Removing the Stigma of Vocal Injury

Pushing-through culture has us all avoiding rest.

Pushing-through culture has us all avoiding rest.

A crucial time in any singer’s life is the moment something doesn’t sound quite right. It can happen once, or many times over the course of a life or career. As much as I advocate now for artists to seek treatment as soon as they feel something is off, I remember my own prideful nature when I was young. I just tried to ignore the strange flipping sound on 2-3 of my notes, hoping it would go away. Someone else had to tell me I should go. Even though we read articles, watch documentaries and have a general sense of how to take care of our bodies, sometimes it necessitates an authority figure to encourage you to take a closer look.

I’ll Sound Better Tomorrow

Keep it to ourselves. Don’t tell anyone. Is this really happening? I shouldn’t let anyone know. Is this because of the fact that we can’t see our voice box, so out of sight out of mind? Is it because we feel that emotional connection to our voices and if we admit that we are vocally injured, how are we supposed to keep creating art? I think perhaps the biggest factor is that we feel our career will be over. It’s hard enough to be a singer with a fully-functioning set of pipes. Who wants to hire one with a history of injury?

Do we feel so overprotective because creating voice is an instrument that compares to no other? So many things have to align like breath, blood, energy, rest, hearing, feeling, and memory that while singing seems like what most people do in the shower, a well-trained and engineered performance takes so much dedication and practice.

Let’s Talk Sports…

A similar media coverage falls on athletes. If they are injured (possibly because of the size of muscles or bones that are commonly injured, and possibly because compensation by other body parts can occur) there is usually always a positive outlook. “He’ll be out for a few games.” “He’s out for the rest of the season". “He received a shot and can play for the rest of the game.” Everyone takes a knee, they all stand when the player is walked off the field, and when they get carted out of the stadium everyone cheers in solidarity. Vocalists do not get that same positive outlook. It seems to always be shrouded in mystery. It’s as if it is leprosy or a slow-killing cancer that will grow if it’s talked about, and can ruin anything it touches.

Home Remedies are just that…

We seem to search for the cheap or friend-recommended fix a lot of times because as artists, we are strapped for cash. Any person truly relying on gigs to make a living can relate to this. You may have 5 gigs during a week that you are constantly preparing for, and expecting pay from. All the while, people are constantly trying to devalue your work because you are “just a singer,” and wish to pay you the smallest rate possible. If injury sets in, how will you cover your bills? On the other hand, the small percentage of folks who have seemingly “made it” because they have a management team and a slew of publicity, still have people depending on them for commission and jobs. They feel very similar pressure when vocal problems occur.

People want to know how they can fix the voice problem on their own. This is dangerous for many reasons. If you wait too long after you know something is not right, you are potentially causing more damage that will make it difficult to recover. If you take medication to help you “push” through a performance, you are again putting yourself at risk for further or more extensive damage. If you get a medical opinion early on, you can do the best thing for your instrument. A broken string gets replaced right away on a violin. A reed gets replaced if malfunctioning. If only, there was no stigma for singers.

Hashtag #voicerest

Social media has made it seem like artists everywhere are having vocal issues. News spreads a lot quicker and more widely than ever before. I believe, however, that it is just a way that artists can be more truthful about it to help disgruntled fans understand and to help work through it themselves. Recently, Texas Country Artist Wade Bowen had a very public showing on his Facebook Page about his vocal injury and physician recommendations. He attended a big show after his surgery, and was present and played, but did not sing because he was healing. Producer, Singer and Actor Justin Timberlake, vocally injured, recently did an interview with Jimmy Fallon completely silent, as he was on vocal rest. Singer SZA recently publicly announced her vocal injury issues on Twitter, only to delete the tweets soon after. I feel that if more individuals were able to compensate, like Justin and Wade did, with no fear for backlasth, and by completing their engagements to a degree without having to cancel, the stigma would not be so great.

A New Leaf

I am hoping that if more individuals see that vocal problems may not always mean the end for a career, we can help artists navigate the murky waters of vocal rest and modification. Help by sharing your own vocal issues so that together, we can lessen the stigma and help encourage self-care.

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She rehabilitates voice and swallowing at her private practice, a tempo Voice Center, and lectures on voice science nationally. She is part of the Professional Development Committee for ASHA Special Interest Group 3, Voice and Upper Airway Disorders, and a member of the National Association of Teachers of Singing and the Pan-American Vocology Association. Knickerbocker blogs on her website at  www.atempovoicecenter.com. She has developed a line of kid and adult-friendly therapy materials specifically for voice on TPT or her website. Follow her on Pinterest, on Twitter and Instagram or like her on Facebook.

Posted on January 16, 2019 .

Fit Voices? The Rise of Vocal Injury in Fitness Instructors

The amount of fitness instructors who experience voice issues that continue to recur is 44-70%, according to Rumbach 2013. 78% report feeling a change in their voices after teaching just one class. And the very sad thing is that 80% of these folks regularly use microphones, but they constantly malfunction or the instructor has no idea how to use them efficiently. 

Posted on February 13, 2018 .

We've Partnered with MedBridge. Get Your Unlimited Discounted CEU's Here!

If you're like me, we have the disease of being busy. I have caseloads, business opportunities, blogs, family, taxes, billing, and as my head starts to spin, I could go on for days. In the past, I have waited for specific CEU's to roll around that I knew would be applicable to my patient demographic. Sometimes this would put me in a tough situation where I would have to spend money on airfare and hotels just to get certified in something that was voice or swallow related. 

MedBridge and I have partnered to offer quality CEU's at a very discounted rate so you can afford to educate yourself in the areas of knowledge specific to what you treat. MedBridge has observed that dealing with overpriced CEUs is a constant issue with SLPs (among other disciplines) and they have created a website that offers online continuing education and patient engagement tools. These video courses are accredited and contain excellent research based approaches. 

No longer do you have to travel to get CEU's (unless you want to, of course) and no longer do you have to shell out big bucks to do so! Since running my own business, all my CEU courses have been my financial responsiblity, and last year I spent over $1,000 for a course I attended in person. The year before that, it was a little less than $600 for an online certification in my area of specialty. NO MORE! Medbridge is offering a special pricing discount so you can earn your CEU's anywhere at anytime. (PJ's and coffee encouraged!) 

MedBridge has hundreds of CEU courses, live webinars and is an ASHA Approved CE provider. Use Promo Code: atempoVOICECENTER or click here to get your own discounted annual subscription to MedBridge for only $95! That's saving you $175 right away. 

You also get exclusive access to the home exercise program builder (HEP) which allows you to customize exercise programs specifically for your patients with over 5,000 video exercises. HEP's can be easily printed, texted or shared online. This means your patient is more likely to adhere to your home program, know what is expected and make progress. That's really what it's all about. 

Students? It's even better for you! If you use the student promo code: ATEMPOVOICECENTERstudent you will have a yearly subscription at only $75! Remember, you must sign up with your email address ending in ".edu" for this to be honored. You still get everything in the yearly regular SLP membership, except for CEU credit, because you aren't eligible to earn until you have your license. 

The best part is that huge names in the voice community have recorded webinars that are available to you 24/7! This means voice gurus like Joseph Stemple, Edie Hapner, Mary Sandage, Robert Grider, Sarah Schneider, and even Julie Barkmeier-Kraemer sharing valuable and applicable knowledge. If you are a Many Hats SLP, you can expand your knowledge in many other areas. Plus MedBridge is adding more every day.

I hope you'll take advantage of this fantastic offer, because you shouldn't feel like you are just getting CEU's to fill your quota. You should have affordable options to learn about areas specific to you. This benefits you as a clinician and most of all, your patients. 

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She rehabilitates voice and swallowing at her private practice, a tempo Voice Center, and lectures on vocal health to area choirs and students. She also owns and runs a mobile videostroboscopy and FEES company, Voice Diagnostix. She is an affiliate of ASHA Special Interest Group 3, Voice and Voice Disorders, and a member of the National Association of Teachers of Singing and the Pan-American Vocology Association. Knickerbocker blogs on her website at  www.atempovoicecenter.com. She has developed a line of kid and adult-friendly therapy materials specifically for voice on TPT or her website. Follow her on Pinterest, on Twitter and Instagram or like her on Facebook.

 

Posted on September 21, 2017 .

A Day in the Life of a Voice SLP

Working for yourself is not an easy out. It takes dedication and learning how to sift through the murky waters to pull through to the sun above. You can enjoy, but you have to keep trying to get ahead. If you want a 9-5 where you leave it all at work, I would encourage you to re-think working your own business. As for me, I couldn't imagine it any other way....

Posted on August 16, 2017 .

But Your Swallow Study is Fine.....What is Muscle Tension Dysphagia?

As a graduate student in Speech-Language Pathology, there are so many names to learn about with regard to terms coined, rehabilitation techniques researched and therapy approaches we don't even use anymore. As a patient, you just want answers. Terminology is important, and Christina Kang, Joseph Hentz, and Dr. David Lott have pioneered a term to describe symptoms for dysphagia that does not show up routine swallow studies.

Kang and team took a retrospective look at folks who came into their clinic for swallow and laryngeal studies including VFSS and flexible laryngoscopy. VFSS stands for Videofluroscopic Swallow Study, or Modified Barium Swallow Study, which looks at the swallow function under x-ray with the patient drinking and eating barium. The important thing here is that no swallow weakness or organic pathology was observed in these tests. This means there was no structural cause for the patient complaints. 97% of the patients chosen for this study that were complaining of swallow issues, also had abnormal laryngeal muscle tension. 82 percent had laryngeal hyperresponsiveness. This means that the larynx would respond to stimuli even when it wasn't present, like in refractory chronic cough, paradoxical vocal fold motion and globus sensation. Inflammation, or swelling and irritation, was also found in 52% of these people. 

Credit: Kang et al 2016 article.

Credit: Kang et al 2016 article.

Kang thought, what if we targeted muscle tension in the larynx through voice rehabilitation, to see if these symptoms resolved? So, 13 of the initial 67 attended voice therapy sessions that specifically focused on unloading muscle tension. Treatments consisted of a combination of Resonant Voice Therapy, Semi-occluded vocal tract exercises, diaphragmatic/low breathing and cirumlaryngeal massage. 

Guess What? ALL 13 reported a complete resolution of dysphagia symptoms! Why is this so exciting? I don't know about you, but these patients seem to get pushed to the side if VFSS shows nothing abnormal, but the patient still feels symptoms. The most common symptom sometimes during my week at the clinic is, "I feel like something is stuck in my throat." Having complaints seemingly dismissed after a diagnostic test that shows no problems can make the patient upset, feel like it's "all in my head" and lead to continued and unnecessary testing and physician visits. Kang and team are proposing Muscle Tension Dysphagia or "MTDg" to describe a certain group of patients with functional dysphagia. 

The important and amazing thing here is that these patients improved! There is a possible solution to the problems that brought them to the doctor in the first place. We no longer have to send these patients away with no option for treatment.

Of course further testing is needed in this area, but what a great treatment option to offer patients who normally just get sent home and told to "stop worrying about choking, you'll be fine."

 

Reference: Kang, C.H.; Hentz, J.G.; Lott, D.G. Muscle Tension Dysphagia: Symptomology and Theoretical Framework. June 28, 2016. 

 

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She rehabilitates voice and swallowing at her private practice, a tempo Voice Center, and lectures on vocal health to area choirs and students. She also owns and runs a mobile videostroboscopy and FEES company, Voice Diagnostix. She is an affiliate of ASHA Special Interest Group 3, Voice and Voice Disorders, and a member of the National Association of Teachers of Singing and the Pan-American Vocology Association. Knickerbocker blogs on her website at  www.atempovoicecenter.com. She has developed a line of kid and adult-friendly therapy materials specifically for voice on TPT or her website. Follow her on Pinterest, on Twitter and Instagram or like her on Facebook.

 

 

Posted on July 13, 2017 .

Resonant Voice Exercise is Better than Vocal Rest?

What Kittie Verdolini Abbott likes to call the "Scream Study" shows just that. She and her cohorts (including Ryan Branski and Clark Rosen) took a group of 9 folks and subjected them all to the same task to "tax" their vocal fold tissue (talking loudly for 1 hour, with a few small breaks in between). Then, they separated them into 3 groups.