Case Study: The Rivet In The Soprano’s Neck

Every physician knows that diagnostic skills improve with age. After years of working with patients, eventually you see just about everything that can happen to the human body. The annoying corollary is that, more and more often, you find yourself saying to your patients, “Actually, I’ve had this myself.”

This case study concerns poor Renee, a professional soprano whose voice had changed. Had I not experienced my own version of her symptoms (which due to my obsessively pessimistic personality I erroneously self-diagnosed as throat cancer) I doubt I’d have made the diagnosis as quickly as I did, escorting her directly from my office down the hall to see chiropractic physician Cliff Maurer.

Ultimately, he’d be able to enunciate that most delectable of phrases: “Seems you’re now cured.”

In the months before her visit, Renee had noticed the feeling of a lump in her throat that was accompanied by an ache somewhere in her neck when she swallowed. The symptom occurred most often when she sang. And as the discomfort slowly worsened, to her dismay she discovered she was having increasing difficulty hitting her high notes on stage. At the end of every performance, her neck felt stiff and painful and her head difficult to turn, almost as if someone had insert a rivet in her neck.

As if that weren’t enough, she knew the stress of all this was worsening her symptoms and that worrying about her changing voice escalated her stress, further ramping up her symptoms.

Renee had an important concert in a few days and was seriously worried

As she related her story to me, she’d been experiencing this on and off for years, and had seen her throat specialist (every soprano has one) several times. She was told it was likely esophageal reflux and was advised to use a Nexium-type product. Never having experienced heartburn, she doubted the diagnosis and when she tried the pills nothing changed.

Interestingly, the lump in Renee’s throat, along with her neck stiffness, would go away a couple of hours after each performance. However, over the previous few months she’d been seriously overworking herself, some days singing for as long as six hours straight followed by three more hours teaching voice classes. Often when giving a concert not only did she have her head tilted back to project her voice to the upper balcony, she’d also hold a heavy leather-bound music score in one hand, turning pages with the other.

I told her this sounded like torture. “Maybe not that bad, but during a performance everything does start to ache,” she said, adding that whenever she felt stressed, even when not performing, her neck and upper back tightened up. I explained that these muscles are especially vulnerable to stress. Consider all the massage chairs out at O’Hare, each with a massage therapist grinding away at a clenched-jawed executive about to depart for anywhere except the one place he/she could use, somewhere like Puerto Vallarta.

When I applied pressure to Renee’s shoulders and upper back, I could have been massaging a cement block. The image of Atlas carrying the entire world on his shoulders popped into my mind. I shared this with Renee and she agreed at once.

Remembering my own lump-in-the-throat experience, I told Renee she could be helped, but definitely not by me. I left my office and went looking for Dr. Maurer.

Chiropractic fingertips

The moment he began his examination, Dr. Maurer knew something was wrong. Not only was her neck extremely tense, but it became obvious that certain postures worsened her symptoms while others seem to relieve them. Throughout the exam, he had her sipping water so she could feel if the lump sensation was still there, disappearing, or getting worse.

Then, with his chiropractic fingertips, he suddenly found it: the rivet in the soprano’s neck. A certain set of joints in her cervical spine (neck bones) did not move as they should have when he applied pressure. The same joints correlated to Renee’s all-important larynx—her vocal cords. When these bones aren’t moving properly, your voice isn’t either, soprano or not.

Renee’s lump and rivet–and my own misdiagnosed throat cancer–were both mechanical problems.  She improved enough after her first treatment to give a stellar performance in the important upcoming concert.  But because her symptoms had been around for quite a while, the loosening of her cervical restriction required return visits for additional manipulation in order to maintain the mobility in her spine. Also, Dr. Maurer taught Renee exercises to stretch and strengthen key muscles in her neck and upper back. Well motivated by this initial success, Renee has been an excellent student.

In the tunnel vision of conventional medicine, the effect of the musculoskeletal system on the rest of our bodily functions is simply overlooked. The very first chiropractic case study described how a man whose hearing had been failing had suddenly improved after manipulation (I suspect the chiropractic physician managed to open a blocked Eustachian tube).

An actor from the early years of the 20^th century, F. Matthias Alexander, knew he was losing his voice. Observing his posture in a mirror, he discovered that when he held his body erect and his head up, his voice returned to normal. He went on to originate a type of bodywork called the Alexander Technique, especially popular among theatre people.

Chiropractic manipulation of the thoracic (chest) spine has been documented to improve lung function in patients with asthma and emphysema. And most chronic pelvic pain in women doesn’t require a hysterectomy because the pain usually begins in the muscles of the pelvic floor. It often clears completely under the ministrations of a physical therapist specially trained in pelvic floor therapy.

The rivet in Renee’s neck is now gone. I’m sure somewhere later today, wherever she’s performing, the high notes of her extraordinary soprano voice are reaching up and out, all the way to the cheap seats.

Be well,
David Edelberg, MD