Part II Voice Physiotherapy & altered head posture in my opinion ….

In part I of voice physiotherapy I explained what MTD is and what physiotherapy for the voice involves. In this post we are going to talk about what you need for efficient voicing and things you can start thinking about for yourself .

There are a few things you need for effortless use of your voice, such as;

  • Healthy vocal cords
  • dynamic vocal cords that are able to be used in an efficient way in walking, sitting and talking
  • efficient breathing pattern and control
  • good laryngeal posture and also overall posture

In this blog my main emphasis will be overall posture. Why? Well In my experience physiotherapists loooove to harp on about “good posture” …… and well … I guess I better stick to the stereotype. But in all seriousness, it is often the one basic thing, that is contributing to peoples symptoms and often all that is needed is a little conscious awareness of habitual positions to change symptoms.

Why is it so important in voice physiotherapy?

It is because head and neck position has a direct influence on how the larynx is positioned.

An “altered head position” often results in a forward head and has been found to decrease the natural curve of the neck. As a result of this angle change, there is a change in the resting length in the neck muscles, in particular, the suprahyoid group. These muscles are located above the hyoid bone (horse shoe shaped bone) and are made up of mylohyoid, digastric, stylohyoid and geniohyoid.

What tends to be the issue is that there is a relative shortening of these muscles. The flow on effect is that this results in a lift of the hyoid bone which then results in an elevated larynx due to the fact that there are muscles that attached from your hyoid bone to your thyroid cartilage.

When this happens there is a disruption to the way the cricothyroid muscles work (see below for image). The cricothyroid muscles are not attached to the vocal folds however they influence their length and thickness by causing movement at the cricothyroid joint, which indirectly causes the vocal folds to elongate and narrow, raising the pitch of the voice. When there is an elevated larynx the cricothyroid muscles are placed in a biomechanical disadvantage where they have to work harder to elongate the vocal folds.

So to put it simply, having an altered head position results in vocal range difficulties due to structures and muscles having a biomechanical disadvantage. This makes muscles work harder and inevitably making them weaker. It takes time to improve your posture, you may need some flexibility in your thoracic spine, strength and endurance in the posterior muscles of your body and you may even need to increase your body awareness. However if you are having issues with your voice whether that may be poor quality, increased effort, fatigue or pain why not see if using your voice with a nice neutral position of the head and neck and see if that changes your symptoms.


  1. Honda, K., Hirai, H., Masaki, S., & Shimada, Y. (1999). Role of Vertical Larynx Movement and Cervical Lordosis in F0 Control. Language and Speech, 42(4), 401–411. doi:10.1177/00238309990420040301
  2. Jull, G. A. (2000). Deep Cervical Flexor Muscle Dysfunction in Whiplash. Journal of Musculoskeletal Pain, 8(1-2), 143–154. doi:10.1300/j094v08n01_12
  3. 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

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