The artist has been out on the road weeks singing full-throttle most nights, then catastrophe strikes – you’re suddenly spitting blanks. There’s another forty-dates ahead and you need a consultation and some serious healing. Who are you going to call?

When the big voices - Mick Jagger, Sting and Sam Smith - are in town they drop into The Voice Clinic and visit Aaron Low, MS CCC-SLP. In fact, Aaron has worked with seven of this year’s Juno nominees including Shawn Mendes. Keep in mind, this isn’t vocal training but vocal health. With everyone heading west for Juno weekend I thought; why not a few words from a specialist.

Bill King: How many patients will you see in a day?

Aaron Low: Ten one hour visits.

B.K: Amateurs to professional singers?

A.L: It is. I see everyone from voice pathology perspectives where they’ve had radical head/neck surgery. I had a patient today who had half the tongue removed and a number of muscles from the neck – to a lawyer who is a professional speaker to an opera singer. Someone who’s in a choir – someone who has had major reconstructive voice surgery – music theatre – someone who chokes when they try to swallow, even a woman who is basically older who wants to sing yet is having problems. Singing and voice based problems but through a scope of everything from cancer to high-end opera.

B.K: What are the most common issues you hear from singers?

A.L: Generally, about seventy per-cent of the problems for speakers and singers correlates to muscle tension dynamics. We have slow motion cameras to look at vocal cords and take pictures so we can prove to patients everything is fine with the vocal cord tissue. Sometimes reflux is a common diagnosis and can be easily seen. If they don’t have reflux it’s still the symptoms they are feeling we have to fix. A lot of the time programs in Canada and in the States and worldwide don’t have curriculum that teaches laryngeal muscle assessment. What we want is to sort of advance that and push more knowledge into the system that’s general health care. Most GPs don’t understand the voice box. Most of the time even ear, nose and throat doctors look for vocal cord pathology or a tumor or a bleed or a hemorrhage but they don’t find that – they basically don’t know what to do with the patient at that point. They send some to me.

It’s about tension. If we work out the tension – the voice problems go away. The range comes back, the power, the resonance, speed and control. It’s a dynamic correlated to athletics. There’s not a broken bone or major tear. There are a couple major joints in the voice box we have to keep lubricated and moving properly and the brain that runs them can get the sound out of it,  it wants.

B.K: What is your relationship with the vocal coach?

A.L: I work also in the music department of the University of Toronto and teach voice anatomy and pedagogy at the Master’s level. I’m learning about different types of vocal coaches and what they are going to teach. A vocal coach is kind of like a hockey coach – they want their performer to be in healthy shape and if they aren’t that’s where we have to educate each other about what is fixable with say for example, hands on massage technique – something I actually do where I take your voice box and relax it quickly in a couple of hours and give the singer back to the vocal coach and they then train that singer that isn’t injured, that isn’t stiff – stuck in a voice structure not able to be helped with singing exercises. We have to assess them. Just hearing the voice is typically what vocal coaches do. From my perspective at the office – we get to see their voice – perform different things acoustically so we can measure tension in numbers and once we see that change to the patient then push them back to their singing teacher to go back training – back into that program.

Especially with opera and jazz – there are things you have to reach to sing certain music and if you can’t reach it then you have to continue training.

B.K: What would a Sam Smith or Mick Jagger come to you for?

A.L: Typically, they need it all done quickly. That’s the one thing we provide that’s different. Here at the Voice Clinic we do things that are after hours. I’ll come in on a Sunday afternoon for a rock singer or a pop star, someone who’s basically in the city for a concert that day or the next day. We have to differentiate what’s right and what’s wrong with their symptom set. I work alongside an ear, nose and throat surgeon – a doctor of ear, nose and throat medicine - and he helps me with sinuses – the understanding of their ear symptoms – their throat symptoms so if there is sickness, we can say if it is sickness - can’t be fixed by tonight or there is no sickness, but the feeling of sickness and he can then give me the green light and say, “Aaron there is no infection so now we work with that singer until we find the voice.” It typically takes a feel of the voice box before we understand the true muscle dynamics and then we work on their muscles as long as it takes.

B.K: There must be psychological issues too? Having to sing nearly every night and protect the voice can play on the mind.

A.L: Definitely! There are a couple of muscles in our voice box that respond when we get stressed out. They respond and ruin pitch. They can respond and control your pitch without you controlling your pitch. Often times when we see a singer who may be a little off of the centre of the pitch – their brain hears the pitch they are trying to sing – their voice box isn’t playing the pitch they are trying to sing – that’s just muscle dynamics changing as a reaction to stress.

We could eventually add a sports psychologist or someone like that and include on staff. Right now I think the biggest psychological benefit we can give is confidence they are ok. If a singer thinks they have hemorrhaged they are going to believe that until they see their voice structure as being clear and healthy. Once they see that, they can still be confused asking – why can’t I hit this high note or why can’t I do that?

B.K: A young singer like a Shawn Mendes who is just learning how to pace himself on a gruelling tour needs special attention.

A.L: I think it’s how you train your voice, being able to sing. If we look at some of my exercises we would use in training there’s breath strength – not training how to breathe – not training words around breathing because I don’t use words like diaphragm in my clinic – it’s not a helpful word to use. If someone says breathe from your diaphragm, I disagree with that. We do strengthening with the breath; speed-based exercises with the breath and try to create a breath dynamic function and there is no pressure – you’re not playing the game. As you work on the exercises your game gets better.

When we take away breathing and singing in triads, scales or arpeggios which I don’t do, that works the muscle that works their skill. If you were working in an opera or a fast jazz performance you’d need that speed. I’m basically doing the rehab of broken muscles, broken singers, not training a singer.

B.K: What would a session at the Voice Clinic cost?

A.L: A speech pathologist will range between, $120-$190. I’m in that ball park. Performers that pull me in on a Sunday don’t get that rate. We are regulated by the government.

Sometimes the singing teacher has no degree in anything – there’s no one regulating that person so they might be saying, I’m a singing teacher and I’m going to charge a hundred bucks an hour and have a Royal Conservatory piano degree. We look at it as we should be able to share. They may have a great singer and great skill in teaching singing but they aren’t going to know what muscles I’m touching or what I’m going to have to do to stop someone from coughing while they sing – it’s a different mindset.