Learning to sing hinges, to a great degree, on learning to breathe efficiently, and then learning to coordinate the great bellows of the chest (and abdomen) with laryngeal movements and postures. Once this link is mastered, singers will sing most effectively. Until it is learned, many problems occur. These problems—including lack of support, overblowing, and excessive muscling of the voice—form the basis of vocal pedagogy, and it would be inappropriate for me, as a non-singing physician, to write about them.
After 39 years of marriage to a cellist, I conceptualize ideal breath for singing much like a bow drawn across a string. The bow engages the string and sets it into vibration. Inadequate bow pressure produces a weak and airy sound. Excess bow pressure chokes the string and prevents proper vibration. Correct bow pressure, however, sets not only the string vibrating but also engages the resonating cavity of the entire instrument to produce a large and rich sound.
Similarly, excess air blows through the larynx and produces a breathy, noisy voice. By contrast, trying to engage the vocal folds using inadequate or residual air usually triggers excess muscle tension in the larynx, producing a thin, harsh, and nonresonant voice. When airflow and laryngeal tension are optimally linked, the voice is “on the breath,” the tension in the larynx and supraglottic chambers is not excessive, and the voice speaks readily and resonates in the supraglottic larynx and the pharynx.
Medical issues which affect proper breathing for singing are the real topic for this column, and there are several which are common and should be considered in cases where the singer experiences difficulties with breathing or support.
Inspiration requires contraction of the diaphragm, which displaces the contents of the abdomen downward (and outward) while expanding the thoracic cavity. The ribs, which are hinged to the breastbone in the front and the spinal column in the back, swivel slightly like a bucket handle during this process—up and outward during inspiration, then down and inward during expiration. Even though breathing for singing is ideally abdominal breathing, some movement of the ribs, aided by the intercostal and supraclavicular muscles, does occur.
What medical problems impair normal inspiration? Obviously, major deformities of the breastbone or ribcage would be an issue. Discomfort on drawing a deep breath, due to injury or inflammation of the ribs or joints, results in splinting the ribcage and drawing a shallower breath. Pain on inspiration should always lead you to the doctor’s office, since this symptom can have many causes.
One commonly overlooked problem, especially in young women, is scoliosis, or lateral curvature of the spinal column. This may be minor, but can at times be significant. The curvature reduces the distance between ribs on one side, and limits their normal bucket-handle movement during breathing. Secondary muscle tension in the muscles of the upper back and neck further impair good phonation in these singers. While mild scoliosis does not require treatment, it should be identified as a possible cause of impaired inspiration and muscle tension.
Chronic obstructive lung disease (COPD), such as emphysema and bronchiectasis, is usually the result of years of smoking, but it may occur spontaneously, even in nonsmokers. The lung tissues become stiff and cannot expand adequately on inspiration—you simply cannot fill your lungs adequately. While one needs to breathe to sing, other issues—such as getting enough oxygen—take precedence for these patients. Fortunately, this is an uncommon condition in the generally nonsmoking singer population.
A much more common complaint is that, as you breathe in, you just cannot completely fill your lungs, unable to get a full breath. In the absence of medical problems, this complaint is normally a symptom of anxiety and resolves over time.
Abdominal problems can also impede inspiration. Spasm of the abdominal muscles limits their ability to relax. Splinting and guarding of the muscles causes the breath to suddenly stop during inspiration. Apart from muscle pulls or other athletic injuries, the most common cause for this in women is menstrual cramps. Endometriosis, which can cause irritation of the inner abdominal wall, can also cause cramping, with a spasm of the abdominal muscles.
The usual treatment options include analgesics and antispasmodics. One issue with these medications is the slight increase in potential vocal fold hemorrhage with aspirin-like analgesics, and increased dryness of the mucous membranes with some antispasmodics. Long-term contraceptive therapy, which prevents menstruation for months, should be considered. Acupuncture for menstrual cramps is an excellent option also. When looking at hormone therapy, however, consider that some hormones may masculinize the voice—best to discuss this with an understanding gynecologist.
What about expiration? While inspiration loads up the lungs, it is the act of expiration that directly drives the voice. Expiration, in turn, is driven by the muscles of the abdomen, which push the abdominal contents up against the diaphragm to empty the lungs of air. This is like a plunger in a hypodermic syringe—you push in the plunger to empty the barrel of the syringe of its contents.
Asthma is a common cause of impaired expiration. When the lining of the bronchial tubes becomes swollen, expiration is slowed. Air is exhaled more laboriously, with less air flow. As air is forced through the narrowed air passages, a wheeze is produced—a classic symptom of asthma. Unfortunately, milder cases of asthma (ones with no wheeze) are often missed. Since asthma can present in atypical ways, if you feel any difficulty with exhalation, even in the absence of an asthma history, you should see your doctor for a pulmonary function test.
A final breathing problem, one that is specific to singers, has to do with rapid weight loss. Remember that expiration powers the voice, and the voice depends on your muscles pushing your abdominal contents upward, against the diaphragm. These muscles get used to a certain resting position and load—i.e., your abdominal contents. If you rapidly lose weight, whether through diet or surgery, the rules are altered—you have reduced the size of the plunger. When this occurs, the singer often attempts to re-create the voice in memory by increasing muscle tension not only in the abdomen but also the throat, and an altered, inferior voice results.
What is the solution here? Ideally, try to lose weight gradually to give your muscles time to adjust their resting length and ability to contract. If you do lose weight rapidly (such as after bariatric surgery), don’t try to mimic your previous voice with your new body. Give it time! During the adjustment period, be aware of the misguided tendency to muscle the voice as compensation.
In general, singers are knowledgeable and aware of their larynx. But don’t forget the 500-pound gorilla in the corner: your lungs. If, despite good teaching and hard work, you have difficulty projecting or sustaining the voice, have your chest examined—both structurally (physical exam or X-ray) and functionally (auscultation, pulmonary function tests).
