Hello, Fit for Broadway!  

Welcome back, for week 3 out of 4, in this series on vocal athletes. We ended last week by considering, essentially, the schedules that sports athletes keep.  To refresh your memory:

Football games happen once a week. No NFL athlete would play 8 games a week; but what’s more, no NFL athlete would play 8 games a week, then run 5 miles between games, take a boxing class at halftime, and then go home and do more pushups and planks. That is what many singers end up doing, analogously, when they sing 8 shows a week, do interviews or auditions between shows, go out to dinner at loud restaurants with friends, and go home and talk with their family, friends, or roommates.  

I happen to be a New England Patriots fan (I know some of you will stop reading immediately at this moment. #sorrynotsorry), and I like using what I imagine Tom Brady’s schedule to be as a template for illustrating some ways that vocal athletes might consider their activities during any given week. I imagine that this week, in anticipation of the Super Bowl, he is training every day, throwing the ball, running plays. He may well be doing conditioning, strength training, flexibility exercises. But I imagine he is also reviewing game tape with his coaches, discussing strategy, analyzing the Rams’ defense. Above all, he is doing everything he can to hone his mechanics in anticipation of a big performance, and, I would imagine, taking care to prevent an injury.  

Inevitably, however, injuries in sports are common; in fact, they are expected due to the sheer demands that are placed on the tissues and muscles. As I wrote in week 1 – can you imagine if a hockey player broke his nose on the rink and was ashamed of it? In baseball, there is a DL – a disabled list! – for players who are out because of injuries. Throughout this football season, sportscasters have commented every week on players who are out due to injury, and during gametime, sideline reporters will provide updates on athletes who sustain injuries during the game.

Could you imagine what it would be like to live in an arts culture that was so free and open about the real injuries that vocal athletes sustain during a grueling performance schedule? 

At this performance, the role of Elphaba will be played by X; Y sustained a vocal injury and is on the disabled list and is on vocal rest (wearing a fabulous t-shirt to proclaim it!) but is under the care of her doctors and is optimistic about returning soon! 

In fact, it is not uncommon for dancers to call out of shows due to injury; why, then, do we think any differently about singers who call out of shows due to injury? [In case you have any doubts about the kinds of stigma and sneering judgments that armchair commentators cast on injured vocal athletes, witness the response to the singer Adele’s tour cancellations, about which I wrote last year, here]

I think the root of much of this stigma, as is the case generally with stigma, is ignorance. I believe that we as physicians and voice scientists have not been as proactive as we could be about sharing our knowledge and research with voice teachers and coaches. This allows myths to flourish, and perpetuates the cloak of mystery under which some voice technicians continue to operate. That is why we are here, standing next to Fit for Broadway to shed light into these often dark corners, to empower you with knowledge.

There are entire textbooks on vocal injury and pathology, but the kernel I want to impart to you in the final paragraphs of this post is that breaking down stigma around vocal injury, and embracing the paradigm of vocal athleticism, starts with understanding and being specific about what “injury” really means. In our world of laryngology and voice science, we often use the term “phonotrauma” to refer to things that can happen to the vocal folds as the result of making sound – hence, ‘phono’ for sound, and ‘trauma’ for an injury. I think there is an important distinction in this discussion between acute (sudden/short-term) injury and chronic (longer-term) lesions. 

I find it more helpful, and more accurate, to understand acute injuries as events like vocal fold hemorrhage (bleed) or, some might include, sudden swelling resulting from an upper respiratory infection. I consider nodules (and by the way, that’s generally what we call them these days, as opposed to “nodes”) to be the result of – in fact, the body’s wound healing response to – chronic, repeated injuries to the vocal folds. They do not happen suddenly, but they can build over time. So, when you encounter a sudden vocal crisis – as in, your voice was fine in a moment and then gone the next – you should not worry that you all of a sudden developed a nodule, because nodules do not pop up suddenly. Many singers come in to our office extremely worried about this – that suddenly, they developed nodules. This just doesn’t happen. What can happen, suddenly, is a quick increase in swelling either due to an upper respiratory infection or an unusual, excessive amount of voice use; or indeed, a hemorrhage.  

You may be surprised to learn that vocal fold hemorrhage is somewhat rare. More commonly, vocal crises emerge from a slow burn – that is to say, the cumulative effects of heavy vocal demand, insufficient rest and recovery, coupled to some event that may be the proverbial straw that breaks the camel’s back – whether an especially long day of rehearsals, or a shift to a different genre of singing, or a cold, or life stressors or anxiety, or added dance routines, or heavy costumes, or any of the hundreds of things that feed or compromise the athletic mechanics of your voice.  

How vocal injury occurs, and the ways that the body responds to it, is the subject of a lot of the research that my colleague, Dr. Ryan Branski does in his lab, and there is some incredible insight emerging from these investigations. I want you to hear, above all, that there is not currently, nor has there ever been, scientific evidence that vocal injury can be correlated in a simple way to vocal technique. These things you hear in the community – “she got nodes because she belted too high;” “he got a polyp because he switched fachs;” “obviously she has nodes because she has no idea how to sing” – not only are they vicious, but hear this: they are ignorant, and not supported by science. Imagine if a coach said to a wide receiver: “you tore your ACL because you’re a bad athlete and don’t know how to play the game,” or a coach to a baseball pitcher “obviously you need surgery because you throw incorrectly.” Why do we tolerate analogous mis-truths in the singing community?

No more. Let’s continue this discussion, publicly and loudly, and joyously, knowing that the future is in MORE discussion, MORE interdisciplinary communication, and MORE people just like you, seeking to better understand the athletics of voice, in glad collaboration with the scientists and physicians who adore you for the inspiring art you create with your voices. 

Toward that end – next week’s post is dedicated ENTIRELY to your questions!!  So send them in!  I’ll try to answer as many of them as space will allow. Thanks for your enthusiasm and energy!

P.S. Thank you all, also, for your immense response to, and interest in, our limited edition t-shirts!! The response has indeed been enormous, so we are running low on certain sizes; we’re working with Jane to produce more, but please be patient with us, and we’ll get you your shirts as soon as we possibly can. Don’t forget to take a selfie wearing the shirt, if you feel so moved, and share it to your social media accounts!

To get your limited edition, FFB x NYU Voice Center “I’m on Vocal Rest” shirt, visit The NYU Voice Center Donation Page.  Also, to learn more about the NYU Voice Center, visit www.nyuvoicecenter.org

“I’m on Vocal Rest” is an original Fit for Broadway Apparel design. We are so grateful for to be a part of this mission with NYU Voice Center and believe this message is worth spreading in our global community!

Join the conversation below in our comments section. Part 4 of our series will be a Q&A with Dr. Paul so please don’t be afraid to ask questions below!