Tag Archives: health tips

Prevent Voice Damage
Recent News

Doctor Explains How to Prevent Voice Damage

Bob Dylan never had the most beautiful voice among musician, but listening to him today it’s easy to hear his voice has gotten even coarser over the years. With the release of his newest album, Shadows in the Night, Dylan is coverings songs made famous by singers like Frank Sinatra. Not exactly the easiest songs to sing with a voice like Dylan. Seeing how getting older can affect the voice of all musicians, we’re glad Vulture reached out to otolaryngologist Dr. Milan Amin, director of the NYU Voice Center, for an explanation and more importantly, if there is any way to fix it.

Amin listened to some of the new album Shadows in the Night and compared it with Dylan’s earlier hits from the ‘60s. “The top part of Dylan’s pitch range has dropped, so he can’t access that.  When he’s trying to go up in his pitch with certain words and phrases, the voice gets rough. The other thing is that his whole tone is lower.

Amin explains that vocal cords are basically muscles underneath layers of collagen and a watery substance called hyaluronic acid. “As you get older, you lose muscle bulk. The layer starts to lose both collagen and hyaluronic acid, so the entire vocal fold sags, just like skin would. How you produce voice is by having the vocal folds come in contact with each other and blowing air past them, so if the vocal folds can’t contact each other, then you can’t produce as strong a sound.”

Amin right away points out smoking can only hurt, and being in dirty bars for so long filled with smoke certainly didn’t help either. He points out that performing on a rigorous schedule for so long will wear down the vocals. He also attributes it to late night performances, lack of sleep to rest the vocals, and even eating before bed causes acid reflux which can inflame the voice-box region.

Amin makes a great analogy comparing it to a person’s joints. “You get a little ding and they don’t work like they used to. The surface lining of the vocal cords ends up getting little nicks, so they can’t vibrate like they should.”

Luckily, and very importantly, this isn’t irreparable. Unlike most other muscles in your body where you need to use them to build strength, the vocal cords can’t do that. As Amin points out, “singers would have these huge, fat vocal chords and wouldn’t be able to breathe.”

The most common solution is simple airflow exercises and behavioral modifications to make sure they aren’t damaging their voice. There are also surgical measures, as Amin explains, “You can inject materials that will essentially give the vocal folds more body. That can give you better contact between the cords and better volume. If you give the cords better volume, they can increase their pitch range.”

For all you musicians out there, take this as a warning. Listen to Dr. Amin on how to prevent voice damage. You need to protect your voice and be careful, or you will lose it. If you have an tips to share with how your keep your voice healthy, let us know in the comments below.

Health, Resources

Less Is Best When Treating TMJ Disorder

EDITOR’S NOTE: This article uses research from several resources including the National Institute of Dental and Craniofacial Research at the National Institutes of Health (www.nidcr.nih.gov). The AFM urges musicians to seek professional medical advice when dealing with health issues.

If you are a musician suffering from temporomandibular joint (TMJ) pain and/or dysfunction you are not alone. One study showed that 75% of the population experiences one or more TMJ disorder symptom in their lifetime and those numbers are even higher among musicians.

The TMJ connects the lower jaw, called the mandible, to the temporal bone at the side of the head. If you place your fingers just in front of your ears and open your mouth you will feel the joints. These joints are flexible, allowing the jaw to move smoothly up and down and side to side for speech, singing, chewing, and yawning.

When the mouth is open, the rounded ends of the lower jaw, called condyles, glide along the joint socket of the temporal bone. They slide back to their original position when the mouth is closed. A soft disc lies between the condyle and the temporal bone to absorb shock. This combination of hinge and sliding motions makes the TMJ among the most complex joints in the body.

There are three basic types of TMJ disorders—myofacial pain (discomfort in the muscles that control jaw function), internal derangement of the joint (displaced disc, dislocated jaw, or condyle injury), and arthritis. You may suffer from more than one of these conditions at the same time.

Any musician could be affected by TMJ disorders, but violists, violinists, wind instrumentalists, and singers, seem to be more susceptible due to the stress they put on the TMJ. Other musicians may develop TMJ disorder because of poor posture or anxiety, especially if they tend to clench their jaw or grind their teeth at night. Other causes of TMJ disorder include arthritis, jaw injury, or muscle fatigue.

There is a wide range of TMJ disorder symptoms, which include radiating pain in the face, jaw, or neck; jaw stiffness; limited jaw movement or locking jaw; painful clicking or popping when opening and closing the jaw; or a change in the way the upper and lower teeth fit together. Some of these symptoms overlap with those of other conditions, such as sinus and ear infections or toothache, making TMJ difficult to diagnose. A health care provider may use X-rays or MRI images, in combination with medical and dental history, for proper diagnosis.

There is no certified medical TMJ specialty, so finding the right care can be difficult. Look for a health care provider who understands musculoskeletal disorders (affecting muscle, bone, and joints) and who is trained in treating pain conditions and able to understand your special needs and stresses as a performing musician. Performance Arts Clinics are often a good source of advice, particularly when pain continues over time and interferes with your career.

Complex cases, marked by prolonged, persistent, and severe pain; jaw dysfunction; coexisting conditions; and diminished ability to work, may require a team of experts from various fields, such as neurology, rheumatology, pain management, and others, for diagnosis and treatment.

For most people, TMJ problems will go away on their own. So, it is best to start with conservative treatments. Patients may be advised to make it a habit to take frequent breaks while rehearsing, relax facial and jaw muscles frequently during the day, avoid chewing hard foods and gum, apply ice packs, avoid extreme jaw movements (for example, yawning or loud singing), and learn relaxation techniques.

Even for persistent TMJ, most people do not require aggressive treatment. Short-term use of over-the-counter pain medicines or nonsteroidal anti-inflammatory drugs (NSAIDS), may provide temporary relief. When necessary, your physician can prescribe stronger medications to ease the symptoms.

Your doctor or dentist may recommend a stabilization splint or bite guard, especially if nighttime teeth grinding is suspected. These plastic guards fit over the upper or lower teeth and should only be used for a short period of time and should not cause pain.

Other irreversible treatments, such as orthodontics to change the bite, surgery, and implants are controversial and should be avoided. If your doctor recommends them, be sure to seek a second opinion.

For more information on TMJ disorders and support visit the TMJ Association website (www.tmj.org).

Health, Resources

Vision Protection: More Than Meets the Eye

There are plenty of obvious injuries that can result from repetitive music practice and playing. Carpal tunnel, tinnitus, and neck pain are just a few injuries musicians should look out for. One commonly overlooked problem area is the tool used to read music—the eyes.

Factors that put musicians’ eyes at risk for injury and strain include focusing on small notes on a page for long periods of time, frequent reading with inadequate light, dry eyes, and playing loud and high pitched notes on wind instruments, which can double eye pressure.

The eyes weren’t meant to repeatedly scan small text such as musical notes for an extended length of time. Doing so overworks the muscles in the eyes to the point where they begin to spasm and cause vision to blur. This is called eye strain and it can sometimes lead to ocular migraines

Prevention is the best way to curb eye strain. One simple way to relieve stress on your eyes is to blink or carry eye drops. When the cornea becomes dry, the eye begins to ache. Blinking lubricates them. If you wear contact lenses, you are more susceptible to dry eyes. Consider wearing your glasses to gigs or when you rehearse. Also, be mindful of having proper light and taking appropriate resting breaks when your eyes begin to fatigue.

Janet Horvath of Local 30-73 (St. Paul Minneapolis, MN), author of Playing Less Hurt: An Injury Prevention Guide, and associate principal cellist for the Minnesota Orchestra, says a major cause of eye strain stems from the strenuous, uncomfortable positions musicians sit or stand in when playing in a group or with a music stand. Horvath suggests, when practicing at home or with a group or orchestra, make sure the room is brightly lit; that you aren’t too far away from the sheet music; and that you aren’t craning your neck to see the pages.

If you practice with a music stand, be sure to adjust it to eye level or slightly below and place it where you won’t have to turn your body or crane your neck to see the notes. Maintaining a neutral head and neck position is a key element to reducing the occurrence of eye strain. If you share a music stand with another musician and are used to craning your neck to one side, try switching places to create a better balance. “Studies show there is a higher rate of astigmatism in musicians,” says Horvath. “Some musicians often have to play in chronically asymmetrical positions and the amount of eye movement and head movement when tracking an object, like notes on a page, should be balanced.”

Those who wear corrective lenses should consult an optometrist or ophthalmologist on what types of product is most helpful for a particular performance situation. Horvath actually brought along her stand and a page of sheet music to her eye doctor appointment to illustrate the distance at which her eyes had to work when playing with the orchestra. “If you can take the instrument, that’s even better,” says Horvath. “The doctor wouldn’t know it’s quite a few feet away, it’s not book reading distance and not long driving distance.”

Horvath recommends progressive lenses for musicians in their 40s and 50s. These “allin- one” lenses pack every scenario, reading, driving, and watching TV, into one convenient pair and lack the lines that bifocals and trifocals have.

Since space issues are a common problem in orchestras, it’s important to make your conductor and orchestra aware of any discomfort or difficulty seeing the sheet music. Work with your stand partner to find the best placement of the music, where it is comfortable for both of you. Sometimes, simply turning a chair in a different angle is preferable and works better than twisting your pelvis, core, or neck to view the sheet music. “The most important thing is figuring out your head and neck angle and how you are tracking the music,” says Horvath. “This is essential to avoid injury to body, spine, and shoulders too.”