Voice physiotherapy (Part I) in my opinion …..

When you think of physiotherapy, your first reaction may not necessarily be to think of the voice, rather you might think about shoulder or back pain… and to be honest voice physiotherapy is a relatively new concept in the physio arena. However over the past decade there has been an increase in evidence to show that there is efficacy for the use of manual therapy of the laryngeal and perilaryngeal (around the larynx) area for Muscle Tension Dysphonia (MTD).

So lets talk about Muscle Tension Dysphonia. What is it?? MTD is a common disorder of the voice where there is excessive muscle recruitment which results in incorrect vibratory patterns of the vocal folds and altered voice production. This can really negatively impact your life especially when you think about the fact that your voice is how you communicate with the world and if you use your voice as part of your profession and daily work then it may impact you quite heavily. I think it is important to remember that it is not only singers who use their voice in their profession… school teachers, trainers, lawyers, hairdressers, call centre employees all use their voice an extensive amount.

How does MTD start? Before we answer that lets think about normal anatomy of the voice, when there is normal voice production the expiratory airflow causes the small intrinsic muscles of the larynx to vibrate. The muscles contract and relax allowing the vocal folds to move and produce sound. The larger extrinsic muscles such as the supra hyoids and infra hyoids give the larynx stability while the voice production is being made.

Tomlinson and Archer (2015) explain that MTD starts when there is an increase in tension of the extrinsic muscles, this increase in tension can cause mal-positioning of the larynx which then has a flow on effect of increasing the tension of the intrinsic muscles and vocal folds.

What symptoms do people report with MTD?

  • Altered vocal quality
  • increased vocal effort
  • vocal fatigue
  • pain
  • elevated hyoid bone and thyroid cartilage

What does voice physiotherapy involve?

The main aim with voice physiotherapy is to restore the tissue quality, length tension relationship between muscles and improve bio-mechanical efficiency, with an overriding goal to improve the efficiency of the vocal fold vibration and voice production.

Voice physiotherapy sessions may involve:

  • soft tissue and myofascial releases
  • trigger point therapy
  • laryngeal mobilsations
  • cervical spine mobilisations
  • TMJ management
  • soft palate release
  • diaphragm release
  • shoulder girdle management

A common theory that is spoken about in voice physiotherapy is the idea that a “maladaptive voice cycle” occurs with MTD. When you are in the cycle compensatory neuromuscular recruitment keeps you in the loop. It is also important to note that there are many other factors feeding into this loop such environmental, psychological and vocal load.

Because MTD is multifactorial in nature it is really important to have a team to support you on your healing journey because once you start to get a better length tension relationship with your voice muscles it is important to use this window to then reeducate the muscles in this area to produce a more efficient voice production. So as well as physiotherapy it is crucial to have one or more people on board; voice coach, speech pathologist, ear nose and throat specialist, GP.

If any of this resonates with you, please feel free to contact me to book an appointment.


Tomlinson, C. A., & Archer, K. R. (2014). Manual Therapy and Exercise to Improve Outcomes in Patients With Muscle Tension Dysphonia: A Case Series. Physical Therapy, 95(1), 117–128. doi:10.2522/ptj.20130547

Rubin, J. S., Blake, E., & Mathieson, L. (2007). Musculoskeletal Patterns in Patients With Voice Disorders. Journal of Voice, 21(4), 477–484. doi:10.1016/j.jvoice.2005.02.001

Van Lierde, K. M., Bodt, M. D., Dhaeseleer, E., Wuyts, F., & Claeys, S. (2010). The Treatment of Muscle Tension Dysphonia: A Comparison of Two Treatment Techniques by Means of an Objective Multiparameter Approach. Journal of Voice, 24(3), 294–301. doi:10.1016/j.jvoice.2008.09.003