Alexa: Genevieve Tawiah, I need a straight up recommendation because I've had a stiff neck for about 11 years and I thought if we're speaking to a physiotherapist She's bound to have some really great pillow recommendations. What are your pillows like?  

Gen: I always find it a bit of a tricky one because different people need different things depending on what the neck issue is. 

As a kind of rule of thumb, Pillows that are really, really thin without support aren't great for necks, so if you have neck pain, people tend to like a medium firm pillow, but then not everyone likes memory foam, so, I always ask what people already have, and, Have a look at how they present before I recommend like whether they should go with something really really firm or you know,. The key thing with pillows is if you've got neck pain and it's stiff and you've lost movement dont stack more than like two or three pillows up because you'll be sleeping in a funny position  

Alexa: Yeah, i've been sleeping with a flight pillow  

Gen: I sometimes tell people if they haven't got, that kind of setup, they can kind of triangle [00:01:00] their pillows so they're not like moving around rapidly when they sleep.  

Alexa: Yeah. This is a really weird tangent, but when me and my sister were little, we used to stay at my grandparents house and every Friday night we would make up this game where we would sit at the end of the bed, because we used to share my nan and granddad's double bed. And we would throw the pillows, and wherever they landed, we had to sleep like that.  

Gen: Oh really? And then your Nan and Grandad's are waking up to, like, you in different corners of the bed.  

Alexa: Yeah, but one time we threw them in such a good position and we called it Pillow Paradise.  

I can't replicate it now. I can't for the life of me throw my pillows and find Pillow Paradise again. But at least I went there once.  

Gen: The perfect sleep position.  

Alexa: Yeah. Well, Jen, it's really lovely to welcome you to the Singing Teachers Talk podcast. And you are somebody who specializes in vocal physiotherapy. So can you help us understand what that actually is?  

Gen: Vocal physiotherapy is an umbrella [00:02:00] term. It's an umbrella term for the different elements of physiotherapy that we can offer to someone who's struggling with their voice. Now that might be the terms that people already know as like laryngeal manual therapy, which is a hands on treatment that is predominantly around the neck. 

Or it might be treatment elsewhere in the back, around the ribs. It might be kind of respiratory physio where we're looking at the efficiency of someone's resting and exertion breath. It could be considerations that we sometimes have for neurological physio, where we're kind of looking at nerve pathways coming from certain areas and How aware people are of certain regions or their sensation and all the things to do with nerves. 

It could be exercise linked. There's a few different tangents that we all bring together from physio and then apply to someone or assess with someone that might be presenting with a voice difficulty and then we pick out the elements and then treat as appropriate.  

Alexa: So you might actually do some manual therapy might you, or some myofascial release. It's kind of [00:03:00] like you get to pick and choose what you apply? 

Gen: Yeah, I think the key thing with it is, like any other injury, let's say you had a shoulder problem, this region, where the voice predominantly comes from, is surrounded by muscles and is affected by every other region in our body, we're a bit of a chain. 

In the same way as we might treat hands on for someone with a shoulder injury and we might, let's say, offload around the back to make the shoulder be able to be in a better position, we might do some hands on around here, or around the shoulders, or around the back, depending on how they present to facilitate the voice. 

Alexa: Why is this an important part of the multidisciplinary network for the performing artist?  

Gen: I think the biggest thing is Not everyone does the vocal physiotherapy. It's not trained as part of a standard physiotherapy course. A lot of the people that are practicing it have done it via learning from their seniors and kind of developing and applying their own approaches to it with their knowledge of physio, or going to shadow speech language therapist [00:04:00] ENTs and bringing our physio knowledge to the table. 

And whilst it is developing, It's something that already has quite a big impact for people, particularly with muscle tension dysphonia, because we're thinking about people that are struggling with their voice as a result of function, or as a result of their daily activities contributing to it. Let's say, for instance, heavy exercise training with poor technique. 

As physios, we look at exercise training every single day. Looking at someone's exercise form, tweaking their exercise program, and taking away that element to what's driving their dysphonia, allowing them to then perform better, or go to their vocal coach and learn and demonstrate the skills better. 

 It's just a, I believe, a really important part of the team uh, where we can throw something in and someone else can, and the end result is a person being able to manage the different factors of their voice problem better.  

Alexa: And when you say exercise form, is that to do with what they're actually doing in the gym and how they're using [00:05:00] their bodies in a physical fitness way? 

Gen: It can be., I think The tricky thing about summarizing it is, it's going to be different for everyone. So let's say for instance, what I'll quite often do when someone comes in with a voice problem, I want to know about them as a person, not necessarily just the voice.  

So I will talk through their history of the voice problem. But then I want to know, what do you do on a typical Monday to Sunday? are you exercising in the morning? Are you going to the gym? Are you inactive? Do you cycle to work? what are the things that happen in your day? For some people, it's, they're carrying a massive backpack on one shoulder and they've forgotten about it because it's so automatic it doesn't typically cause them any bother. But then, We assess them and their right shoulder is like up by their ear and they're a bit restricted on their right movement, but that doesn't bother them day to day. But when we come to looking at how they voice it might be bothersome. Whereas for another person, they might be super, super active in the gym all the time, actually just got a PT and they might be doing really well with their fitness training, but, [00:06:00] that might be implementing, um, influencing their voice. 

Alexa: And even though it is quite individual and different between people, are you seeing patterns of what's going on in people's lives and our lifestyles now in what, the 21st century, that is actually playing a role in dysphonia for the vocalist? 

Gen: Yeah, I'd say there's certain factors, particularly since the whole kind of, we must not talk about lockdown, but, With the increase in people working from home, we see a lot more people maybe doing like voice coaching or singing sessions online. And then we want to consider, well, what's the desk space set up? 

Have they actually considered that? Or have they just started working from home suddenly because it's easier financially and for flexibility on timescale? And are they sat at a rubbish desk having to lean over and really trying to listen closer because they haven't got the right speaker set up? And is there posture coming into it? 

Or is stress a bit higher because people are maybe struggling [00:07:00] for certain jobs a little bit more, , in certain sectors, , and does that kind of stress management come into it a little bit more frequently , for, for instance, performers versus, , someone who might be in a full time job doing presenting?  

Alexa: You mentioned before about your history taking form and all the questions that you asked to understand what's actually going on in somebody's life more expansively. So what is your process after that in terms of assessing a singer and what is it that you're particularly looking out for to help guide you towards maybe a diagnostic or the potential culprit? 

Gen: I think in practice what I really try to pride myself on is giving people space to just talk and listen because I think quite often when I'm allowed to do that and have the flexibility and time to do that. the patient will tell me exactly what's wrong, whether they've realized it or not. And sometimes there is a bit of frustration where they have been to GP or they've been to a couple of different [00:08:00] clinicians with a short appointment and they haven't been able to kind of elaborate and find problem solves themselves. 

So that history taking is really, really important in terms of that timeline and how they're feeling and how they're presenting. , and I'll often deduce quite a lot from that. but besides that, I'll pair that information. I'll probably have a few things stashed in my mind as to what it might be, who they might need to see what support they've already got in. 

And then it's kind of, we moved to physio land in a movement assessment. So I'd look at neck movement. I'd look at shoulder movement, back movement, how they move through their lower body, how they stand. If they play an instrument and that is part of their factor and they've got the instrument, I will have a look at how they're playing, or if they've got footage of that, great. If there's certain things that have been flagged in their injury history per certain area, so let's say I use the shoulder example, they've got a history of a shoulder injury, I will look at how that shoulder is functioning. , I will then typically look at how they voice now, not [00:09:00] from a kind of speech language, kind of vocal coach point of view, but from a physio point of view of, Are they voicing and craning their neck forward or are they voicing and hitching to one direction because that's how they stand when they've got their guitar or Is there any obvious habits that they might not be aware of that I can just tweak or support That might change their voice because sometimes you can just tweak someone's position and they feel a little bit more free and Though they might be deemed or looked upon as like quick fixes, it's more just a, how do we facilitate it and where it's going to have most influence. 

 So that's kind of the direction I would go to next in terms of assessment. Then it's kind of dependent on what I find, , from their reports versus what I see.  

Alexa: Do your approaches differ, and if so, how do they differ when you're assessing a singer in particular, compared to another performing artist like a dancer, an actor, or a puppeteer, because I know you've worked on shows like War Horse. [00:10:00]  

Gen: , I think that again, largely comes to the situation they're trying to better because let's say for singers, we want to consider that depending on what their singing environment is, they might have a microphone, they might be working in a team and that might present slightly different in terms of, , the dynamic that they've got to respond to from other people or the positioning that they've got to be in.  

Versus like whether they're a singer that moves about and dances whilst they perform, or whether they're a static singer, and then that transfers to let's say they are a performer actor that they're voicing in a sitting position or standing or they're quite dynamic or maybe they've got a ridiculous costume Or something quite cagey around them that i've got to consider , and again that would often come from Their kind of subjective report of what they have to do or how their week looks in terms of their demands. 

And I would try to, where possible, replicate the sitting, the prop, the something other [00:11:00] factor, or my knowledge of, oh, well, if you're having to wear a corset, you're not going to be able to expansively breathe. So we need to consider X, Y, and Z and try and apply those specific examples to what they're aiming for. 

Alexa: how do you help, say, a classical role who is wearing a corset, does have maybe a heavy wig and a headdress, and is in heels, for example? That's quite a lot to contend with.  

Gen: , Good question. I will always, I will keep emphasizing that it depends on the individual. Um, but we've got to look at the factors and what kind of support they've got in place. Number one is, do they have a vocal coach? Do they have experience? Are they voicing correctly? Is that a thing? , have they had a significant increase in vocal demands? 

If there's anything surrounding that where their form might not be good anyway, or they might be coming from a place of let's say post illness, performing on strain, and they need some form of like voice support, the number one thing there to do is to [00:12:00] get them to a vocal coach or speech and language therapist if it's been deemed that they've been cleared by an ENT and there's nothing structurally going on. 

 If they've done that, and they've ticked, that's tick ping, it's then the consideration that actually, yes, their breathing form and their amount of movement is going to be different in said . , And it's then like, have they got accumulating restriction in their resting breath, which is driving the difficulty singing, , do they do any release work between wearing the corset? 

So it's then like, can we look at restorative movement in between their shows to make sure actually throughout the day , they're not working in the same way as they are in show. And then I guess with heels and wigs, it's then it's about balance. So if you're spending, I don't know, a couple hours a day where you're tipped forwards, you're working really hard through your calves, , to counter that, it's then what opposite movement can we put in? 

How do we free up those structures and how do we make it so that they've not just got this accumulating presentation of I'm fixed in this position to voice. [00:13:00] It may get restrictive and then it may release and then it may get restrictive and release, but it's just bringing them back down to that baseline in between those opportunities and giving them the right strategies to move through their body before they've got costume on and, and find comfortable positioning with their costume on,, to allow them to perform. 

Alexa: This is where kind of the question of methodology comes in, because if you're fixed to one way of doing things, when you're then put into a position where that Particular thing is not available anymore because of say, a costume or, or a position you have to be put in you then don't have a strategy to find a way to do that just as effectively. So even though there are some really great things we can pull from lots of different methodologies, it really does support the idea that having lots of different ways to do one thing effectively is going to help you in the long run? 

Gen: 100 percent and I think there's also the consideration of that [00:14:00] between the multidisciplinary teams sometimes there's an action whereby we go, someone's struggling with their voice let's say, and in an example where it's not a structural thing but they are finding it difficult, where we go well, you're in a corset We're not voicing very well in a corset, but you can voice well without, and it's because of X, Y, and Z. 

Do we need to be the go between between you and company manager and do a letter and just say, actually, for X reason, this person is struggling and might not be able to maintain their show ability because of the costume. Is it amendable? And sometimes it's discussions as well to create that flexibility, because when you kind of look at the bigger picture, it's, Do you want to tweak a costume in that scenario or do you not want the person on show? So there's those considerations as well.  

Alexa: As we're on topic of the rib cage and the, and the breathing system, What would you consider to be a problem in a singer's breathing system and respiration and how would that maybe [00:15:00] manifest in the body for you to pick up on or for the singer to complain that something doesn't feel quite right? 

Gen: Now some people already have diagnosed breath difficulties, whether that be asthma or something allergy linked, or if we're talking more COPD, et cetera. And in those cases, we already, or we'd commonly know some of the presentations that might come alongside that, where they might not be able to take deep breaths. 

They might be a bit more restrictive around here because around here being the neck, for those who are listening Um, because they can't move well around their ribs. There might be certain things that correlate with their diagnosed condition that we can already feed into. however, some people come in with a new presentation and that might be, for instance, in this climate post COVID or respiratory infection where they've not realized they're breathing a bit differently or they maybe haven't got back to doing their cardio. 

And when we give them a bit of [00:16:00] exercise, they're struggling. We look for the signs in their reports and in how maybe when they're sat talking, how they're presenting. So sometimes I have people who come in, they're talking to me and they're taking big gasps between their sentences. And I can see them like really gasping for air and not using anything around their lower rib cage. 

And that's a nice spot to go, right. Okay. That person might need a bit of input or awareness in that, did they know it was even a habit? Are they noticing that just in a conversation that they are struggling? So what happens when they're under more exertion, dancing and singing? So some people might present with that kind of gas pattern. Sometimes it's running out of air in terms of like they'll speak and they'll take a really long pause before they go again. Sometimes it's really quick breathing. Um I think we're just kind of looking from patterns that deviate away from the norm. 

Or Sometimes it's a pattern of when I put my hands on people's ribs, there's just [00:17:00] no movement and it's a bit like, how are you, finding your breath and does it feel restrictive and what does it feel like? 

Alexa: When it comes to you actually being hands on on the rib cage, likely us teachers are not going to be doing that, but we might be able to visually see something. 

How much movement is, again, it's individual, but how much movement would you say is optimal compared to when we would consider something to be rigid?  

Gen: Now the strategies for how let's say in a physio assessment if we're concerned or monitoring someone's improvement that we might measure at certain levels but if we're going off the eye I think the best spot is if you've noticed a pattern where they are, what I term apical, where they're shrugging their shoulders or really pulling at their neck to try and get their breath. 

And you put your hands, let's say around the lower ribs or the back or the front, and there is zero slash minimal movement, you know that that is likely a bit of a compensation strategy for unknown [00:18:00] factor yet to be discovered. so we're looking at the difference in where the compensation is and where there's nothing. 

We kind of want a little bit from everywhere, but we also must have the understanding that Let's say when someone is sprinting, that breath pattern would be different to when they are sat still. So it's just kind of testing what moves, what doesn't. And where they're aware of versus where they have no awareness of. 

Because people will quite often go, how do I do that? Or that feels unnatural when they're taking a resting breath versus a big breath versus like a breath hold.  

Alexa: You mentioned there things like asthma, COPD, COVID. Are there any other maybe lifestyle things that we're doing? You've mentioned being over the desk and working from home that might contribute to more breath system and respiration difficulties. 

Gen: Yeah, I think kind of, uh, and most people will, I'd hope, have awareness of this. Obviously smoking, that's going directly into the airway, [00:19:00] vaping, ... on the breath system mainly, um, sometimes levels of exercise can be a thing. If people are particularly sedentary, they haven't exercised in a while and actually, let's say, and this might happen between contracts, people often find that their fitness drops quite a bit. 

Let's say if they've been on a really tough contract, they've been exercising every day and then they might have been out of work for a year and just prefer to be relaxed when they come into their first kind of back to training, back to doing warmups every day in an active show, they can feel a bit like they're lagging. 

And sometimes that fitness difference and just getting your cardio back might be a factor. That adjusts, but just might be a factor nonetheless. 

Alexa: We've spoken with the wonderful Jenny Morton for a few episodes of this podcast, talking on topics of posture and integrating the musical theatre disciplines in training. And she's often referenced working on the feet as a way to create impact elsewhere. And you were talking earlier about how if somebody says that they've got a shoulder problem, you might work on the back [00:20:00] or somewhere else to create a little bit of freedom. 

So when you're working with somebody, if they might be presenting with whatever, a stiff rib cage or a shoulder problem, what typical treatment pathways are there to help resolve the problems that aren't necessarily targeted to the exact area that they have prescribed for themselves?  

Gen: So I love the term that the body is a chain. 

Everything is linked to everything in some way, shape, or form. And we are one whole person. , after collecting information about, , the potential cause or what the symptoms are I don't think it's a bad thing as, in fact, I think it's a good thing as physios. We've got the skills to assess different joint areas, so we might with the patient's consent choose on that session to zoom into said area. 

So let's say it's a lower back rib cage linked discomfort or an inability to breathe deeply because of that. There's no harm in us with our [00:21:00] assessment skills looking at how their back moves. Can they bend forward? Can they side bend? Can they rotate? What happens when they take a deep breath? What happens when we put them in standing versus sitting versus lying and functional positions and how Is that area getting affected by things that they might do throughout the day? 

And once we've collected that information or put a diagnosis on it or figured out what is influencing it, because sometimes back pain is linked to the hip or linked to the foot, et cetera, we can then go, right, it's influenced by this. We need to take this action. And it might be strategies to ground your feet and improve your foot control. 

It might be just stretches for the back. It might be, Oh, actually, every time you do this exercise, you're doing it with not so great form and you're doing that every day, we find. the key to unlock, gradually unlock the problem. Or we might do some form of treatment strategy to offload the area. And then we go, well, how do we keep it? 

And , I think the beauty [00:22:00] of being a physio and being someone that works in healthcare is we want to give people tools for their toolbox. So we want to empower people and give them the skills, the knowledge to go away self manage that where they can. , obviously help them on their way to get it better as soon as we can, but ultimately we want people to manage well themselves and know their body well. 

Alexa: I think that's why I really like Chris Johnson's movement assessment series, because it gives you a bunch of exercises that you can implement. They can be quite quick, but you can start noticing the patterns and how one influences another. 

So you can start to kind of map out, okay, is it breath that I need to work on first potentially? Or do I need to maybe go and work? tongue or jaw or whatever else it might be. So yeah, I quite like that kind of chain effect and looking at lots of different exercises to start finding out what actually might be where you want to work. 

Gen: That's it. And I think we often don't get the chance to just kind of take a moment to go, well, I'm [00:23:00] gonna listen to what my body's saying today because we're doing things or we're in the show or we're prepping for the show or we're not in the show. So we're looking for work. And I think. 

What's nice about going to an appointment or doing the care around looking after the voice or whatever it may be, is you're given that opportunity to spend that set amount of time that you have got just focusing on you. What a beauty, what an absolute beauty that we're like, the people that come to see us allow themselves. 

So it would be a disservice to not then go, right, you've spent the time thinking about yourself. How do you do that in your own environment? It shouldn't just happen in the space of the clinic room. It should have some degree of carry over to maybe when you get out of bed in the morning, or maybe it's before you warm up so that people kind of know what to look for. 

It's that understanding their body's own language.  

Alexa: And following on from that. You say that you're passionate about improving patients awareness and understanding of their bodies. And this is something shared amongst us as singing teachers who [00:24:00] aim to guide singers into a more connected bodily and vocal awareness. 

So how do you assist performers with this so that they can take it outside of a session with you and implement it into their everyday life?  

Gen: Part of it is done in the space for discussion and that space where on an initial appointment, I just let them talk through anything that has ever happened to them in terms of injuries where appropriate. Having the space to allow someone to explain through their history of injury or their history of their voice complaint or whatever it may be, or their history of potentially stress recent 

will allow them to, one, identify some causes if I kind of point out things as they go, or sometimes it's just when people have a moment to go back through their history, they go, oh yeah, I completely forgot that happened in that month. And it's acknowledging that and allowing them space to recognize what may have influences. 

[00:25:00] Sometimes it's then as we assess things or as they've explained, helping them interpret what a sensation might be. So for instance, Sometimes when people use words such as burny, tingly, nummy, we might associate that with like a neural injury or some form of sensation different. sometimes when people describe their breath as like wispy or difficult, we know that maybe there's a bit of a closure influence if they are terming breathy. And then we might already start thinking, is it ENT influence? Is there anything in their respiratory system or respiratory influences that could be influencing? It's almost signposting and highlighting. And then I guess on a treatment viewpoint, we might do some treatment that initially needs to be a bit hands on or with guidance in physio, but it's then allowing, us space to record films, send programs out, teach in sessions, because there's certain things that people can do [00:26:00] themselves, and making sure they have somewhere to refer to, or some form of like checklist to go, oh, if you feel this, consider x, y, and z, or something to refer to so they can go, Oh yeah, actually, I remember that from physio, so I could probably try that myself and see if it helps.  

Alexa: Particularly when you're working with performers who say, have to lie down or have to fly or have to lean over. Once you know that you're going to do that once, if you have a contract again where you have to do the same thing, you sort of know the most optimal position for your, for your body to lean forwards but still be efficient or lie down and still do its job. 

Gen: 100 percent and that carryover hopefully should stay but also like in life we forget things and that's fine and I think What we try to promote or what I try to promote as a physio is we're here not for just when things go wrong We're here to try and reduce the risk of it. So if you just want to check in with yourself to try and get ahead [00:27:00] of any influences that might come and influence the voice or your body, come in. 

If you want a bit of maintenance, and actually life's changing, it's a bit busy, you maybe haven't been able to do the program that you were previously given, but you know it, come in, or go through it. And it's just having that flexible approach to doing it, and also the knowledge that our bodies change. 

And sometimes that's a really huge thing for singers, performers, when they're, you know, maybe getting a bit older, their voice feels a bit different in sound or they're getting fatigued quicker than they normally do, it's just that acknowledgement that actually maybe your body's been through a few things, maybe you've been ill since then, maybe there's some other influence on your lifestyle that is different to when you last did this job or this role and that they now have to contend with. 

Alexa: Being around dancers and also having caught some of the Olympics that have been on recently, it's not uncommon to see. some of this support tape kind of striping their bodies. [00:28:00] So firstly, what does that do and can it apply to the singer?  

Gen: So taping comes in a few different forms. Um, we've got like a firm tape that really holds a joint or area firmly to try and offload a certain movement. 

Or we've got kinesio tape, which is a bit more flexible that allows you a bit more movement, but we'll try to facilitate or give the the person a bit more feedback about a position or where it's favoured. And that's more commonly used in sporting activities. So people can do the thing they're trying to do, but just have a bit of feedback and offload. 

 I actually touch on this in the article that I am putting together with my colleague, Lucie Rayner, ,, we are doing carefully amongst normal work. , but there's no research on, the influence of kinesiotaping to, and voice management at all, but if we think about what physios might use this for so like your example in sport to facilitate to offload to hold places It would be really interesting to see whether it has a [00:29:00] favorable Impact when it's used alongside what we as physios do as part of the vocal physiotherapy used alongside exercise prescription to facilitate voice. 

Gen: So I often use it in clinic. Let's say, let's say for instance, and I'm just going to go with a really rocky example. Let's say we're talking about the person who's sat on zoom, leaning forward, no awareness of posture, and they're getting loads of neck tension and tension around the jaw because they're doing it all day. 

It might be that I've tried to give them a few exercises and they can't quite pinpoint what it feels like to open their chest. And in that case, I might. kinesio tape over around the shoulder or down their back extensors. So they can feel the muscles that they're trying to find to open up that position. 

And it won't necessarily rigidly hold them there, but they can feel the pull. So they're more likely to when I give them the exercise that they're doing throughout the day, be able to And I might use that for a few days just to get them familiar, take it off so they can imagine and try and replicate it. 

And I find that really useful. , and often so do my patients and it [00:30:00] just feels nice having something almost like hugging you into the right position, but not in a aggressive way. , so I think it's quite good for learning and like that initial awareness when you're trying to. build the blocks of getting someone independent doing something. 

Alexa: For singers who might be interested in figuring this out for themselves, would you advise that they go ahead and tape themselves, or does it need somebody who is really sure on where these structural bits need to be?  

Gen: Self taping, it just requires a bit of awareness of anatomy. , so sometimes some people will come in and they'll already have the tape and they'll have found a way because they're in tune with their body. 

They'll know, Ooh, it doesn't feel nice when my shoulder's in this position. So they'll find some form of way to offload it. , and I think the interesting thing about taping, if you're not rigid taping to, let's say there's a significant injury, you're trying to offload it with the K taping. There's no one right way to do it. 

So sometimes [00:31:00] people can work it out themselves. However, if there is an injury or a pain or some form of neural issue or something, it's always best to get a bit of like medical guidance so that, you know, you're taping it in the right direction. That's not going to influence more problems because if they don't have the anatomy knowledge and they wing it and they tape it in such a way that actually drives their issue is not helpful. And, and all it is, is a quick question to a clinician as well. So, ask if you're unsure, but if you've got some form of awareness of anatomy and you know, the position you want yourself in, you might get away with it. 

Just don't leave it on for too long so your skin doesn't get irritated. And also just to add to that, we must remember that the taping. really is to enhance the benefits or understanding of the exercises. So taping won't resolve an issue. It might offload or help you in your awareness, but if you then don't do anything with that, nothing will change. 

Alexa: Do you envision the day where a student comes into a studio with [00:32:00] tape on their face to help with something like TMJ? 

Gen: I'm not really thinking of it in that factor. I think the example that I described is more of the factor that I'm thinking of. I think there might maybe be a role of taping around there. 

However, I just think in terms of how people feel, around voice issues or jaw issues anyway often it's a thing that people maybe are a bit insecure about or don't want people to know about. So I don't imagine that having tape around the face or neck will do much for the emotional side of what influences voice. 

However, having tape on the back of the neck for posture or back of the shoulder or something around there might be useful in their gain moving forward. I just think there's so many other techniques that you can do to manage jaw pain or those other factors that I imagine that research would say it doesn't have a, like, a significant impact if you were to do it anywhere around the face. 

And I imagine it would probably cause other issues. [00:33:00] Yeah. , if anyone was to ever research it, it'd be more for does kinesiotaping have a significant influence when paired with exercise or when paired with manual treatment or something like that, as opposed to just on its own. And I think that's the case anyway in, like, sport. 

Alexa: I would be too busy wondering, well, I've got blue tape on, so what top am I gonna wear?  

Gen: Yeah, does it coordinate with my outfit?  

Alexa: Yeah, like, what a look! Could you give us a case study where physiotherapy, vocal physiotherapy, has significantly improved a singer's performance or resolved in a reduction of dysphonia? 

Gen: Yeah. I find that when people come in with a diagnosis of muscle tension dysphonia, often diagnosed by their laryngologist, or their speech and language therapist, that there's often been advice, so sometimes I'll get a referral letter asking for some manual treatment or some [00:34:00] exercise strategies to facilitate whilst they're working with their speech and language therapist or their vocal coach, etc. So it's happening in conjunction with., and I think there are several cases that I can think of that maybe come in for their first session. I'm going to use a singer as an example where they, they can sing, but they've reported it to be higher effort. uncomfortable, or maybe at the top of their range or somewhere within the range, there is a break or the quality goes away, or you can just see them really pushing. And there's sessions where sometimes people come in, they have the release, they have the education, they have, a bit prompts on their breath awareness. 

And I treat and they hit the note and it's great. And then it's then about, right, we need to maintain this. Here are your exercises. This is this from physio go to your speech and language therapy session or your vocal coach, hopefully within a short window afterwards. And that paired together keeps them the [00:35:00] vocal range. 

Sometimes it takes a bit longer depending on the history of it. And, And what else they're working on. But there's often scenarios where I'll see people pre audition, pre performance, and they'll come back and, or they'll drop a message to, just saying that it was a lot easier, or they hit notes that they hadn't hit for quite a while, or they felt more confident in their voice. 

Which I think is really important as well, that reliability of knowing that my voice is going to do what I want it to do, as opposed to, oh, I don't know what's going to happen. So it can be quite beneficial in that way, That timescale of response just depends on the number of factors influencing voice, whether, how they're being looked after, I should say. 

Alexa: Whilst keeping in mind that all of us are different and our days are set up differently, what would be your advice or a check in or an exercise that us singing teachers could do in order to make sure that we're posturally set up efficiently for our online lessons or podcasting or [00:36:00] admin that we have to do to prevent or manage things like pain or locking tightness as we do our jobs? 

Gen: So this transfers across my physio practice, whether that be voice linked or, , shoulder back foot injury. , I just think it has so much value. I always talk to people about body mapping and just that concept of sitting for a minute or putting a timer on and just allowing yourself the space to stop and go, what is my body telling me? 

And I often do it in workshops as a getting people to lie on the floor or a scenario where they're undisturbed away from phone, , closed eyes, and just doing a top to toe scan of What does my head feel like? Have I got a headache? Have I got loads of pressure around my eyes? What's going on there? Color code it. 

Red, orange, yellow, green. Red obviously being, maybe it doesn't feel great today. And just doing that all the way down the body because [00:37:00] People will often quite quickly go, It's my shoulders or something doesn't quite like you'll you'll have a moment enough to go Well that feels good and that doesn't and then afterwards it's just deciphering Well, what information do I have in regards to that? 

Oh, yeah, I went on a really long run the other day That's probably why my legs are tired. We usually can answer quite a lot ourselves It's just I find for a lot of people having the space to do that. , just having the two minute check in in the morning or before you sing or before you start your lessons to go what's my body telling me okay i spotted i know about my shoulders it might be that in that instance you have to continue but then you've already told yourself right at some point today i've got to do something about my shoulders because they don't feel happy and then it's just working out what that factor is  

Alexa: You've got a really busy autumn coming up. You're back on Strictly. Um, what else is coming up for you?  

Gen: So, yeah, the back end of the year is usually busier for me. Um, yes, back on Strictly with my colleagues at [00:38:00] Prehab. They are brilliant and we are looking after the pros and celebs as we come into recording the next season. , aside from that, I'm still available in clinic doing bits there, predominantly in Chelsea, but I pop up elsewhere depending on what's going on in life. 

I recently just,, presented at PAMA, which is the Performing Arts Medicine Association that came to London, which was brilliant. The next step, which I'm really excited about is we're going to the CSP, which is the Chartered Society of Physio, , and kind of taking and bringing awareness about the vocal article there. 

And that is in, I think, October. But aside from that, I'm just excited. I want to get the article done. , it's been really challenging, being honest, writing an article alongside continuing work and having continuous ideas about what I want to do work wise. But I feel that it's really important and has the potential to have a big impact. 

So it's something that I'm really keen on getting finished. We're ongoing juggling the projects and enjoying doing that, but I am [00:39:00] going to be, probably after kind of getting into strictly routine and doing the CSP presentation, I'm going to be pushing on with that. 

Alexa: . So where can our listeners find out more about you, get in touch, even book a session? 

Gen: My Instagram is tawiah physio So it's T A W I A H, physio, P H Y S I O, give me a follow on there. If you inbox me, I'll usually pick that up, but I'm best getting me direct. So, maybe we'll put my email address and, , website on some form of bio or something because that will probably be easier basically just drop me a message or call my work phone i'm, typically about a worker flexi schedule so that I can Be firsthand to answer queries and things like that and I am available in clinic. 

I'm available for workshops I do mobile appointments because I drive, ask and I will see what I can do. And my team is hopefully expanding soon. So, yeah, watch this space.  

Alexa: Amazing. Well, Genevieve, Tawiyah, Gen, [00:40:00] thank you so much for keeping us company. You go do that article. I'm going to go to Benson's for beds and get some more pillows. 

Gen: Thanks for having me.