to increase respiratory capacity has already been mentioned, but
stretching the whole body has a great effect on loosening and relaxing the muscles to be more
responsive. We need to feel grounded and balanced when performing, so that we can easily
respond and move, as the music and message expression dictates. This is much like the “ready
stance” needed for athletes to make a “free throw” in basketball or return a tennis volley.
Use it or lose it. You must use your body, to build muscle, and increase the length of time you can remain
active. Interestingly this also applies to the singing voice as well. Inactivity can lead to decreased range
of motion, weakness, and stiffness. A good fitness program that includes regular aerobics, stretching
and muscle development is highly recommended. Yes of course anyone can sing, but you if you want
to take it to the next level, good fitness will allow you to do your craft stronger and longer. Anyone
who’s done a full role on the stage, whether in a play, musical theater, or an opera can attest to the
total physical strength needed to perform well.

Common Physiological Challenges

The Common Cold, and Influenza:
This is probably the most frequent and most debilitating of challenges vocalists encounter. We can do our best
to avoid these, but sadly there still is no cure for the common cold. The average person will have an
upper respiratory infection (URI) at least twice a year. Vocalists are especially vulnerable since the
mucous and inflammation is in close vicinity of the vocal mechanism. You can only manage a URI with
the following suggestions:
 Cleanliness. Most bacterial and viral URI’s are spread by fluid…this can be airborne such as
coughing or sneezing or touching an infected area. Washing your hands frequently, not touching
your face or nose, staying away from those infected, are common-sense practices.
 Knowing when you are most contagious and be patient. Don’t infect others! A URI usually has a
life span and you are usually the most contagious in the first 3 or 4 days. You usually become less
contagious after 5 days. If your URI persists after 2 weeks, it’s possible you may have contracted a
secondary infection or a more severe causality. Seek diagnosis and treatment from a medical
professional.
 Hydrate. Water helps the process of flushing out unwanted toxins.
 Listen to your body. Rest. If you feel weak or experience fever, or experience lower
gastrointestinal symptoms, give yourself permission to rest. Also, acid from vomiting can irritate the
vocal folds.
 Increase your immunity. The body will fight the unwanted infection and can sometimes work more
efficiently if you already have antioxidants built in your system.
 Lessening Symptoms: Duke recommends the following remedies: 1) Lozenges that moisten the
cords that contain pectin, or slippery elm are best, 2) External moisture such as humidifiers and
steam, 3) Nasal washes and sprays, 4) Guaifenesen helps to thin and move mucous (avoid
antihistamines that can dry).
  Should you sing over a cold? General rules: 1) It’s possible to sing, but do so sparingly and wisely,
2) Don’t alter your technique. You can develop overcompensating habits, 3) Seek guidance from
your teacher, and make sure you are not contagious, 4) If singing causes pain or fatigue, then stop.
Puberty: If you are a vocal teacher of children and teenagers, you need to understand that their bodies are
continually changing, in that they are not singing with the same instrument just months earlier. The
biggest physical change happens at puberty. This is especially true for boys. Their larynx grows to
40% larger, and therefore effects registration. Tenderness in tissues that stretch and grow so rapidly
should be treated with more care. Choose appropriate non-taxing repertoire and help the student
become more aware of his body.
Menstruation: For women pre-menstrual syndrome PMS, and then the actual discomfort of menstruation can
affect singing. During menstruation there is blood loss, as the body expels uterine tissue. This often
causes water retention or edema in the vocal cords. The cords can be more swollen and may not
phonate efficiently. Pain, and discomfort accompany the experience in the lower abdomen which is
needed to employ support. Most recommend taking care during this phase of menstruation. Drugs can
aid in the symptoms. Most recommend Acetaminophen as the best for pain, since ibuprofen, aspirin,
naproxen sodium thin the blood risking hemorrhage in other incidental injuries.
Hormones and Gender differences: Hormones can affect our singing. For women, Estrogen is thought to
increase elasticity, and the decrease of Estrogen from menopause can lead to less collagen and
elasticity. Transgender singers undergoing hormone therapy can also experience vocal change.
Age related differences: As we age, so does the vocalism. However, of all the professions that require use of
the body, singing may have the most longevity. With good vocal health care and regular use, a singer
can sing well into their later years. Generally, men’s vocal cords tend to thin, and as a result male
speaking voices get higher in pitch. For women the opposite happens. Speaking voices tend to lower.
For singers, sometimes the stiffness of the tissues causes a less responsive and uncoordinated
oscillation of the vocal folds, and a wide vibrato or wobble can develop. Vocal instructors can help
counteract some of these effects through exercises and practice.

Substances
Alcohol: Alters your muscles coordination and balance, and will therefore, compromise singing. Alcoholic
drinks are high in calories and have a drying effect.
Tobacco and other inhalants: Smoking develops residue in your lungs, lending them less efficient in oxygen
absorption. Other inhalants can dry and damage the cords as it passes through the airway. Marijuana
has the additional effect of dulling the senses and relaxing muscles needed for singing.
Drugs: Some drugs may be prescribed or necessary based on your physical needs but remember to tell your
physician that you are a vocalist. Know your drugs and their side effects. Some drugs can stay in your
system over time. Do your own research on prescribed drugs by using this link:
http://www.ncvs.org/rx.html

More Severe Vocal Issues

Nodules, Polyps, Lesions: Can occur through a sudden vocal event or through over-use. These are hard to
detect, but symptoms usually include hoarseness, a decrease in pitch range, a loss of volume. Since
there is no real feeling in the vocal fold itself, these are difficult to self-detect. If something unusual is
compensating the voice for a long period of time its best to be looked at and properly diagnosed by an
Ear, Nose and Throat (ENT) professional. This will usually require being scoped. The malady is
generally treatable with time and appropriate therapies administered by a Speech, Language
Pathologist (SLP).
Acute Laryngitis: Usually a viral Inflammation on the folds and around the folds. The folds may be swollen to
the point that it won’t vibrate, or it may be too painful to phonate at all.
GERD: Gastroesophageal Reflux Disease: This is cause by stomach acids redirected back up the trachea
and irritating the vocal cords. This is sometimes prevalent in those who may have a lot of stomach fat
or perhaps pregnant. The stomach can be displaced and closer to the cords. Other contributing
factors may be what you eat, or a prescribed medication that causes the phenomenon. For instance,
one student on birth control, had a bad habit of taking it late at night, causing nausea and sometimes
and accompanying reflux. This is also treatable through acid reducing medication, better eating habits,
and sleeping in a more upright position.
Edema: Swollen, or fluid filled vocal cords that compromise phonation and can be caused by a variety of
reasons such as menstruation, infection, over-use, etc.
Neuro-related Disorders: Sometimes the brain and nervous systems create a disconnect on the coordination of
the vocal mechanism, such as vocal fold paralysis. Seeing an ENT as well as an SLP is
recommended.
Muscle Tension Dysphonia: Usually caused by a dysfunctional use of the musculature around the vocalism.
This can be brought on by an unlearned overcompensation to an illness of event, or some other
physical or emotional cause. Undue tension can cause the vocal folds to inefficiently match and
vibrate. Since small muscles are overtaxed, then it can also lead to the voice not being able to sustain
a sound or phrase. Another symptom is a break in the voice, as it tends to give out. This should be
diagnosed by an ENT and SLP and is usually treatable with therapy and more healthy vocal habits.
Surgery and Anesthesia: In the event you are in an accident or need surgery that requires intubation, make
sure the health technician knows you need to protect your voice as a singer or speaker. The tube runs
past and rubs against vocal cords that can cause irritation or even damage. Generally, the technician
should take more care and perhaps use a smaller tube to help avoid additional damage to the cords.

Prevention, Wellness, and Therapy

Vocalists would be wise to investigate and employ techniques that are proven to help overall wellness of the
body and the psyche. These are few that are recommended:
 Yoga: A popular practice, and there are many studios and classes readily available. Videos can
help as well
 Alexander Technique: Most effective in developing greater kinesthetic awareness and a more
accurate body map so that you can change any dysfunctional habits, or repetitive injuries. This is
especially good for understanding posture, breathing, and balance.
 Massage: Always good. A good massage therapist can find and workout unwanted aches and
tensions that may be affecting your singing
ENTs and SLPs: Find these now. When you have a problem, you will need help soon. Also seek insurance
that will cover vocal injuries.
Mental and Emotional Health: Since art and expression are so connected to emotion, it stands to reason that it
will also affect the voice. Studies also show that mental and emotional well-being is directly connected
to physical wellbeing. MTD studies found that depression, grief, stress, and loss affect healing and can
even contribute to the cause of the malady. Here are some important tips for mental and emotional
health as it applies to vocalizing:
 Seek professional help. There is no shame in working with a counselor who can help you address
any emotional issues.
 Seek balance. If you are stressed overall, you may not be able to perform at your best. Look at
your priorities and manage them.
 Seek a good support system. Look for mentors and friends who will buoy you up and give you
honest feedback.
 Realize your own worth beyond, your vocal instrument. This is hard for singers since our voice is
often tied up in our identity, and the competitive nature of vocal professions causes us to
unnecessarily compare ourselves to others. Run your own race and be kind to yourself.
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