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Laryngeal Massage: or, “Why would I let anyone put their hands around my throat?”

!Pril2017.UCLA.demo   “Vocal Massage”/ “Manual Therapy for Laryngeal Muscle Tension”/ “Circumlaryngeal Massage”/ “Myofascial Release for Speech Pathologists”/ “Voice Massage”/ “Hands-on Voice Therapy”/ “Musicians’ and Vocalists’ Massage”/”Adjusting the Voice Box”/ “Manual Laryngeal Musculoskeletal Tension Reduction.” There are lots of names for this kind of voice work, and it’s getting a lot of buzz. All of these labels generally mean that the muscles directly around the voice box (larynx) are being treated by hands-on touch therapy.

This area is typically avoided by standard massage therapies. But sometimes, direct touch or massage can help these “circum-laryngeal” muscles work better, feel better, or both. As a result, the vocal cords inside the “box” can find more ease of movement, which means better or wider-ranging vibration (sound). People with medical issues that give them trouble swallowing are also sometimes helped by this approach.

As far as I know, the concept was formally introduced into voice care in the 1980s by Dr. Arnold E. Aronson of the Mayo Clinic. Osteopath Jacob Lieberman, in London, became known in the 1990s for his “Voice Massage” treatments for singers. In 2011, the idea “buzzed” more publicly in in the USA, when ABC-news showed the Cleveland Clinic’s Claudio Milstein, Ph.D, a speech pathologist, using manual techniques to rapidly restore the voice of a woman who’d “thought she’d never speak again.”

Now, here in body-therapy-and-entertainment-heavy Los Angeles, I know of singing teachers, music-industry-oriented massage spas, acting teachers, and at least one physician, as well as licensed voice/speech therapists like me, who offer variations on laryngeal massage. And you can find several videos online that show you how to do it yourself. (I haven’t curated them, because I don’t generally believe that throat massage should be taught this way.)

The “Why would I let anyone…?” gasping response, from a singer that I know, confirms that the throat/front-of-neck is a tricky area. At one end of the spectrum are vocal artists who consider laryngeal massage to be the new guarantee of a great voice. At the other end, some feel so protective of their “inner jewel” that the thought of direct touch makes them gag! Either way, it makes sense to be careful.

Just for starters, the voice box surrounds and protects your airway (windpipe), meaning that your basic survival is right inside! And the laryngeal area is not far from the major bloodlines between your heart and brain. These are some of the reasons why most massage therapists, and even most licensed physical therapists, avoid working there. It’s definitely not a place to jump into DIY.

This is also an area that is psychologically/emotionally very hot, as shown by common phrases “I got all choked up,” “that idea was hard to swallow,” “the decision was forced down my throat, ” or “what a pain in the neck!” So even when people work with a practitioner who knows anatomy, and who is specifically trained to help the muscles in this region, there’s a wide variation in how much hands-on contact each client can tolerate.

To confirm: with some clients, this type of therapy is one of my top choices. But it’s not right for everyone. And I firmly believe that hands-on voice work is best as one ingredient in an individualized “recipe” of vocal exercises, breath-work, health education, and other approaches to vocal wellness. It’s not a magical cure for every problem, and it’s not the only brush in my paintbox.

Keep in mind that I’ve not only taken the standard training now offered to speech/voice therapists. I’ve also taught voice-related anatomy at a university; I spent years working in medical settings with sick and fragile in-patients; and I’ve studied massage and other forms of energy healing at places like the Esalen Institute and the Theta Institute.

In my 15 years as a voice therapy specialist, a hands-on muscle checkup is part of my assessment of every new client, meaning that I’ve touched around 2000 throats. Each one is different. I can usually tell pretty quickly who will tolerate what kind of contact, and when touch-based therapy is/isn’t going to be helpful—but sometimes I’m wrong. The classic healthcare principle of “First, do no harm!” is in my mind every time.

One client told me about having seen another specialist who had done only a short interview, then proceeded to manipulate her front-of-neck muscles so aggressively that the client felt bruised and sore for a week afterwards. If this practitioner had asked about the client’s history, a pre-existing trauma—near-choking by an ex-spouse!—might have come to the surface, to help explain why the muscles were so tight (protective). But few questions were asked, and the client felt too overwhelmed to say anything. That kind of experience does not help anyone sing!

Another student described a theater teacher (not a voice specialist, apparently) telling his class during warm up to “wiggle the hyoid bone until it clicks.” This teacher didn’t seem to know that both silent and “clicky” movement of the hyoid can be normal; it varies from person to person and is not any kind of sign of readiness (or not) to perform onstage. Freedom of movement in that area is a fine idea, but forcing or expecting an anatomical “click” falls between ignorant and dangerous.

I’ve also heard of vocalists who pay a voice coach big bucks for a “laryngeal adjustment” every time they’re onstage— sometimes repeatedly, in between songs. This might be done appropriately, and might feel good in the moment. But I worry that it risks dependency, and it gives the coach an incentive not to help the artist reduce muscle tension in other ways.

I nearly always combine my massage with verbal instructions to help clients participate in making change (for example, to soften or stretch the back part of the tongue, which interacts closely with the voice box.) And if regular massage around the voice box seems helpful, I will teach clients to do it themselves. I want to build independence, not the opposite.

Another concern about laryngeal massage, when it’s separated from a comprehensive training or voice-rehab program, is that it does not answer the question of WHY vocal-support muscles are overworking. Are other muscles not doing their jobs? Is there some kind of weakness in the vocal cords themselves, or elsewhere in the whole voice system, so that the outer throat and neck muscles get unconsciously recruited to compensate? Has the client even had a vocal exam (internal “scope”) to help answer those questions?

What if massage and other relaxation techniques make the voice sound worse? Does the practitioner understand this possibility, or do they just believe that muscle tightness is always bad and that relaxation solves everything? Non-licensed vocal arts teachers generally are not trained to deal with vocal-weakness conditions, and massage therapists know even less about the complex inner mechanics of the voice. A licensed vocal therapist almost always starts with some medical information about a client’s vocal cords, and is trained to think carefully about all aspects of a complaint.

My initial consultation with clients does include a short hands-on testing of these around-the-voice-box muscles. In that first contact I’m “listening” carefully to the body, and asking for verbal feedback on how each little area feels. Some clients flinch at a light, almost grazing, touch; others let me press deeper. I respect both.

In that first meeting we also talk about many other aspects of your voice and vocal demands. Sometimes a person’s technique is basically good, but they’re just doing too much. Big-picture, real-life strategizing is as important as detailed in-the-moment muscle relief. If we decide to do more work together, touch-based therapy may or may not be part of the package. We decide together.

For healthy performers, I also offer a one-shot “Massage and more” session. This combines extended hands-on work around the neck and throat with a whole-body energy-balancing experience. It’s a great boost for performers on tour.

Wherever you are, and whomever you choose to go to for help with your voice: please know—ask!—what you’re getting into.

  • If someone with no license in speech therapy, other medical care, or bodywork, advertises laryngeal-area massage, or “vocal massage,” ask about their training, and how they’ll know what you individually need.
  • If you are working with a licensed medical person whose materials emphasize massage, ask what other techniques they might use to round out your plan of care.
  • Look for direct, comfortable communication about your vocal needs, and about the benefits of touch-based treatment. A responsible person will tell you what they’re going to do, and will ask what intensity (depth) of pressure feels most useful and safe for you on that particular day.
  • If an arts teacher tells you to manipulate your throat in a way that feels weird, or is rushed-through, first listen to your own body and respect your limits.
  • Look for a minimum of “blaming” language (implying that your muscles are tight because they, or you, are doing something wrong.) Subtle shame/blame messages about the body don’t help anyone feel better. Especially if combined with aggressive forms of touch, there can be an unfortunate “punishment-because-I need-it” dynamic.
  • Instead, seek someone who accepts that you and your muscles are doing the best you know how, and who suggests improvements with compassion, rather than with criticism or even a subtle frown. Seek an attitude of “Let’s find out how I can help you,” versus “Everyone gets fixed the same way.”

And if, as with my singer-friend, the whole idea makes you squeamish: that’s OK too! Ask for alternative ways to retrain your voice, or for very small, “trial doses” of laryngeal massage.

Nutshell: voice massage can be a great tool, if everyone is careful!  And taking good care starts with you.

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