“Voice Rehab”

“Voice Rehab”

“The wound is the place where the light enters” Rumi


I saw an old friend last night who had been seeing the limitations of themselves in relation to their injury. We do this. We limit ourselves. What happens when we are no longer able to do the things we were doing effortlessly and pain-free before? How can we not be hard on ourselves or punish ourselves, or as my lovely friend Sara says ‘let ourselves off the hook’. Why is injury judged and what makes one judge it?

I had an accident back in June, and suffered whiplash (not for the first time either), with ongoing treatment being required. How may we work ourselves out of an injury? So many questions spring to mind. Is it easier if we have a high level of technical knowledge pre injury? Does it make it harder or easier if we have awareness about what is happening to us?  Where does our fear sit when we have an injury? Do we go into fear at all or is it all encompassing? If we know more what might go wrong, how difficult is it to surrender and allow healing and recovery to take place? How can we move out of the emotions that might be overwhelming, and move to a place of acceptance? What we know is that when we focus our intention upon the present and plan for the future that lies ahead, with all its unknown qualities, it leads to an easier path.

As a Speech Pathologist, my role is mulitfarious in terms of recovering the injured voice.  I create structures and guidelines (often quite strict) for my clients in order for them to rehabilitate vocally. Not to whisper, shout, sing, or in some instances talk much at all, depending upon the injury or infection. It is a big ask for someone to stop speaking, or at least, speaking as much as they used to. To stop singing, even for a short time, can feel as if someone is asking them to be one handed. Often as an explanation, in our voice clinic, we use the analogy of a vocal athlete. It is a wonderful analogy, so much so I created a business from this model www.vocalathletics.com Singers and other professional voice users are our vocal athletes. The opera singer sings a marathon night after night. (Wagner may be a double marathon!) But so is the local school teacher who runs the equivalent of 25km a day!

We usually don’t think twice about an AFL footballer or elite sportsperson doing a “corky” or a “hammy” or sustaining an injury, especially at the elite level. In some ways we almost expect that this might happen. Post injury, these sport players get elite and frequent rehabilitation.The media reports on it (as a general rule) without punishment or blame and gives regular updates on how players are recovering. Not so, it seems, with elite singers. The recent surgeries of the likes of Adele and John Mayer received less coverage. We don’t know who their surgeons were (unless we look extensively on the web), or what their rehabilitation was like. I could not find out who their Speech Pathologists were. It seems enshrouded in secrecy, as if these voice difficulties are best hidden. At the other extreme, such as in the case of Julie Andrews, negative publicity was generated because of her poor voice outcome. She later teamed up with those same surgeons in an effort to promote their work and raise awareness of these issues surrounding the voice.

Most of my clients, particularly those from the media or international/national singers do not want to be known to have had “Speech/ voice therapy”. Obviously,  I respect their privacy fully, as it seems that they feel that they too may be judged from this. If they had a personal trainer to get a great physique, we would know about it, I am sure.

I speak highly on both a personal and professional level of the amazing specialist voice physio Annie Strauch of Performance Medicine Physiotherapy. A sports physio for the vocal athlete! Is neck tension and a tired larynx something to be ashamed of? I do not always think so, especially if our technique is good. Is it because they think they have done something wrong? Does an AFL player blame themself for their injury(ies)?  I do hope that this attitude is one that will change in future years, and that voice rehabilitation is not something to b ashamed of. The more awareness we have of the voice and how we can look after it well, the better, in my opinion. We are not flawless human beings with flawless medical histories.

So. look after your precious voice: “You don’t know what you’ve got till its gone…they paved paradise and put up a parking lot” Joni Mitchell

With voice injuries, I always suggest that a sound structure goes a long way- an email outlining what has been happening (usually a set of 3-4 varied emails depending upon who the recipients are) as well as a voice message on phones (recorded by them or somebody else) that suggests an sms or email is the preferred as a way of contacting them whilst they are having difficulty. This does help to take some of the pressure off the repetitive nature of retelling the story and the injury. Could we imagine the person with the “hammy” standing up and re-enacting the dreaded scene and showing us the same pose that they were in when they were injured. No. No, I think not. Yet the voice is perceived as different. It is of course, and yet also needs some of the same treatment.  

In terms of “real life”, others judgement and concern certainly happens quickly. The questions usually come when they least want them; scuttling out to get milk and the cashier says- “oh, what is wrong with your voice, you should really get that checked out. You sound dreadful”. Or friends who are wanting to be supportive and want to talk all the time with them. How do we say what is in our hearts when we are not able to use our speaking voice? How can we do it especially if we have not addressed the important emotional aspects of the recovery. What if we want to cry or yell in frustration every time we go to open our mouths? Can we do our job silently? Do we have 10 jobs that we are juggling? How do we make money? Most jobs these days require that we use our voice. Would you be able to perform your job duties if you had to be minimally speaking? How do we find that elusive patience and mindfulness in the midst of this process to really know it is a process and not focus on the immediate outcome. So many questions also means that people feel that their lives are no longer in their control, and it is an interesting and sometimes unfamiliar place to be.

Voice rest is a controversial issue currently. How long should we not make sound for if we have had an injury (or lost the voice?) What if we misused it on a night out and sang too much karaoke? How much rest would we need then? There are many factors for us to consider, and it is usually recommended on an individual basis. And for those for whom surgery is indicated, how long post surgery should one be completely silent for? As yet, we do not have the definitive answers according to the evidence, however it is becoming clearer as time and research continues. A Speech Pathologist and a Specialist ENT have some up to date answers on this. Unfortunately I have seen too many people who were advised voice rest (of up to one month) with no follow up specialist referral when they had a serious injury. Time lost in the most important part of the process, so that recovery can occur in a timely manner. 

And as my Nan used to say “A stitch in time saves nine.” So if you are not sure about your voice, and it has been niggling at times, or you have had unexplained voice loss, croakiness, soreness and trouble talking perhaps it is a wise choice to book in with someone who knows. And I mean really knows. Not the “my friend who is an occasional singer told me that……” An excellent voice coach or a Speech Pathologist who has extensive experience with voice is a good place to start. We may think we have excellent vocal technique, however sometimes this is far from the truth. And our voices are important to us. Often only found out when it gives us trouble. We also can learn from when it is not feeling good. We can then take steps to care for it. and find the easier path to great and fabulous “shibumi” voicing!