I recently received a query from one of our readers. She has been looking at her neck and noticing that the veins become distended when she sings. Her concern is whether this means anything significant in terms of excessive tension during singing. Rather than giving a simple answer, I thought this might be a good opportunity to review the neck—a particularly busy part of the body and one of specific interest to singers.
Beyond the daily ritual of inspecting for wrinkles and sagging skin, a singer should be familiar with the neck for several reasons. It not only supports the head, but also houses the larynx (among many other important structures) and serves as a conduit for blood vessels and nerves that connect the brain to every other part of the body. While most schools now teach vocal anatomy to voice students, a basic knowledge of the neck, both what you can see and what you can feel, is also useful. So, here we go!
The neck is supported by the cervical spine, seven vertebrae which connect the thorax to the head. The vertebrae describe a gentle forward curve, so you can usually feel only the lowest one—the rest are hidden by the posterior muscles of the neck. The main palpable muscles are the trapezius, connecting the neck to the shoulders on each side, and the SCM (sternocleidomastoid) muscles—two broad straps that run obliquely down from the mastoid bump behind your ears and forward to the collar bones and sternum.
Excessive tension in these muscles—whether from a sprained neck, stress, or habitual posture—can increase the tension in the laryngeal muscles and cause muscle tension dysphonia. If the tension is caused by just stress (rather than, say, arthritis of the cervical vertebrae), then massage, neck exercises, and mindful awareness (as with Alexander Technique) can do a great deal to relax the tension. The triangle defined between these two muscles, the posterior triangle of the neck, contains lymph nodes which may become enlarged with inflammation. Normally, however, this area contains nothing that can be palpated.
The anterior neck is more interesting. It is defined by the two SCM muscles, one on either side, and extends from the notch above the sternum up to the chin. Most interesting for singers here is the larynx. The most prominent part of the larynx, the thyroid notch, or Adam’s apple, corresponds approximately to the level of the vocal folds. You can feel the two flat sides of the larynx (thyroid cartilage) on either side. You can grasp the larynx between your fingers and gently move it side to side. It is attached above to the hyoid bone and below to the trachea, but moves freely to the side. By doing this maneuver, you can also relax the muscles that hold the larynx, a useful technique in cases of excess tension.
As you move your finger down below the thyroid cartilage, you encounter a raised, firm ridge. This is the anterior part of the cricoid cartilage. The cricoid forms a complete ring, and posteriorly it provides attachment for the arytenoids, which swivel to open and close the glottis. For phonation, this is where the action is: the arytenoids approximate the vocal folds so you can phonate. Unfortunately, this area is deep in the neck and cannot be physically felt or manipulated.
Below the cricoid ring, the trachea continues down and eventually behind the notch at the top of the breastbone. Sometimes the upper one or two rings of the trachea are palpable, but more commonly you cannot distinguish them from overlying soft tissue. It is in this area of the upper trachea where the two lobes of the thyroid gland are connected. The connecting part (thyroid isthmus) usually covers the trachea. In normal cases, neither the thyroid isthmus nor the two lobes (which are on either side of the trachea, and medial to the SCM muscle) can be discreetly palpated.
Above the larynx (thyroid cartilage), you can feel the hyoid bone. The space between the thyroid cartilage and hyoid bone may be easily felt—or it might be quite tight. When your larynx is low and the supraglottic resonating spaces open, you should have no problem inserting thumb and forefinger between the hyoid above and the thyroid cartilage below (thyrohyoid space). Conversely, in untrained singers, or singers with a great deal of vocal tension, you may have difficulty even distinguishing this potential space with your fingers.
Now grasp the thyroid cartilage between your thumb and forefinger and swallow. You can feel the larynx moving up, out of the way of food or drink coming down from above. This is the main purpose of the muscles above the larynx—to pull it up and out of the way in order to protect the airway.
Two other structures can be felt, neither of vocal interest. If you gently put your forefinger into the angle between the jaw and the SCM muscle, you may feel the pulsations of the carotid artery. Do this gently: excess pressure in this area can cause fainting!
Finally, you can feel some fullness just under the sides of the jaw on either side. This fullness, which becomes more prominent with age, is the submandibular gland, one of the major salivary glands. With age, skin and subcutaneous tissues become thinner, and the muscle support for this gland weakens, so the gland drops down, and may be mistaken for a “lump in the neck.”
A general comment about lumps: most structures in the neck are bilaterally symmetrical. When you feel your neck, you should generally not be concerned unless there is a marked difference between the two sides. If you do, or have significant symptoms, that would be a good time to call your ENT doctor.
And, now, those veins. The jugular veins run down in front of the SCM muscles, draining the blood from the head into the chest. Veins have relatively thin walls and are easily distended when the blood flow backs up. As you sing, you raise pressure in the chest, and the veins become prominent—but the amount of visible distention depends on many things, including the size of the veins, the thinness of their walls, and the amount of soft tissue that overlies them.
Certainly, these veins become more prominent as you sing with more effort, but there is no direct correlation between singing with excessive effort and the appearance of the veins. I would certainly not make a diagnosis of “singing with excess tension” based just on the appearance of the jugular veins. That diagnosis is better made on the basis of vocal quality, vocal difficulties, and physical discomfort during and after singing. One final important point: if your neck veins are either fully or partially distended even at rest, you need to see your doctor, since this may reflect a cardiac problem.
