By Jean McClelland

“Can you help me? I’ve lost my voice,” the woman pleaded on the telephone. From the sound of her voice, it seemed as if she might have a neurological condition called Spasmodic Dysphonia (SD). This condition causes involuntary spasms in the muscles of the larynx making a voice sound strained or strangled. Because we use our voices all the time, it is a devastating condition. SD usually arises spontaneously, and although there is agreement that its origin is in the basal ganglia of the brain, scientists aren’t sure of the cause, although in some instances it may be genetic. Somewhat curiously, the vocal cords of someone with SD are completely fine. There is no inflammation nor is there any evidence of vocal abuse or vocal nodes, all of which could be seen readily by a laryngoscopic exam. 

Botox, the only medically approved treatment for SD, began being used in the mid-80s. Botox is injected into the laryngeal muscles and the spasms “relax” for a time. Botox is not a cure; injections must be repeated, on average, every six months.

SD is a dystonia, a condition which causes involuntary muscle contractions and twisting in one or more parts of the body. It can also cause weakness in muscles, including the diaphragm. A weak diaphragm cannot support air pressure in the lungs to vibrate the vocal cords. Interestingly, when a person with SD spontaneously agrees, laughs, coughs or even sings, their diaphragm engages, and their voice is momentarily normal. These spontaneous, “rooted” sounds show the role of the diaphragm in vocal production. When a person suffering with SD understands how their body was designed to breathe it is a first step in redeveloping the strength of their diaphragm.

The following exercise can help strengthen the diaphragm. It involves using your fingertips to stimulate the diaphragm to move up in exhalation. 

First, find the bottom of your ribcage and place your fingers so that you feel the fleshy area under the sides of ribs as you see demonstrated below.

Next, with your fingers, apply a little “in and up” pressure as you exhale on an “ss” (hiss) sound. Imagine you are pressing into clay or bread dough. You are stimulating the diaphragm to press on the lungs to expel carbon dioxide from the lungs in exhalation.

When you get the diaphragm to move up, it helps to re-develop its strength. It’s very important to make sure only your fingers are doing the work and that you are not forcing breath from your mouth. Think of your fingers as if you were stepping on a gas pedal. If you spontaneously inhale when you release your fingers, you will know that you have done the exercise correctly.

SD is a very challenging condition, and many people are genuinely reluctant to use Botox to ease their symptoms. Thankfully, developing good habits of breathing to strengthen the diaphragm can lead to noticeable improvement in the use of their voice.

Jean McClelland is on the faculty of the Graduate Program in Acting at Columbia University and a guest lecturer in the music department at William Paterson University. She is an AmSAT certified senior teacher of the Alexander Technique and studied with Carl Stough at his Institute for Breathing Coordination. She is one of fewer than a dozen people worldwide personally selected by Stough to teach his work. In addition, she has performed extensively in musical theater and is a member of Actors’ Equity Association. She teaches in-person and virtual private lessons and group classes. For more information, visit JeanMcClellandVoice.com.