Upright, Buoyant, and Balanced: How Posture Shapes the Singing Voice (Part 1)

Stand up straight with your shoulders back!

The old adage echoes in rehearsal rooms across the world. We’ve all heard it, and we’ve all said it. But what does good posture really mean for healthy, efficient singing? Evidence suggests that freedom, not stiffness, is the key to maintaining a healthy posture.

The Foundation of “Good” Singing Posture In vocal pedagogy, posture is about appearance and functional alignment. As McKinney (1994) described, efficient posture “avoids unnecessary tension without undue expenditure of energy.” The spine’s natural curves provide dynamic balance, not rigidity (Feldenkrais, 1977). Arboleda and Frederick (2008) expanded this idea by defining optimal alignment through a lateral “plumb line,” where the ear, shoulder, hip, knee, and ankle stack in gentle balance.

When posture collapses or stiffens, breath and phonation systems compensate. Rounded shoulders, a forward head, or locked knees restrict the rib cage and abdominal movement needed for steady breath pressure and resonance. Conversely, a balanced, upright, and buoyant bearing promotes freedom throughout the body, including the large joints of the ankles, hips, knees, shoulders, and neck, and the small structures of the jaw, tongue, and laryngeal suspension. Singers benefit from a stance that allows gravity, rather than muscle tension to support the singer’s body.

What Happens Inside the Body We can learn from classic respiratory research that posture and breath are inextricably linked. Hixon et al. (1973) demonstrated that gravity’s pull on the rib cage and abdomen changes how the lungs fill and empty depending on position. Upright posture encourages expansion in the ribs and abdominal wall during inhalation, maximizing air intake and allowing fine control of exhalation. Later studies confirmed that upright alignment improves lung volume and phonatory efficiency (Sundberg et al., 1991; Lopez et al., 2020). Confidence, Presence, and the Singing Mind Posture also communicates emotion and confidence. In “Power Posing and Collegiate Singer Confidence” (Sale, 2021, unpublished), singers who assumed expansive “high-power” poses with their feet grounded, chest lifted, and hands-on-hips, reported greater confidence during a sight-reading task and sang more accurately than when in contracted postures. The findings align with psychological research showing that open, upright postures enhance perceived capability and focus under pressure (Briñol et al., 2009; Cuddy et al., 2015). For singers, this suggests that posture serves as both a physical and mental cue, priming the body for vocal freedom and the mind for expressive performance.

Looking Ahead New research continues to investigate the interaction between posture and voice physiology. A 2025 pilot study from Michigan State University and Pontificia Universidad Católica de Chile examined muscle activity and airflow during singing in four standardized postures, ranging from upright to the “Leaning Tower of Pisa” posture, and even on an unstable surface (Castillo-Allendes et al., 2025). Their findings revealed no significant aerodynamic or muscular differences among trained singers, although subtle pitch variations were observed on unstable surfaces. The study suggests that experienced singers adapt easily to mild postural shifts, maintaining efficient voice function through fine motor control and proprioceptive awareness.

In Part 2 of this blog, we explore what such adaptability means in practice, highlighting how posture retraining is a pathway to restoring balance, ease, and vocal efficiency in novice or injured singers.

A Practical Takeaway. The good news is that these patterns aren’t set in stone. Training the cricothyroid muscle, the primary driver of vocal fold elongation, can be done through simple, time-tested exercises. Decades of voice science have demonstrated that this muscle plays a central role in pitch control (Hirano, 1988). Gentle glides (glissandos) on an open vowel encourage the folds to lengthen gradually, developing strength and coordination without strain. Over time, this training allows the voice to extend higher while staying balanced and resonant.

Quick Tip: Find Your Dynamic Center. Instead of “standing up straight,” think of finding your dynamic center for an upright, balanced, and buoyant bearing.

1. Start with your feet. Without judgment, look down at your feet. Don’t rush to change anything. Notice how far apart your feet are in your habitual stance. Now, stand with your feet comfortably apart. Note that biomechanically, females generally require less distance between their feet for balance than males, as a woman’s childbearing hips create a more pronounced angle from the hips to the knees. Feel your weight evenly distributed across the foot tripod.

2. Play with “Shifts.” With each of the following shifts, notice any muscle engagement or tension that occurs in the body, including the toes, feet, ankles, calves, thighs, rear end, lower back, mid-back, shoulders, neck, jaw, and tongue. After each shift, use the following assessments without judgment or rushing to change.

• Shift your weight forward. Assess.

• Shift your weight backward. Assess.

• Widen your habitual stance. (It is ok to experiment with an excessively wide stance.) Assess.

• Narrow your habitual stance. (It is ok to experiment by bringing the feet completely together.) Assess.

• There are any number of shifts you can explore. For example, try rocking your hips forward or backward, or tipping your chin up or forward. Create your own shifts. With each shift, repeat the assessments.

Consciously repeat the following assessments after each suggested shift.

1. Notice muscle engagements, tension, or pain throughout the body.

2. How is your balance affected by the shift?

3. If it helps, ask yourself, “Why aren’t I falling?”

3. Come to a balanced, upright stance. Without judgment, look down at your feet. Don’t rush to change anything. Notice how far apart your feet are after exploration. Experiment with your stance in your own way, shifting to find optimal uprightness, ease, buoyancy, and balance throughout your body. This simple awareness exercise supports both alignment and breath coordination, an interaction shown to enhance “appoggio,” the balanced breath support that frees the voice.

Institute for Healthy Singing & Voice Research
Jamea J. Sale, PhD
Director, Institute for Healthy Singing & Voice Research
Sing for a Lifetime
JSale@HealthySinging.org

References

Arboleda, B. M. W., & Frederick, A. L. (2008). Considerations for maintenance of postural alignment for voice production. Journal of Voice, 22(1), 90–99. https://doi.org/10.1016/j.jvoice.2006.08.001

Briñol, P., Petty, R. E., & Wagner, B. (2009). Body posture effects on self-evaluation: A self-validation approach. European Journal of Social Psychology, 39(6), 1053–1064. https://doi.org/10.1002/ejsp.607

Castillo-Allendes, A., Delgado-Bravo, M., Reyes Ponce, Á., & Hunter, E. J. (2025). Muscle activity and aerodynamic voice changes at different body postures: A pilot study. Journal of Voice, 39(2), 439–447. https://doi.org/10.1016/j.jvoice.2022.09.024

Cuddy, A. J. C., Wilmuth, C. A., Yap, A. J., & Carney, D. R. (2015). Preparatory power posing affects nonverbal presence and job interview performance. Journal of Applied Psychology, 100(4), 1286–1295. https://doi.org/10.1037/a0038543

Feldenkrais, M. (1977). Awareness through movement. New York: Harper and Row.

Hixon, T. J., Goldman, M. D., & Mead, J. (1973). Kinematics of the chest wall during speech production: Volume displacements of the rib cage, abdomen, and lung. Journal of Speech and Hearing Research, 16(1), 78–115.

Lopez, E., Lee, S. H., Bahr, R., Carey, S. L., Mott, B., Fults, A., & Kim, E. S. (2020). Breathing techniques in collegiate vocalists: The effects of a mind-body integrated exercise program on singers’ posture, tension, efficacy, and respiratory function. In Perspectives in Performing Arts Medicine Practice (pp. 111–125). Springer.

McKinney, J. C. (1994). The diagnosis and correction of vocal faults. Nashville, TN: Genevox.

Sundberg, J., Leanderson, R., Von Euler, C., & Knutsson, E. (1991). Influence of body posture and lung volume on subglottal pressure control during singing. Journal of Voice, 5(4), 283–291. https://doi.org/10.1016/S0892-1997(05)80057-8

On a High Note: Research Indicates Skill Beats Structure

If you’ve ever marveled at how professional singers float effortlessly into the upper reaches of their range, you may have wondered what makes their voices different from everyone else’s. The answer lies in a combination of anatomy and training. Recent research has given us a clearer picture of what’s happening inside the larynx when singers take on high notes.

The vocal folds work a bit like elastic bands. To produce pitches in the upper range, the vocal folds stretch and lengthen. A trained singer is capable of lengthening their vocal folds by nearly 20 percent across two octaves, as opposed to the typical 10 percent by those who do not practice singing (Storck et al., 2025). That extra flexibility allows singers to raise pitch without strain and with control.

The cricothyroid joint (CTJ) in the larynx can be likened to a small hinge that helps determine how easily the vocal folds can stretch. Some people are born with a joint structure that allows for smoother elongation, while others have a less mobile version. But the striking finding from this study is that training makes a greater difference than anatomy alone. Even those with less favorable joint types can sing effectively by strengthening the correct muscles (Storck et al., 2025).

The Role of Training

Professional singers achieve most of their vocal fold lengthening in the first octave above their speaking pitch. This foundation makes the second octave much easier to navigate. A 3D imaging study confirmed that nearly 85% of vocal fold stretching happens in the first octave, with only about 15% in the second (Unteregger et al., 2017). Non-singers, by contrast, don’t stretch the folds enough early on. To compensate, they often raise the larynx, narrowing the resonance space to “force” higher pitches. The result is more effort and less freedom in the sound. As a 2025 study from the University Hospital Basel found, non-singers likely increase pitch by elevating the larynx rather than by sufficient vocal fold elongation, underscoring the value of targeted training (Storck et al., 2025).

A Practical Takeaway

The good news is that these patterns aren’t set in stone. Training the cricothyroid muscle, the primary driver of vocal fold elongation, can be done through simple, time-tested exercises. Decades of voice science have demonstrated that this muscle plays a central role in pitch control (Hirano, 1988). Gentle glides (glissandos) on an open vowel encourage the folds to lengthen gradually, developing strength and coordination without strain. Over time, this training allows the voice to extend higher while staying balanced and resonant.

Final Thought

Reaching higher notes isn’t about possessing rare anatomy or extraordinary talent. It’s about teaching the voice to use its natural mechanisms more efficiently. With thoughtful practice, any singer, professional or amateur, can develop greater ease in the upper range, singing with both freedom and confidence.

Institute for Healthy Singing & Voice Research
Jamea J. Sale, PhD
Director, Institute for Healthy Singing & Voice Research
Sing for a Lifetime
JSale@HealthySinging.org

References

Hirano, M. (1988). Vocal mechanisms in singing: Laryngological and phoniatric aspects. Journal of Voice, 2(1), 51–69. https://doi.org/10.1016/S0892-1997(88)80058-4

Storck, C., Murer, R., Honegger, F., & Lieb, J. (2025). The influence of cricothyroid joint type on vocal fold elongation in professional male singers and non-singers. Journal of Voice. Advance online publication. https://doi.org/10.1016/j.jvoice.2025.09.015

Unteregger, F., Honegger, F., Potthast, S., et al. (2017). 3D analysis of the movements of the laryngeal cartilages during singing. Laryngoscope, 127(7), 1639–1643. https://doi.org/10.1002/lary.26430

The Trouble with Tongue Tension: A Cross-Disciplinary Concern for Music Educators-Part 2

If tongue tension interferes so profoundly with resonance and ease, how can singers identify it and what can they do about it?

Awareness is the first step. Press gently under the chin while phonating; if the tissue stiffens, the tongue root is likely overactive (Friedlander, 2011). Other signs of tongue tension include muffled vowels, jaw fatigue, or even a false vibrato produced by tongue wobble (Stoer & Swank, 1978). Trollinger and Sataloff’s (2025) new research underscores that these same symptoms can arise in students who play wind instruments, since many learn their instruments with little regard for throat and tongue efficiency.

Practical solutions include:

• Mobility drills: “Tongue push-ups,” side-to-side stretches, or the “peanut butter clean” help free extrinsic muscles (LeFevre, 2011).
• Release strategies: Yawn-sighs, tongue-out singing, and consonant anchoring ([v], [f], [z], [s]) restore neutral posture (Miller & Schutte, 1981; Stoer & Swank, 1978).
• Whole-body awareness: Because jaw and tongue tensions usually co-occur, massage, posture checks, and semi-occluded vocal tract (SOVT) exercises can help reset the system (Cole, 2019).

What is new in the Trollinger & Sataloff study is the recognition that instrumental pedagogy can reinforce or reduce tongue tension just as much as vocal pedagogy. Singing teachers, band directors, and wind instrument teachers can collaborate on healthful teaching strategies. Partnership ensures that students who sing and play will not reinforce tension-producing habits across disciplines.

The takeaway: freeing the tongue is not about one “perfect position” but about restoring softness, mobility, and independence. With research-backed exercises and mindful teaching, singers can release tension, maintain vocal health, and cross-train successfully, even if they also play a demanding wind instrument.

References

• Behrman, A., & Haskell, J. (2019). Exercises for voice therapy (Vol. 1). Plural Publishing.

  Cole, A. (2019). Balance and tension: The jaw and tongue in relation to the whole. Australian Voice, 20, 7–14.

• Friedlander, C. (2011, April 20). Taming the wayward tongue: Workshop recap. The Liberated Voice. https://www.claudiafriedlander.com/the-liberated-voice/2011/04/tongue-workshop-recap.html

• LeFevre, C. (2011). Tongue management. Journal of Singing, 68(2), 157–163.

• Miller, R., & Schutte, H. K. (1981). The effect of tongue position on spectra in singing. The NATS Bulletin, 37(3), 25–29.

• Stoer, V. L., & Swank, H. (1978). Mending misused voices. Music Educators Journal, 65(4), 47–51. https://www.jstor.org/stable/3395549

• Trollinger, V. L., & Sataloff, R. T. (2025). Teaching singers who play wind instruments. Journal of Singing, 81(5), 559–562. https://doi.org/10.53830/sing.00132

The Trouble with Tongue Tension: A Cross-Disciplinary Concern for Music Educators

When singers think about healthy technique, they often focus on posture, breath, and resonance. But one of the most overlooked muscles in vocal efficiency is the tongue. Its posture shapes vowels, colors tone, and even influences the mobility of the larynx. If the tongue is tense, the entire vocal mechanism is compromised.

Traditionally, voice pedagogy has warned against tongue root retraction, flattening, or exaggerated arching, habits that lead to muffled vowels, restricted range, and fatigue (Miller, 1987; Emmons, 1980; LeFevre, 2011). Now, new research is broadening the conversation.

In a recent article in the Journal of Singing, Trollinger and Sataloff (2025) highlighted the risks of carryover tension between singing and wind instrument playing. They note that many young musicians engage in both activities, and that instrumental habits such as biting mouthpieces, retracting the tongue to accommodate reeds, or closing the throat after inhalation can foster the same kinds of throat and tongue tension that cause vocal inefficiency. Notably, the authors emphasize that singing and wind playing can be mutually beneficial if both are taught with healthy technique.

This positions tongue tension not only as a vocal issue, but also as a cross-disciplinary concern for music educators. Whether in the choir room or the band hall, poor habits can hinder vocal clarity and contribute to long-term problems such as fatigue or even injury.

For singers, the lesson is clear: the tongue is not just an articulator but a central player in resonance and laryngeal balance. When tension creeps in, whether from nervousness, poor pedagogy, or crossover with instrumental habits, the result is diminished clarity, flexibility, and ease.

Next week’s blog will explore how to identify tongue tension and provide practical strategies—drawn from both traditional voice pedagogy and emerging research—that singers and teachers can use to restore freedom and efficiency.

References

• Emmons, S. (1980). Vocal technique: The tongue as master of your singing—Vowel modification. Choral Journal, 20(6), 9–15.

• LeFevre, C. (2011). Tongue management. Journal of Singing, 68(2), 157–163.

• Miller, R. (1987). Taming the terrible triplets of the vocal tract: Tongue/Hyoid bone/Larynx. Journal of Singing, 43(5), 33–42.

• Trollinger, V. L., & Sataloff, R. T. (2025). Teaching singers who play wind instruments. Journal of Singing, 81(5), 559–562. https://doi.org/10.53830/sing.00132

Singing Breath Benefits for Stress, Immunity, and Connection - The Health Benefits of Respiration in Singing - Part 2

This article is the second of a two-part series on the health benefits of singing breath. Part 1 explores how breathing for singing supports posture, digestion, and vocal freedom, while Part 2 examines its wider impacts on stress, immunity, and social connection. Together, these insights highlight how breathing for singing contributes to both vocal function and overall well-being.

A lifetime of singing, a lifetime of health.

Every phrase in singing is a breathing exercise. Beyond fueling the voice, singing breath offers wide-ranging health benefits, from calming the nervous system to supporting immunity and even building social connection. Research is showing that the act of singing is not only an artistic expression but also a whole-body wellness practice.

Breath and Stress Reduction

Breathing is one of the body’s most direct tools for managing stress. Research by Moore (2025) demonstrated that slow breathing, around six breaths per minute, increases vagal tone, improves heart rate variability, and activates the parasympathetic “relaxation response.” Singing naturally incorporates this rhythm: long, sustained exhalations and measured phrases mirror the benefits of guided biofeedback breathing.

James Nestor, in his book Breath, describes how cultures and athletes have long used slower, controlled breathing to build clarity, resilience, and calm. Singing engages these same principles, allowing performers to regulate stress in the very act of producing sound.

Mental Health, Immunity, and Connection

The benefits of singing extend beyond the lungs and nervous system. Rebechinni (2021) found that music-making supports both mental health and immune function, effects linked in part to the calming, regulated breathing that singing requires.

Singing also creates social benefits. Delius (2023) showed that choir members’ breathing patterns align during performance, a phenomenon known as “interpersonal synchrony.” Research has further demonstrated that this synchrony can extend to heart rhythms (Müller & Lindenberger, 2011; Vickhoff et al., 2013) and even to subtle postural movements. In other words, when voices blend, bodies literally fall into rhythm with one another across multiple systems. This shared physiological entrainment fosters feelings of connection and belonging, amplifying the individual health effects of singing.

Singing as Exercise

Although not the same as aerobic exercise, singing engages the respiratory muscles in a sustained way. Aliverti (2016) described how these muscles act like an “auxiliary heart” during exercise, aiding circulation. Singing trains this system, potentially improving respiratory endurance and contributing to cardiovascular resilience over time.

Actionable Tips for Singers

The Alexander Technique reminds singers that breathing is most effective when it is allowed, not forced. By maintaining awareness of posture and avoiding excess effort, singers can experience both musical and health benefits.

1. Stress-Relief Breathing (Ease in Exhalation)

Choose a comfortable pitch and hum while exhaling slowly for 6–8 seconds. Keep the neck and shoulders released, letting the breath flow out as a controlled release rather than a push. Pause briefly, then allow the next breath to enter naturally.

2. Singing Walk (Natural Coordination)

Take a relaxed walk and sing or hum in rhythm with your steps. Maintain an easy, upright posture, imagining the head balancing freely on the spine. This coordination encourages efficient breathing without strain and reinforces the calming, cardiovascular benefits of singing.

Closing Thought

Singing breath is far more than a vocal tool. It brings together healthy respiratory patterns in ways that reduce stress, strengthen the body, and build community. Through music, singers practice habits that nurture both artistry and overall health.

If you missed Part 1, learn how singing breath supports posture, digestion, and vocal efficiency, the foundation of a healthy voice.

Jamea J. Sale, PhD
Director, Institute for Healthy Singing & Voice Research
Sing for a Lifetime
www.HealthySinging.org

“In the Alexander Technique, breathing is understood as something the body allows rather than forces. By cultivating awareness of posture, releasing unnecessary tension, and letting the breath enter naturally, singers can reduce effort and enhance both musical performance and overall wellbeing.”

— BREATH AND THE ALEXANDER TECHNIQUE

---

References

Aliverti, A. (2016). The respiratory muscles during exercise. Breathe, 12(2), 165.

Delius, J. A., & Müller, V. (2023). Interpersonal synchrony when singing in a choir. Frontiers in Psychology, 13, 1087517.

Moore, E. C. (2025). Personalized Biofeedback for Stress Reduction: Modulating the Autonomic Nervous System through Slow breathing and Cardiovascular Monitoring. https://louis.uah.edu/honors-capstones/946

Müller, V., & Lindenberger, U. (2011). Cardiac and respiratory patterns synchronize between persons during choir singing. PLoS ONE, 6(9), e24893. https://doi.org/10.1371/journal.pone.0024893

Nestor, J. (2020). Breath: The new science of a lost art. Penguin.

Rebecchini, L. (2021). Music, mental health, and immunity. Brain, behavior, & immunity-health, 18, 100374.

Vickhoff, B., Malmgren, H., Åström, R., Nyberg, G., Ekström, S. R., Engwall, M., Snygg, J., Nilsson, M., & Jörnsten, R. (2013). Music structure determines heart rate variability of singers. Frontiers in Psychology, 4, 334. https://doi.org/10.3389/fpsyg.2013.00334

How Breathing for Singing Supports Posture, Digestion, and Vocal Freedom: The Health Benefits of Respiration in Singing - Part 1

This article is part one of a two-part series on the health benefits of singing breath. Part 1 explores how breathing for singing supports posture, digestion, and vocal freedom, while Part 2 examines its broader impacts on stress, immunity, and social connection. Together, these insights highlight how breathing for singing contributes to both vocal function and overall well-being.

Breath is often described as the “fuel” of singing, but it is also a whole-body health practice. While singers may think primarily of sustaining tone, science shows that the way breath is managed during singing supports posture, digestion, and overall physiological balance.

The Physiology of Singing Breath

Singing requires more than simply filling the lungs with air. The breathing system operates as a coordinated unit involving the diaphragm, rib cage, abdominal muscles, and the pelvic floor. Classic studies by Gould (1971) and Hixon (1973) revealed that posture and respiratory support directly influence how freely the vocal folds vibrate and how efficiently airflow is managed for sustained sound.

The pelvic floor plays a surprising role in this coordination. Research has shown that the pelvic floor contracts and releases in cooperation with the diaphragm to regulate intra-abdominal pressure, stabilizing the trunk and supporting airflow (Hodges, 2007; Park, 2015; Talasz, 2022). This makes core engagement and posture not simply supportive extras, but integral to healthy breath management.

Breath and Digestion

Recent studies also highlight how breathing influences digestion. As the diaphragm moves with each inhale and exhale, it creates gentle pressure changes in the abdominal cavity. This rhythmic movement acts as a kind of “massage” for the intestines, stimulating peristalsis, improving blood flow to abdominal organs, and promoting more efficient digestion (Peiqi & Lei, 2024). Singing breath, therefore, not only energizes the voice but also contributes to digestive health.

Actionable Tips for Singers

Breathing for singing may sound complex, but small adjustments can build awareness and efficiency. The Alexander Technique frames breathing as an allowing process rather than a forced one, emphasizing posture, release of unnecessary tension, and whole-body coordination.

1. Body Scan Breath (Release First)

Before inhaling, pause to release your jaw, neck, and shoulders. Then place one hand on the sides of your lower rib cage and the other on your lower abdomen. Allow the breath to enter naturally, noticing how the rib cage expands, the abdomen softens, and the pelvic floor gently releases. As you exhale, sense the recoil of the ribs and abdominals and the natural upward lift of the pelvic floor without pushing.

2. Singer’s Stretch Breathing (Lengthen and Widen)

Stand with an upright and buoyant relaxed posture. Allow one hand to rest gently around your neck, and notice whether there’s activity under your palm as you inhale. If so, there may be tension you can release. Inhale again and imagine your torso lengthening upward and your ribs widening outward and backward as you inhale. Think of the breath “arriving” rather than being pulled in. This activity reduces chest and neck tension and fosters a freer, more efficient breath.

Closing Thought

From vocal fold efficiency to intestinal health, singing breath demonstrates how closely interconnected the body’s systems are. Each phrase sung draws on healthy respiratory patterns and, in the process, supports balance, posture, and overall well-being.

In my next post, I will explore how singing breath impacts stress reduction, immunity, and even social connection in ways that extend far beyond the practice room.

Jamea J. Sale, PhD
Director, Institute for Healthy Singing & Voice Research
Sing for a Lifetime
www.HealthySinging.org

“The Alexander Technique is a method of mind-body
re-education that teaches awareness of posture, movement, and breathing. It frames breathing as an allowing process rather than a forced one, emphasizing release of unnecessary tension and natural coordination of the whole body. Many singers use it to develop ease, efficiency, and vocal freedom.”

— THE ALEXANDER TECHNIQUE

---

References

Gould, W. J. (1971). Effect of respiratory and postural mechanisms upon action of the vocal cords. Folia Phoniatrica et Logopaedica, 23(4), 211-224.

Hixon, T. J. (1987). Respiratory function in speech and song. (No Title).

Hodges, P. W., Sapsford, R., & Pengel, L. H. (2007). Postural and respiratory functions of the pelvic floor muscles. Neurourology and urodynamics, 26(3), 362-371.

Park, H., & Han, D. (2015). The effect of the correlation between the contraction of the pelvic floor muscles and diaphragmatic motion during breathing. Journal of physical therapy science, 27(7), 2113-2115.

Peiqi, L., & Lei, S. (2024) The Interaction Between the Respiratory System and The Digestive System: A Preliminary Study.

Wood, A. C. (2025). The Feasibility of a Hybrid Telehealth Respiratory Muscle Strengthening and Coordination Program on Chronic Constipation Outcomes (Doctoral dissertation, University of Miami).

Vaping and Your Voice: Hidden Risks for Singers

Based on Research by Madison, et al., The Laryngoscope (2022)
In recent years, vaping has often been marketed as a safer alternative to traditional smoking. However, research shows it can harm not only your lungs but also your voice. For singers, educators, and other professional voice users, vaping’s effects on airway health, tissue hydration, and vocal fold function can undermine both breathing efficiency and healthy sound production.

How Vaping Harms the Lungs, Airway, and Voice

A 2022 study in The Laryngoscope examined the short-term effects of e-cigarette use on vocal fold physiology and respiratory function. Results showed that even brief exposure to vaping aerosol can cause airway inflammation, increase mucus viscosity, and impair mucociliary clearance, the airway’s natural cleaning mechanism. These changes make it harder for the vocal folds to vibrate freely. They can raise the phonation threshold pressure, the amount of air pressure needed to start and sustain sound.

Research on small particle lung health and vaping shows that e-liquids produce ultrafine particles that can penetrate deep into lung tissue, triggering inflammatory responses similar to those seen in chronic bronchitis. Johns Hopkins Medicine also reports that certain vaping liquids contain propylene glycol, glycerin, and flavoring agents that can dehydrate the airway lining, leading to vocal dryness, fatigue, and irritation.

Healthy singing depends on efficient breath support and vocal fold vibration. Inflammation, dehydration, and thickened mucus from vaping create extra resistance, requiring more effort from the respiratory system and laryngeal muscles. Over time, this can lead to compensatory vocal behaviors such as pushing, straining, or constricting, which increase the risk of long-term vocal injury.

• If you vape, be aware that its effects are not limited to lung health; they can directly interfere with your ability to sing with ease.

• Lung health matters for breath control. Inflammation, irritation, or reduced lung capacity from vaping or second-hand aerosol can limit how much air you can inhale and how steadily you can release it. This makes it harder to sustain phrases, manage dynamics, and maintain vocal stability.

• Recovery from vaping-related irritation involves complete cessation, consistent hydration, and sometimes voice therapy under a qualified specialist.

• Even occasional vaping before a performance can impact your stamina and vocal quality. Treat your vocal tract with the same care an athlete gives their body, avoiding harmful agents whenever possible.

The Takeaway for Your Voice: Vaping may seem less harmful than smoking, but for singers, the science tells another story.

Protect your breath, protect your voice; your artistry depends on it.

Jamea J. Sale, PhD
Director, Institute for Healthy Singing & Voice Research
Sing for a Lifetime
www.HealthySinging.org

References

Madison, T. M., Gartner-Schmidt, J., Sataloff, R. T., & Heman-Ackah, Y. D. (2022). Acute Effects of Electronic Cigarette Aerosol on Laryngeal and Respiratory Physiology. The Laryngoscope, 132(11), 2179–2185. https://doi.org/10.1002/lary.32469
Johns Hopkins Medicine. (n.d.). What Does Vaping Do to Your Lungs? Retrieved August 2025 from https://www.hopkinsmedicine.org/health/wellness-and-prevention/what-does-vaping-do-to-your-lungs
Hodes, R. (2021). The Role of Small Particle Lung Health in Vaping-Related Respiratory Effects (Master’s thesis).

Why Your Voice Needs Water (and What Kind!)

You’ve probably heard it before: “Drink more water!” But when it comes to vocal health, that advice is more than just a wellness cliché. Research shows that hydration—both internal and surface-level—is key to keeping your voice working efficiently and comfortably.

What Does Hydration Actually Do for the Voice?

Hydration keeps the vocal fold tissues supple. When we’re dehydrated, those tissues become more viscous (thicker), which increases what’s called phonation threshold pressure—the minimum effort needed to start vocal fold vibration. More pressure = more effort. That means your voice tires out faster and may sound strained, rough, or inconsistent.

A 2002 study (Verdolini et al.) found that even 1% loss of body weight from dehydration was enough to raise the effort level for vocalizing, especially at high pitches. Another study using computational modeling showed that even short periods of speaking or singing can dry out the vocal folds at the tissue level, especially when vocal fold vibration is vigorous.

In other words, dehydration can sneak in faster than you think, and your voice is often the first to notice.

The Two Types of Vocal Hydration

1. Systemic Hydration: This is what you get from drinking water. It supports hydration at the tissue level, but it’s slow. It may take hours for what you drink to reach your vocal folds.

2. Surface (Superficial) Hydration: This refers to the thin layer of moisture that coats the vocal folds. It plays a key role in vibration and impact protection. You can improve this layer more directly and quickly using steam or nebulized saline mist.

Should Singers Use a Nebulizer?

Yes, especially if you speak or sing in dry environments, have allergies, or are recovering from illness. Studies show that nebulizing with isotonic saline (0.9% sodium chloride) can lower vocal effort, improve vocal quality, and support mucosal wave function.

A mesh nebulizer with sterile saline is an affordable and portable tool to add to your vocal health routine. It’s not a substitute for rest or professional care. Still, it can be a game-changer for managing daily vocal fatigue.

Bottom line for singers?
Hydrate early. Hydrate often. And consider both what you drink and what you breathe.

Jamea J. Sale, PhD
Director, Institute for Healthy Singing & Voice Research
Sing for a Lifetime
www.HealthySinging.org

Performance = Potential – Interference: What Singers Can Learn from The Inner Game of Tennis

As a voice scientist and specialist in rehabilitating singing voices, I have observed a common pattern in my students, especially those recovering from vocal injury or who self-identify as perfectionists: they tend to “should” on themselves.

“I should already know this.”
“I should sound better by now.”
“I should be able to sing like [insert artist].”

Sound familiar?

This mindset traps singers in what W. Timothy Gallwey in The Inner Game of Tennis calls the paradox of the “two selves.” Self 1 is the analytical, judging voice (“Come on, you’re off-pitch again!”), while Self 2 is the unconscious mind-body system—the part of you that already knows how to sing when given the chance.

Gallwey’s insight is critical for vocalists: performance = potential – interference. That is,
P = p – i

We often work so hard to get it “right” that we disrupt what our bodies already know how to do. In Gallwey’s words:

“Every time I get near match point... I get so nervous I lose concentration. I’m my own worst enemy.” (The Inner Game of Tennis, p. 6)

In singing, that “match point” might be the high note, the audition, the solo moment. And in trying to control every detail, Self 1 tightens the muscles, clouds the mind with judgment, and causes the very interference that throws us off balance.

Here’s the shift: stop “trying” and start allowing. Let Self 2—your wise, experienced, adaptive body—do what it has been trained to do. Instead of commanding your voice to perform, simply notice. Observe without judgment. Allow the sound to emerge.

This is the essence of relaxed concentration—what Gallwey calls the master skill for excellence in any field. And yes, even singing.

If you’re a singer prone to perfectionism, consider this your invitation to stop battling yourself. Trade judgment for awareness. Trust your body. Let it sing.

Your best voice isn’t forced—it’s freed.

Jamea J. Sale, PhD
Director, Institute for Healthy Singing & Voice Research
Sing for a Lifetime
www.HealthySinging.org

Post-COVID Singing Voice Difficulties: What Singers and Teachers Should Know

Based on research by Dassie-Leite et al., Journal of Voice (2024)

Even weeks after recovering from COVID-19, many people say something still feels "off" with their voice. A recent study helps explain why—and offers insight for singers, teachers, and anyone who depends on their voice.

Researchers followed 45 adults who had recovered from COVID-19. On average, they were surveyed about six weeks after their diagnosis. Participants were asked to reflect on their voice before, during, and after having COVID.

The results were striking:

• During COVID-19, the most common voice complaints were vocal fatigue (73%) and dry throat (71%).

• After recovery, symptoms didn’t just vanish. Over half still reported a dry throat, and many still experienced phlegm, hoarseness, or a tired voice—even after light use.

The study also found that people who had oxygen therapy or who had prior voice complaints were more likely to experience lingering issues.

Why does this happen? The researchers believe it’s partly due to the effects of COVID-19 on the lungs and upper airway. If breathing is compromised—even subtly—it can affect airflow and pressure, making it harder for the vocal folds to function efficiently. Add in dehydration or inflammation, and the vocal system can struggle to recover.

In my own voice studio, I’ve seen a steady stream of singers come in weeks or even months after recovering from COVID-19—many after relatively mild cases. What they share in common is this: they had to keep speaking, singing, and working while their voice was still healing. This often leads to compensatory habits—like excessive tension or pushing for volume—that can become ingrained if left unaddressed. These habits may be subtle, but they interfere with efficiency and ease, and can prolong recovery unless guided support is provided.

What You Should Know: If you’re a singer, teacher, or professional voice user and your voice still doesn’t feel normal weeks after COVID, don’t brush it off. These symptoms are real and common. A voice evaluation from a qualified voice specialist can help you identify what’s going on and start the path to healing.

Your voice matters. And it’s okay to ask for help getting it back.

Institute for Healthy Singing & Voice Research
Jamea J. Sale, PhD, Director
Sing for a Lifetime
JSale@HealthySinging.org

Reference:
Dassie-Leite, A. P., et al. (2024). Vocal Signs and Symptoms Related to COVID-19 and Risk Factors for their Persistence. Journal of Voice, 38(1), 189–194. https://doi.org/10.1016/j.jvoice.2021.07.013

Could a Simple Saline Mist Help Your Voice Work Easier?

Recent research published in the Journal of Voice (2023) suggests that nebulizing isotonic saline—essentially, inhaling a fine mist of saline solution—may provide measurable benefits for both healthy and dysphonic voices. The study showed improvements in voice quality, reduced perceived vocal effort, enhanced mucosal wave activity, and better aerodynamic efficiency following saline nebulization.

Portable Mesh Nebulizer

Why Does It Work? Nebulized saline directly hydrates the surface of the vocal folds, which helps maintain tissue pliability, reduces phonation threshold pressure, and may ease vocal production—especially for those experiencing dryness, irritation, or voice fatigue.

Portable Nebulizers: What You Should Know

Portable nebulizers make saline inhalation easy and affordable. They’re widely available online and in pharmacies, typically priced between $30 and $100, depending on features and design.

• Mesh Nebulizers — Quiet, compact, and highly effective for saline delivery. They use a vibrating mesh to create a fine mist and are often preferred for their portability and low noise.

• Compressor Nebulizers — Larger, traditional units that use compressed air to generate aerosolized mist. They’re reliable for regular use but tend to be bulkier and noisier.

Always choose a device labeled for medical use, and follow the manufacturer’s cleaning instructions to prevent contamination.

What Saline Solution Should You Use? Use sterile isotonic saline (0.9% sodium chloride) intended for inhalation or wound care. Avoid contact lens solution or saline with additives. Single-use vials or sterile bottles are recommended to ensure safety.

Bottom Line: Nebulized saline isn’t a cure-all, but it may be a helpful tool for singers, teachers, and voice professionals looking to maintain vocal health or manage mild irritation. For chronic or significant voice concerns, always consult a qualified voice specialist.

Institute for Healthy Singing & Voice Research
Jamea J. Sale, PhD
Director, Institute for Healthy Singing & Voice Research
Sing for a Lifetime
JSale@HealthySinging.org