Massage Therapy for a Voice Student with Behavioral Dysphonia When Singing: A Case Report

Behavioral dysphonia is a voice condition in which inefficient muscle tension and misuse interrupt the ability of the body to produce the desired vocal function and quality. Treatment methods typically incorporate traditional voice therapy with manual laryngeal manipulation. A lack of treatment approaches for dysphonia exists that address the vocal system including all its subsystems (i.e., breath, phonation, resonance, articulation) and posture. A limited number of reports exist describing the effect of massage therapy to address the vocal system anatomy of a singer with behavioral dysphonia.

This case report explores the effects of a massage protocol targeting the vocal system of a person with symptoms of behavioral dysphonia when singing.

A massage student completing an 8-month massage therapy program performed 90-min massage sessions twice a week for 3 weeks on a 33-year-old student singer/songwriter referred by his vocal instructor with symptoms of behavioral dysphonia. Symptoms presented only during singing and included "tensing up," effortful voice, and vocal fatigue. Massage therapy sessions targeted the structure, musculature, and connective tissue of the whole vocal anatomy. Acoustic, aerodynamic, and physical outcomes were measured pre and post treatment.

Baseline forward head posture, elevated shoulder position, cervical hyperlordosis, and thoracic hyperkyphosis, as well as thoracic/head/neck engagement during singing all decreased. Low laryngeal posture neutralized. Vocal range increased by six whole tones. Despite between-session variability, following the final session, loudness had increased by 6 dB, peak expiratory flow by 174 L/min, and inspiratory abdominal wall movement by 5 cm. Maximum phonation time improved within all sessions except on the final day. Functional measures for respiratory fluency, harmonics-to-noise ratio, and vocal range during singing all improved. Singing Voice Handicap Index improved by 9 points but remained below norms.

A massage protocol addressing the whole vocal anatomy produced positive aerodynamic, acoustic, and physical outcomes in a person who presented with behavioral dysphonia when singing.