The Doctor is in: : Posture and Voice


Young singers spend a great deal of time addressing tension and position in the head and neck. They are told to keep their shoulders relaxed; their head, neck, and torso aligned; and their jaw in a neutral position, not jutting out but also not pulled down and in. But there is a lot more to proper posture for singers, including areas you may not normally think of as relevant.

Good singing involves the whole body and, specifically, the musculoskeletal system. Did you know that muscle tension anywhere in the body raises the neuromuscular tone in every other muscle? When the doctor taps your knee with a hammer (yes, some doctors still do that!), you can enhance the reflex and make your leg jump much higher by just clenching your teeth or hooking the fingers of your hands together and pulling hard. There is no direct connection between the masseter muscle of the jaw and the patellar tendon of the knee, but this phenomenon (called the Jendrassik maneuver) is highly active and reproducible and it affects every part of your body.

So let’s look at some less obvious areas of tension that may cause vocal tension. Neck and shoulder tension is important and may have many causes. Apart from medical conditions such as arthritis or soft tissue injury after a car accident, many of us habitually carry tension in the mantle area. The startle response of pulling the shoulders up and the head down is reflexive, and its deconstruction and elimination is at the crux of the Alexander method.

Some people don’t just startle, however, but are in a chronic state of tension. I can often tell whether a patient is left handed or right handed just by palpating the trapezius muscles. Heavy bags also pull on these muscles and cause a state of chronic contraction in the shoulder which bears the burden. Singers whose day jobs require carrying around laptops or documents (and yes, even those heavy scores and big bottles of water!) often have chronic tension in the neck and shoulder area.

Here are some suggestions to relieve such neck and shoulder tension. Declutter your bag frequently, taking only what you need for the day ahead. Use a bigger bag with a broad strap that you can sling diagonally across from the other shoulder. This distributes the weight more evenly to both sides, and places the load closer to the center of your body, reducing torque. The most ergonomic arrangement is the “wineskin” bag that hugs the hollow of your waist on one side and is slung across your other shoulder. Another healthy technique is a backpack with straps left long so the load sits in the small of your back and rests on your sacral area. At the risk of looking like a bag lady, it may be better to carry two smaller bags in your two hands rather than one big one. And, all else failing, get one of those cheesy little wheeled bags/cases that paralegals and attorneys wheel around. This takes the weight off your shoulders completely.

Moving south in our survey, consider whether you may have any scoliosis. This is a curvature of the spine, usually in the thoracic area, which is especially common in young women and frequently goes undiagnosed. If mild, it does not impair breathing but does create an asymmetry that your muscles need to counterbalance. Excess tension in one side of the body continues into the hips, and muscle contraction creates the effect that one leg is rendered functionally shorter than the other. With all of this, remember that culprit for the voice is not the asymmetry but the chronic low-grade increase in muscle tension required by your body to sit, stand, ambulate, and function normally.

The lower back is a major source of excessive muscle tension. In addition to bona fide disease, such as disc problems or arthritis, the normal curvature in this area (called lumbar lordosis) can be accentuated by poor posture and weak muscles. Obesity creates extra weight in front which further pulls the lumbar vertebrae forward. Some women “sit up straight” by pushing the sacrum and pelvis back to achieve a position of balance. In this regard, high heels are also a villain—not only do they throw the lower body forward, requiring the wearer to excessively arch the upper back for balance, they also raise muscle tension in the lower legs. Remember: tension in any muscle in the body has a general effect.

From the vocal point of view, I have several suggestions. First, shed some pounds until you are down to around your ideal weight. Second, when at the gym, exercise your postural muscles in addition to your usual cardio and stretching routine. These muscles, such as the psoas major, are slow contracting and need a slow, rather than rapid, workout. Third, avoid high heels if possible. While at times you may need to look tall and sophisticated, from the vocal point of view, half-heels or flats are better. And fourth, consider slouching once in a while!

While most of the points so far refer to the musculoskeletal system, don’t forget your internal organs. Discomfort in the abdomen or pelvis can lead to splinting, a reflex contraction of neighboring muscles that minimize movement and pain in the area. A urinary tract infection or lower GI problem can raise muscle tension in the pelvic floor. Ovulation or endometriosis can irritate the inner lining of the abdominal cavity and contract the abdominal muscles. This not only affects breath and support but, again, can also generally raise muscle tension in the body and, specifically, in the vocal tract.

Well, that’s a lot of stuff! Some of it’s preventable, some unavoidable. What to do? Here are my suggestions for reducing avoidable tension. First, be aware of your entire body, somewhat like you have trained to be aware of your vocal tract. Also, learn to sense and release tension, either through meditation, yoga, or other exercises. Your entire body is involved in singing, and every muscle needs to work correctly to support your vocal effort.

Anthony Jahn, M.D.

Anthony Jahn M.D. is an otolaryngologist with a subspecialty interest in ear diseases, disorders of hearing and balance, and disorders of the voice. He is a professor of clinical otolaryngology at Mount Sinai School of Medicine and is the noted author of Care of the Professional Voice. For more resources, go to his website www.earandvoicedoctor.com.