Is There a “Voice Role” for the Pelvic Floor?

April 3, 2020

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Is There a “Voice Role” for the Pelvic Floor?

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In the physical medicine literature, the PELVIC FLOOR is defined as a complex, multilayered structure that forms the base of the abdominal capsule and is known to play a role in abdominal & pelvic organ support, bladder/bowel control, sexual arousal, respiratory & postural support, as well as generation of intra-abdominal pressure (together with the diaphragm, transverse abdominis (TA), and obliquus internus (OI)). Voice science literature reminds us that abdominal muscles are responsible for the generation & regulation of subglottal air pressure necessary for phonation (voiced tasks) & the singing voice literature acknowledges the pelvis as important for postural alignment, something vital for the muscles of respiration to function properly.

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In the Journal of Voice, Gordon & Reed (2018) found that “EMG data & ultrasound imaging CONFIRM the synergistic relationship between the pelvic floor musculature (PFM) & diaphragm, TA, & OI during respiration”. The beautiful synergy: during inhalation, the thoracic diaphragm contracts to draw air into the lungs & the anterolateral abdominal wall distends somewhat & the PF relaxes downward; during exhalation, the PF musculature & anterolateral abdominal muscles (TA & OI) contract as/slightly before the thoracic diaphragm relaxes to TRANSFER intra-abdominal pressure from the abs to thorax. The article describes that in osteopathic medicine, it is commonly taught that FOUR diaphragms play a role in respiration (what?!). They are: the cranial diaphragm (regulates movement of cerebral spinal fluid), the cervical diaphragm (consists of the tongue, floor of mouth, & hyoid complex/musculature & its movement is affected by the tracheal pull during respiration), the thoracic diaphragm (primary inspiratory muscle as we know it & descends during inhale), & the pelvic diaphragm (a.k.a. the pelvic floor, which forms the bottom of the abdominal cavity opposite the thoracic diaphragm & moves downward when diaphragm contracts during inspiration). “All 4 diaphragms move symbiotically with one another and are responsible for the movement of fluid throughout the body during respiration (the movement of the thoracic diaphragm—the ‘primary’ diaphragm—affects the behavior of the other 3 diaphragms)”. How fascinating!

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Per the article, EMG data of the PFM shows activity PRIOR to resisted expiration demonstrating some NEURAL PRE-PLANNING for respiration way down deep in the PF! The article confirms: “the STRENGTH of the pelvic floor MATTERS”. Interestingly, the literature reports that the abdominal musculature must be trained to perform specific tasks, as a high percentage of women weren’t able to perform a voluntary PFM contraction. Inclusion of pelvic floor musculature contraction with transverse abdominis and obliquus internus demonstrated more EMG activity as well as increased intra-abdominal pressure (improved support for voice!). When looking at the impact of a strong PFM contraction on respiration, they found IMPROVED pulmonary function (WITH statistical significance!) primarily w/forced vital capacity & forced expiratory volume. Side note for all performers, fitness instructors, & others who are moving while using voice—the expiratory muscles are activated whenever forced expiration is required (such as breathing in heavy exercise, dancing, etc.). Also, PFM contraction during breathing was found to assist w/& increase effectiveness of diaphragmatic motion. Strong PFM contractions resulted in increased muscle recruitment & strength of the respiratory muscles & an increase in speed of inhalation/exhalation. Women w/stronger voluntary contractions of their PFM were able to EXHALE MORE EFFICIENTLY, especially at the end of exhalation. And isn’t this exhalation exactly what our voices “ride out on” when we speak or sing?! To permit this beautiful synergy to happen, we must also remember to simply ALLOW our body to do what it already KNOWS how to do & ensure we are not holding tension anywhere that may be inhibiting this free & natural synergy from flowing.

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“The main difference between the voice science & physical medicine literature is the inclusion of the PF musculature in the physical medicine literature as essential abdominal musculature involved in respiration & support. The PF musculature is presented not necessarily as a stand-alone force, but one that has a synergistic role with anterolateral abdominal muscles that the voice literature consistently acknowledges for playing an important role in expiration & support…The role of the pelvic floor in generation & regulation of intra-abdominal pressure for muscular support is clear & supported with EMG data. The inclusion of this unique physical medicine data & perspective on the PF muscles could add more clarity of the singing & voice science disciplines” (Gordon & Reed, 2018).