MTD is a change in the sound or the feel of the voice due to excessive muscle tension in and around the voice box. This tension prevents the voice from working efficiently. MTD is a pattern of muscle use that can develop during laryngitis and remain even after swelling of the vocal cords has gone. It can also be caused bystress, overuse and can co-occur with other diagnoses. Voice disorders are most commonly seen in individuals who have high vocal demands at work, such as teachers, singers, call centre employees and public speakers.
MTD generally causes the voice to sound:
Other symptoms may include a voice that suddenly cuts out, breaks off, changes pitch, or fades away; a voice that “gives out” or becomes weaker the longer the voice is used. Patients may also feel pain or tension in the throat when speaking or singing, and feeling like the throat is tired when speaking or singing.
As physiotherapists, we consider one of our key roles as being movement detectives. What is moving and what is not moving, and why? In MTD the common picture is that the posture is less than ideal, muscles of the anterior neck and throat are tight with subsequent weakness in cervical stabilizers and scapular stabilizers. This muscle imbalance creates restrictions on the hyoid bone, jaw, cervical spine and scapula. If postural control is inadequate, then we might see decreased ability to take a deep breath as well as the alignment of the pelvis, thorax and neck and head affected. Hopefully you are starting to paint a picture on the role of the physiotherapists in MTD. Relax some muscles, strengthen others, and improve postural control and education on breathing and relaxation. As with any diagnosis, no patient follows the exact textbook pattern and many other areas need to be explored by the physiotherapist for successful patient outcomes.
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