The Vocal Athlete
By Walt Fritz
As a myofascial release educator, I present my work to a range of professionals, from massage therapists and physiotherapists, but also to athletic trainers, occupational therapists, physicians, and speech-language therapists/pathologists (SLT/SLP). This latter profession is a newer target of my attention; one brought to me after years of receiving referrals from SLPs in my home city of Rochester, New York. I saw the patients they sent me for issues of:
- Voice (dysphonia)
- Swallowing (dysphagia)
- Pressure/tightness in the throat (globus)
- Problems of breathing; and
- Other related disorders.
This sort of treatment seemed confined into a tiny niche, and I never imagined it would become a much larger part of both my practice and, eventually, my worldwide teaching. However, the more I became involved in this work, with patient populations entirely different from the typical physical therapist’s patient profile, the more I saw a need and desire for training and education, as manual therapy is a small (if present) component of the training that an SLT/SLP may receive.
I’m now teaching hands-on seminars to SLTs/SLPs, as well as massage therapists and other professions with an interest in adding a manual therapeutic engagement to their current repertoire of evaluation and treatment strategies.
The style of work I use and teach is still called ‘myofascial release’, but primarily as a nod to the style of engagement, rather than out of a belief that it is fascia that is at the cause of the disorder and that it is fascia that we are selectively targeting with our interventions. These changes represent an evolution of my understanding of the body and its workings, though it frequently meets with disdain from fascial-trained therapists (and other educators).
Who is the Vocal Athlete?
I’ve seen professionals who might be viewed as being at the fringe of this work, doing some pretty exciting work. One group is massage therapists and physiotherapists, who are doing what some term “vocal massage”, working with voice professionals – vocal athletes – such as singers, actors, and other people who use their voice as their profession.
I’ve borrowed the term ‘vocal athlete’ from colleagues Wendy L. Leborgne and Marci Rosenberg’s book “The Vocal Athlete”. While Leborgne and Rosenberg cover many aspects of the care of such a patient, they include manual therapy, massage, and myofascial release in their repertoire of treatment strategies.
Vocal strain, fatigue and loss are common complaints with the vocal athlete, and intervention can often do much to alleviate these issues and can provide the performer-athlete with an improvement in vocal range and quality.
In my ‘Foundations in Myofascial Release Seminar for Neck, Voice, and Swallowing Disorders’, I use class participants as demo patients with every technique sequence covered. Often the volunteer is not only a therapist but also a vocal performer. When such a person sits on my table, I will ask them to demonstrate to the group what they view as their problem, and they will often sing into a range that is problematic to them. My less-than-trained ear often struggles to hear the problem, but to the vocal athlete on my table, it is quite apparent, as well as being evident to similarly trained professionals in the group.
When to Treat
My approach to myofascial release evaluation is not to locate their problem tissue based on my training and years of experience, but instead to find an area that, when stretched, lightly pressed, or in other ways engaged, creates a dynamic that validates and replicates aspects of their experience; of their disorder.
My touch should feel relevant or I must continue to evaluate.
My decision to treat is based less upon my training, experience and beliefs, and more about the response of my patient. I strive to replicate or connect with familiar aspects of their issue, be it pain, vocal distress/loss, trouble swallowing, or a host of other dysfunctional patterns throughout the body.
How to Treat
Once my touch is validated, and I ensure that it feels safe and productive, treatment is often quite simple; I remain with the stretch/pressure as my patient begins to experience the cascade of change.
What drives the change?
What improves their voice, lessens their swallowing issue, reduces the pressure in their throat or makes it easier for them to draw breath? Some might say that I’ve diminished their muscle tension, others that I impacted their trigger points, still others may say that I released their fascial restrictions. All may be possible, though difficult to prove. Realistically I look toward neurological narratives to explain the change, as well as contextual and even indirect effects. Patient perceptions of being listened to, with validation of their symptoms and a caring attitude on my part, may all play a potential role in gains.
What Happens Next?
When my patient sits up from the short demonstration treatment sequence, I will ask them to repeat what they attempted before the session, much as we would do in an actual session. I take a risk asking for such follow up, as on occasion no change is noted or, rarely, someone may feel or sound worse than when we began. But this is the nature of our work and indeed of the myofascial release-type work I use. Most often my demo patient will work their way up through their vocal ranges, feeling less difficulty, hearing and feeling, both auditorily and internally, with better sound emanating. It is satisfying work. The vocal athlete can utilize our services to improve their already stellar qualities or improve upon what they feel is a deficit.
In the references that I share to validate my approach, I include studies performed on asymptomatic individuals, where gains are noted regarding vocal strain (and similar) with continued usage. What is especially gratifying is to have professionals attend my seminar, being aware of their background and clientele, and knowing that my work is being translated through this person to performers of all types across the earth. Very cool stuff.
It differs a bit from the myofascial release (MFR) I was taught early in my Physical Therapy career, though more in explanation than in visual appearance. What I do (and teach) is a bit different than what I was taught as I no longer tell tortured stories to my patients about how fascia is underappreciated and that emotion is stored in fascial restrictions (yes, some people believe this). But I continue to hold my hands in a manner that my teacher taught me and apply slow, very gentle pressures, all while waiting for change. Is this how you treat? Possibly not, which does not imply that your methods are less-than.
I genuinely believe that it is less about the exact manner in which we engage, but more the fact that we are present; that we do engage.
Have you considered working with the Vocal Athlete?
What are your thoughts on expanding your reach, addressing the needs of the vocal athlete? Have you considered this niche? Do you have an interest in working with the vocal athlete, the swallowing-challenged, or the person with constant pressure in the throat?
A simple caution: vocal issues may be an early sign of more severe problems. Proceed with intervention only after your patient has had a laryngeal exam by an otolaryngologist and a voice care team. Swallowing referrals should be accompanied by adequate pre-screening to ensure that appropriate diagnostic measures have been taken before the patient is seen by you.
About the Author
Walt Fritz is a Physical Therapist who practices a primarily myofascial release-style practice in Rochester, NY, USA. He has been a manual therapy educator since 1995 and teaches his neuroscience-based version of MFR internationally. He will be presenting three 2-day seminars in Sydney in August 2019, including his MFR for the Upper Body, Lower Body, and the above-referenced Neck, Voice, and Swallowing Disorders Seminars. All of these seminars are open and appropriate for massage therapists. You can find more information, including his blog articles, at www.WaltFritz.com.
(All images courtesy of Walt Fritz except title photo courtesy of Pixabay.)