Vocal physiotherapy is a growing field in Australia that works behind the scenes to ensure professional singers, actors and performers can raise their voice. A Melbourne physiotherapist is leading the way to merge science with the arts, writes Karen Keast.

When Annie Strauch moved from her home in Melbourne to pursue physiotherapy in the United Kingdom, she never imagined her footsteps would help pave the way for a new career path for physiotherapists in Australia.

Graduating from La Trobe University in 2003, Annie began practising in the hospital system before heading to London where she worked for a private clinic, Physio Ed Medical, providing sports and dance physiotherapy to performers, singers and dancers in the city’s entertainment heart, the West End.

With her own background in singing, ballet and contemporary dance, Annie thrived in providing injury prevention, treatment and movement development services to dance and theatre companies and dance schools.

Annie worked with performers in more than 30 productions, from West End shows such as Dirty Dancing, Chicago, Billy Elliot, Footloose, Cabaret and Jersey Boys, to reality TV shows, including the BBC’s Strictly Come Dancing and Dancing on Ice.

It was here that Annie learnt about vocal unloading - a physiotherapy treatment that unloads the larynx, using manual therapy as a neuromuscular cycle breaker to boost the performance voice, and alleviating any maladaptive voice patterns.

Vocal physiotherapy also works to retrain the voice and body focusing on the performer’s posture, cervical spine, temporomandibular (TMJ), scapular kinematics and breathing patterns.

As a vocal physiotherapist, Annie regularly works as part of a team with performers’ vocal coaches, speech pathologists or ENT specialists.

Annie says singing in up to eight shows a week, plus rehearsals, takes a toll on the voice of musical theatre performers.

“When you’re singing at such a high level and at such a huge load, you may end up with some issues depending on the choreography that you’re expected to do, the costume that you’re expected to wear, and the environment that you’re expected to do it in,” she says.

“All of these things come into play with how much work you need to do on your larynx and the muscles.

“We have many theatre performers who come in and see us when they are doing these high loads as an injury prevention model and it also helps them get a clean sound - helping their vocal chords vibrate more efficiently.

“When we produce our voice, if we have a lot of tension surrounding our neck and the muscles are being over-recruited and working too hard, the vocal chords can’t actually vibrate as well.

“That’s when you hear a husky voice or not what the singers would call a clean sound, so by having the muscular tension released and then retraining some of those postures and some of those head positions…it actually maintains the person’s voice while they are doing these high loads.”

Annie says while the perks of the job are watching the performances, she equates her work to how a sports trainer watches a football game.

“I’m always watching behind the play or looking behind the scenes, looking at what the ensemble are doing or considering the repetitive actions and how that’s going to impact them physically.

“As a dance clinic as well, it’s also treating those injuries. From a voice perspective, it’s looking at their costume or if their mic pack is placed in their wig or on their back, how that is going to affect their head position - is it going to make it more difficult for them to sing?”

An Australian Physiotherapy Association (APA) sports and musculoskeletal physiotherapist, Annie introduced vocal unloading, known as circumlaryngeal manipulation or laryngeal manual therapy in the United States, UK and Europe, to Australian shores in 2009.

Annie runs workshops in vocal unloading for physiotherapists and for speech pathologists. As a result, a handful of physiotherapists are now providing vocal physiotherapy services across the east coast of Australia.

“It’s just really starting out in Australia and becoming more and more well known,” she says.

“I think it’s a field that is going to explode and really grow.”

It’s not just performers who are pursuing the benefits of vocal physiotherapy.

Annie says people with vocal disorders or those who constantly use their voice, such as teachers, barristers, radio announcers, actors and customer service workers are also taking up vocal physiotherapy treatment.

On her return from London to Melbourne, Annie founded her practice, Performance Medicine, which specialises in dance and performance physiotherapy practice, including vocal unloading, in the city’s performing arts precinct.

As the resident physiotherapist for the Melbourne Theatre Company, Annie manages the physical health of performers and provides injury prevention, sustainable direction and choreography for musical theatre productions.

She also works with actors who need to develop their voice and physical traits for specific roles.

“If an actor needs to develop a character with a disability, we talk about how they are going to walk and what that will mean for them in terms of their physical health for the eight to 10 week season, and what it will mean for how they are going to produce their voice.

“We work together with the wardrobe and the director on how to make the costume look as effective and realistic as possible for the performer.

“For characters with amputations, there’s tricks with hemlines and pockets.

“You can make a silicone stump but that arm is obviously going to be longer, so you use a trick with the costumes and we work together with the whole team; wardrobe, direction, the actor, and make sure that it produces a realistic product for the audience really.”

It may sound like a glamorous job but vocal and dance physiotherapy often involves working weekends and nights.

“It’s not glitzy at all - when you go into the theatre and you’re treating a performer, you’re backstage and often in the tiniest room you’ve ever seen with a few costumes and a few random props as well,” Annie says.

“Essentially these people are going to work - so we go in, we treat them and then we leave, and we are just making sure they are safe at work.”

Annie says it’s a rewarding career that enables her to combine her passion for performance with physiotherapy at a time when research in voice production and manual therapy for voice issues is beginning to emerge.

“Performers are athletes - they are elite people who do dancing and singing all at once,” she says.

“The way the performing arts industry is going now, particularly with the voice and dancing, is that we are trying to combine science and art together to make it a safe, sustainable career for people.

“From a vocal physiotherapy point of view, we are really honing in on their elite performance voice and making sure that these people are fit and happy and healthy to be able to produce their voice in the most safe and efficient way.”