Clinical Insights from a Voice Therapist Who Specializes in Hypermobility
Originally published on 19/09/2025 & last updated on 16/10/2025
You might have already read my earlier blog post Hypermobile Singers: From Pretty Impressive to Pretty Painful, in which I share an overview of what’s important to know when you’re (working with) a hypermobile singer.
If you did, you know that as their voice teacher, I would LOVE the hypermobile singers I work with to have a team of therapists, trainers and health professionals that have a deep understanding of hypermobility. Unfortunately, this rarely is the case.
Many doctors still believe Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) in general do not affect the voice, airway or swallowing, but that’s simply not true. And many Speech-Language Pathologists are unfamiliar with EDS-specific deficits if voice or swallowing seem “normal”. This means that we, as voice professionals, have an important role to play in helping these singers feel heard, supported, and safe.
This blog post is for you if you’re a Speech-Language Pathologist, voice therapist, or singing teacher who works with hypermobile clients. If YOU are the singer that this therapist or teacher will work with, make sure that you understand all of this inside and out, so you can advocate for yourself.
Disclaimer: This blog post is educational and not medical advice. If you have concerns about your voice, breathing, or swallowing, please see a qualified physician and SLP.
- Check the agenda for my Online Solo Group Lessons for Hypermobile Singers – You can enroll as an Active Participant or learn from observing the lessons as a Fly-On-the-Wall.
- Subscribe to The singsing! Sofa Library to…
- watch the 2-hour long webinar Teaching Hypermobile Singers: Go from Pretty Frustrating to Pretty Fascinating and learn how to effectively teach hypermobile singers
- watch the 2 webinars led by Christine Schneider, who offers invaluable insights on hypermobility: Core Training for Singers – The Vocal Resilience Cylinder & Core Workout for Singers.
- Of course, you are also very welcome to book Private Voice Lessons & Vocal Coaching and / or Mentoring with me 🙂
Why Hypermobile Voices Deserve Special Attention
Voice, breathing, and swallowing issues are much more common in people with hEDS and HSD than most clinicians realize. Stacey Menton’s research Laryngological Complaint Prevalence in Hypermobile Ehlers-Danlos or Hypermobility Spectrum Disorders (2024) found:
- 22.5% reported hoarseness
- 33.9% reported swallowing difficulty
- 27% reported breathing issues
Stacey is a speech-language pathologist and voice therapist at Mayo Clinic Jacksonville who works specifically with hypermobile patients dealing with voice, breathing, and swallowing issues. Here’s what she sees most often in her hypermobile clients:
Voice Issues
Sometimes vocal symptoms are the first sign that somebody is going to have a flare.
- Muscle Tension Dysphonia (MTD): Muscles try to stabilize weak connective tissue, leading to tightness, fatigue, and that “working too hard” feeling.
- Glottal Fry Overuse: That low, creaky sound might feel stabilizing, but it can mean that there’s not enough airflow and can worsen muscle tension and fatigue.
- Voice Fatigue: Running out of steam halfway through the day.
- Instability: Sudden voice changes, arytenoid or hyoid “slipping” sensations.
Swallowing Challenges
- Discoordination or jerky movements due to weak connective tissues in the neck. Instrumental exams often look normal despite symptoms.
- Aspiration of food and drinks, which leads to coughing during a meal. Reflux triggers couging and irritation after meals.
Breathing Concerns
- High-chest breathing and unefficient use of the diaphragm
- Unconscious breath-holding by tensing the abdominal wall
- Inducible Laryngeal Obstruction (ILO), formerly know as paradoxical vocal fold movement or vocal cord dysfunction, causing scary “I can’t get air in” moments. When you have ILO, you experience something called laryngospasm. Your vocal folds close abruptly, triggered by smells, exercise, hot, cold, humid or dry air. This is likely related to upper gastro-intestinal issues, the role of connective tissue in the mechanics of breathing, and possibly Mast Cell Activation (MCAS) issues.
Voice Therapy Principles That Work for Hypermobile People
As a voice teacher, I’ve learned that what works beautifully for most singers can sometimes be downright unhelpful or even harmful for those of us with bendy bodies.
There are no official guidelines yet for voice, breathing and swallowing in hEDS / HSD, but here’s what Stacey knows helps in voice therapy. This is a snapshot of her evolving understanding and practical approaches.
- Individualize Everything: hEDS/HSD is heterogeneous. Stop or adapt anything that worsens symptoms.
- Low-Dose, High-Frequency: Short bursts (15 to 30 seconds) of for example straw-in-water phonation, 8 times a day. But reduce the frequency if it triggers fatigue.
- Starting with lower load and progressing slower to avoid injury: Drawing parallels from the physical therapy literature, gentle and gradual progression seems to be key.
- Focus on Stability: Prioritize vocal health over extreme range.
- Differentiate between necessary and excessive / compensatory tension in the base of the tongue and neck.
- Resonance: Feeling your voice in front of your face tends to have a positive effect on both phonation and breathing.
- Encourage Airflow: Reduce vocal fry, but avoid drills that cause dizziness. If they do, switch focus to resonance-based strategies. Also don’t demonize vocal fry, it’s OK to use it once in a while, if balanced.
- Semi-Occluded Vocal Tract Exercises: Straw-in-water is very effective for reducing tension and doing a voice reset. Skip the Blowfish, as it can create too much back pressure for hypermobile larynges, possibly triggering arytenoid subluxation.
- Relaxed Tongue Posture: Work on tongue tip resting at the alveolar ridge to reduce tongue-base tension. Skip tongue-out-speech as it can worsen symptoms in hypermobile patients (hyoid “subluxation-like”?)
- In case of Inducible Laryngeal Obstruction (ILO): Laryngospasms can be terrifying. Techniques like the sniff technique can “reset” the vocal folds: 3 to 7 quick sniffs through the nose triggers a brainstem reflex to open the vocal folds. Then slowly exhale on a shhhh or through pursed lips. The pressure feedback will keep the vocal folds open on the exhale. Follow up with 5 open throat single breaths through the nose & out through pursed lips.
Here’s a helpful video, made by Danielle Campbell, an ASHA certified SLP. She explains what laryngospams are and how they look from the inside (filmed with an endoscopy).
She also shares some exercises to train your breathing, and at the end, she explains three very helpful strategies to deal with a laryngospasm attack like rescue breaths, straw breathing and the Larson maneuvre.
If done properly, it should abort an attack within 10 seconds.
- Parasympathetic Activation: Deep breathing exercises with a focus on a prolonged exhale and practices like non-sleep deep rest can help shift from sympathetic to parasympathetic nervous system activation. This can help with brain fog and pain while activating the vagus nerve, which innervates the larynx and is responsible for many parasympathetic nervous system functions.
Our jobs of voice teachers and SLPs is not “fixing” voices. It’s giving hypermobile singers tools to self-regulate and prevent flares , helping them stay in their career longer and allowing them to enjoy singing again without fear of pain or fatigue .
Every time I see a singer light up because they can sing through a whole rehearsal without crashing afterward, I am reminded why this work matters so much.
Show Your Bendy Voice Some Love!
Here’s Stacey’s advice for hypermobile people outside of the voice therapy room.
- Use it or lose it… Home alone? Read aloud, chat with the TV, or have a conversation with your pets. Anything to keep those vocal muscles active and happy.
- Breathing Exercises: If you suffer from Inducible Laryngeal Obsctruction (ILO), learn how to abort an attack by watching the video I shared higher up in this post 👆🏼 Make sure to train these strategies BEFORE an attack, so you immediately know what to do when it occurs.
- Voice Pacing: Schedule short “vocal naps” of about 20 minutes. No need for total silence, because too much rest can actually make your voice stiff again.
- Regular Voice Resets & Hydration Breaks: Quick moments of straw-in-water exercises and a sip of water can do wonders.
- Microphone Magic: If you talk a lot because you are a teacher or another high-vocal-load professional, use a microphone. Your voice will thank you.
- Keep an Ear on Your Voice: Track your symptoms & progress in voice therapy.
- Work Adjustments: If your job involves heavy talking like in a call center, this might not be the job of your life…
- A doctor’s note can help justify aids or scheduled breaks at work.
Meet Stacey Menton: The Voice Behind The Zebra’s Voice
Everything I just shared with you is inspired by an episode of The Bendy Bodies Podcast hosted by Dr. Linda Bluestein, the “Hypermobility MD, who has a special interest in treating performing artists. The podcast is called What Can Difficulty Swallowing and Voice Fatigue Mean? and features Speech-Language Pathologist and voice therapist Stacey Menton, specializing in hEDS and HSD.
In this post, I also drew from Stacey’s research paper Laryngological Complaint Prevalence in Hypermobile Ehlers-Danlos or Hypermobility Spectrum Disorders and her Substack The Zebra’s Voice.
If there were a superhero for hypermobile voices, Stacey Menton would be wearing the cape. She’s a speech-language pathologist and voice therapist at Mayo Clinic Jacksonville who works specifically with hypermobile patients dealing with voice, breathing, and swallowing issues.
Stacey’s PhD will begin the process of developing a formal therapy protocol for hypermobile patients who need voice, breathing, swallowing, or possibly cognitive therapy. Her PhD work will mostly attempt to understand what is needed from SLPs and people with hEDS / HSD in the development of this protocol.
Last, but not least: Thank you very much, Joanne Bozeman, my hypermobility buddy! We regularly draw each other’s attention to interesting resources on hypermobility and she sent me the link to the Bendy Bodies podcast.
- Check the agenda for my Online Solo Group Lessons for Hypermobile Singers – You can enroll as an Active Participant or learn from observing the lessons as a Fly-On-the-Wall.
- Subscribe to The singsing! Sofa Library to…
- watch the 2-hour long webinar Teaching Hypermobile Singers: Go from Pretty Frustrating to Pretty Fascinating and learn how to effectively teach hypermobile singers
- watch the 2 webinars led by Christine Schneider, who offers invaluable insights on hypermobility: Core Training for Singers – The Vocal Resilience Cylinder & Core Workout for Singers.
- Of course, you are also very welcome to book Private Voice Lessons & Vocal Coaching and / or Mentoring with me 🙂
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