Voice Care Advice
There are 5 things that we at the Voice Care Centre recommend that you can do that will cause you no harm, and have beneficial effects on your voice. These recommendations will help to provide a routine of voice care, whether you are struggling with your voice, or whether you feel your voice is in peak condition.
There is a fair amount of misinformation about LPR (Laryngopharyngeal Reflux, or silent reflux) in the voice community. Although PPI (proton Pump Inhibitors) are readily prescribed for symptoms of LPR by GP’s, there is no significant evidence to support this as a treatment option.
Here is a link to the fantastic research to support the claim above.
Stephen King has presented his research entitled “Singer’s Acid Reflux (LPR): Is it really what we think?” at the British Voice Association, Choice For Voice conference. Here he added to the treatment narrative proving in 2 of 2 cases that the symptoms of LPR can be alleviated by a multidisciplinary approach (Speech Therapy and Manual Therapy) over 5 weeks.
Summary: Acid Reflux is thought to be hugely debilitating for elite singers. Because of the intricacies of elite voice production, any dysfunction in the system can negatively impact the spectrum of motor control, particularly if the symptoms listed on the Reflux Score Index (RSI) are present. These symptoms include but are not limited to: hoarseness, excess mucous, sensations of something sticking in the throat and difficulty swallowing. If a score of more than 11-13 is reached on the RSI, then the subject/patient is thought to have an acid reflux diagnosis.
Methods: The study recruited two singers in current employment in West End contracts who have been formally diagnosed with Acid Reflux as a primary diagnosis by a Voice Specialist ENT, within the past 6 months. Manual Therapy intervention and Semi Occluded Vocal Tract (SOVT) Exercises were then used to treat the symptoms of acid reflux on a weekly basis after an initial two week gap. The multidisciplinary protocol lasts 11 minutes and was applied by the same practitioner each week under timed conditions, and the subjects each had a personal, daily protocol to follow comprising of SOVT exercises and a stretch lasting 6 minutes in total. The data was gathered before and after each intervention over a course of five weeks, yielding 5 sets of figures.
Results: After the five week trial study, the results show a drop in both the Male and Female subject’s RSI score from an initial 22/45 to a 2/45 (Male), and 21/45 to 3/45 (Female). Upon the final measurement, neither subject measured an Acid Reflux diagnosis with an RSI measurement, and conversationally both felt that the symptoms of the Acid Reflux had disappeared.
If you are experiencing hoarseness or dysphonia with your voice for more than 3 weeks, the NHS recommends that you should consider booking in with your GP to assess your condition, and take a further look at what might be going on. This is particularly important if you are, or have been, a smoker.
If you are a singer experiencing a change in timbre or ease, then this could be due to a number of biopsychosocial factors, and rarely a cancer or neurological ‘red flag’. A ‘red flag’ is a biomedical diagnostic term for a symptom of a potentially life threatening condition, which is why it is incredibly important to rule out serious ‘red flags’ as early as possible in your journey. Our extensive Initial Assessment process is essential for the safety and efficacy of the multidisciplinary plan. In the 30-45 minute Initial Assessment appointment you will be asked about your physical, mental and social health, you will also be undergo systemic health screening questions.
If any red, or yellow flags arise, you will be immediately referred to either your General Practitioner or our recommended Surgeon.
I’m clear of red flags, what next?
As we are a living, breathing human being we are subject to biological, psychological and sociological interactions with the world. Human beings are complex (not machine -like) and each person we see at the Voice Care Centre is a rich, multi dimensional tapestry of your experiences, biases and knowledge.
In our philosophy led healthcare, we are not just looking to optimise your dysfunction, we are looking to optimise your life. This is why we put you at the centre of the journey, rather than your dysfunction or disease. This is the patient centred model.
In this video (in partnership with CauseHealth and Vocal Health Education) Stephen King talks with leading Manual Therapy education Walt Fritz, PT and Medical Philosopher Dr Rani Lill Anjum who has committed her life to exploring causation in medicine.
They explore Complexity in healthcare, and start to look at you as a fully rounded being rather than a set of symptoms and evidence base.
What is the Biopsychosocial model?
In 1977, George Engel conceptualised that by considering more than just a biomedical viewpoint, and include psychological and sociological factors into the transformation of a dysfunction, we may work deeper and with greater efficacy.
Bio (physiological understanding of pathology)
Psycho (mental health, feelings, emotions, self narratives, stress tanks and coping mechanisms)
Social (work or environmental factors, family circumstances, friendship groups, living arrangements)
At the VOICE CARE CENTRE, we are equipped to manage and improve the biopsychosocial factors which make up your whole human condition.
What is a Chronic Condition?
Chronos is Latin for time, which is where we get the name of a chronic condition. A chronic condition means; a condition that has manifested itself over a length of time (usually more than 6-8 weeks), rather than an acute incident like stepping on Lego or banging your shin.
Pain is really strange, and you as a human being are subject to not only biological factors, but psychological and sociological factors that make up wellness or disease. We are socially conditioned to thinking of the body like a machine. This expands to our laymen understanding of things like joint surgery. It’s somewhat easier to perceive a knee arthroscopy or scraping excess tissue out of a joint rather than the dynamic and complex interplay of chemicals in a pharmacological intervention. The scalpel is far more comprehendible than a re-examination of our relationship with wellbeing.
Because of this social conditioning, we may feel the same about pain in regards to simplicity with a cause and effect. The reality may be far more complex than; “I bashed my knee and there is pain in my knee”… because sometimes chronic conditions can seemingly happen without any cause. Take for example, bending down to tie your shoelace one morning, and feeling your entire back seize up, something which unfortunately lasts for months. Was it the act of tying the shoelace, or was the bending down simply a tipping point for a stressful morning, where you were late to work, the kids were sick, and your partner having a difficult week?
How do you work with Me if I’m at a Chronic stage of my condition?
Social conditioning may lead us to believe that chronic pain should be rested and medicated, but the current base of the pain literature evidence suggests that “movement is medicine” rather than “rest is best”.
We are looking to get you moving again, and moving in a way where you feel empowered to make decisions free from the fears of your condition.