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Vocal Health

The voice is arguably the most personal instrument of all – but also one of the most injury-prone. We look at how singers can maintain good vocal health and get help when they need it.

Last updated: 05 December 2023

Cause and effect of vocal injuries

Vocal health specialists consider most injuries to fall under three categories. ‘Misuse’ refers to a singer using incorrect technique, perhaps with small factors, like slight jaw tension or off-centre body alignment, often with a slow build-up over time. ‘Overuse’ results from a punishing schedule. ‘New use’ can be when a singer is placed in an unsettling situation – for example, a West End singer performing in elaborate headgear. There are also examples of direct trauma, like a tennis ball hitting the neck, as well as non-abuse related illnesses such as reflux. But running through these is anxiety. When we’re anxious, worried, wound-up, we hold our bodies in a state of tension, not in the easy, fluid, balanced way we normally would, and that always affects your voice.

Mindful of the bills, and keen to promote a ‘can-do’ reputation, many singers struggle on. Others don’t address their voice issues – until it’s too late. Pain is actually not a common symptom because we don’t have that kind of sensory feedback from our larynx. Before they start to feel pain, singers will notice their voice isn’t functioning so well. The symptoms of a damaged voice could be a loss of range. You might lose your high notes or get a hole in the middle. You might find you can’t sing quietly or loudly. There could be issues with stamina or recovery time. So the day after a gig, you’ll be knackered, whereas when you’re fighting fit, you bounce straight back.

Where to get help

Singers should be aware they are not alone. One of the music industry’s most respected charities is BAPAM, which leads struggling artists through a logical healthcare pathway, providing experts at every juncture.

BAPAM offers free clinical assessments and hold a list of clinical specialists in performing arts medicine - anybody who’s earning a living through being a performer is eligible for their service. In vocal health, singers experiencing problems must first get an assessment at a specialist professional voice-user clinic, including a laryngeal endoscopy with stroboscopy (slow-motion examination of the vocal cords). Without looking at the vocal cords, nobody can tell what treatment is needed. BAPAM works with singers to ensure they are seen by the right specialist to get a treatment plan delivered by recognised therapists.

The good news is that generally singers who get the right initial diagnostic and treatment advice restore their voice and gain the knowledge to prevent injuries in the future. Be really aware of your voice and what it feels like, and when it gets tired, you should be pacing it. Frequent mini breaks during practice are more important than long ones. It’s also about being aware of what you do when you’re not singing.

A healthy day-to-day lifestyle can counter problems before they arise. No smoking is a must. Reflux can affect your voice, because the acids and enzymes from the stomach creep up the oesophagus and wash around the back of the throat while you’re asleep. There’s keeping stress at bay, using breathing and mindfulness techniques. But other things don’t help. Honey and lemon tastes nice, but what you swallow doesn’t go anywhere near your larynx. The harmful effects of dairy and coffee – that’s generally a myth.

There’s more truth in the emerging philosophy that musicians should strengthen their bodies like athletes. There is research that looked at the rate of reduction of inflammatory markers on the epithelium of the vocal folds. To put that in normal language: when the vocal folds within the larynx get bashed around, they get slightly swollen. This research found that swelling reduced faster in people who are physically fit, because of their overall metabolic function. The CO2 and O2 exchange in the muscles is more efficient, and the whole system will clean itself up more quickly.

Sing smarter

Even backstage, there are strategies to put in place. With a warm-up you should start with very gentle sliding exercises, normally on some kind of buzz or hum, starting low and gradually extending through the pitch range. Next, you should be opening onto valves, and warming up the tongue with articulatory exercises. Then, extending to bigger pitch glides, moving through your whole range, so you’re getting the blood flow to the muscles you’re going to be using, ready for more vigorous work.

A sensible regime gives you the best possible chance of sailing through your career without injury. But just as important as following these preventative measures is to seek help when you need it.

Check out BAPAM's Vocal Rehabilitation Coaches. Learn more about BAPAM’s services at and visit Voice Care Center website for further information. For more on Jenevora’s work, see

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