deactivation stretches

Intro to Voice 2006
Deactivation Stretches
Introductory Comments:
A. Multiple goals can be addressed during the Deactivation Stretches
1. One goal would be to reduce or eliminate excessive tension in the neck, shoulders,
back, and articulatory muscles.
2. A second goal would be to increase the client’s sensory awareness.
3. Third, these exercises provide an opportunity to attend to breathing, which assists
in relaxation and in helping the client to remain within an optimal range of lung
volumes during speech (presumably taking advantage of elastic recoil of the lungs)
4. Fourth, these exercises can be used to assist the client in attaining good posture
(expanded chest, shoulders relaxed down and slightly forward, head resting lightly
on spine…)
B. The exercises and sample directions.
1. The words with in parenthesis () are hint you would say to the client. The words in
brackets [] are things you should do or observe but would not say to the client.
2. When first teaching the exercises, I would emphasize the slow deep breathing in
through the nose and out through the mouth with a wide open throat. If it is hard
for them to breath out through the mouth without constricting the throat, breathe
out the nose. It is more important for them to maintain a relaxed, open throat. Also
if they have trouble with deep breathing at first then just begin with a moderate
breathe (“start where you are”). They also may have to build up to doing them
slowly (it is harder to do them slowly). On the first day you want to introduce them
to the exercise and the breathing but you are not pushing them on performance.
The stretches are performed gently. There should not be any discomfort.
3. It helps to wear non-constricting clothing or to remove constricting clothing to the
extent possible (i.e. jackets)
The Deactivation Exercises
A. Shoulders and back
1. Overhead stretch “Reach for the sky”
i. Stand up with your feet about a shoulders width apart, toes forward, knees soft
(not locked).
ii. As we are doing these exercises take nice deep slow breaths, breathing in
through your nose and out through your mouth. Let’s try that a few times. You
should not feel any constriction in your throat. Breathe in through your nose
and now out through your mouth with a wide open throat. Don’t hold your
breathe, just let the air flow in through your nose filling your lungs and then
feel the air flow out through your mouth.
[although it is helpful to say once “you should not feel constriction”
generally want state things positively when talking the patient through
the exercise..i.e. in terms of what they should do rather than in terms of
what they should not do]
Intro to Voice 2006
Deactivation Stretches
iii. Now I want you to turn palms outward and on your next exhalation gradually
lift arms [try to make sure you are breathing in synchrony with the client and do
the slow arm lift together. It does not matter if palms are touch, fingers are
iv. You should be looking forward with your head resting on your spine (as if there
were a string coming up the spine and through the top of the head lifting the
head toward the ceiling)
v. Now maintain this position for 3 nice slow deep breathes. Feel the air enter
your nose and slowly fill your lungs
vi. On this last exhalation turn you palms out and slowly bring your arms back
down to your sides (the hands should touch the sides slowly and gently [not hit
against the sides of the body])
Different instructions you could give during subsequent sessions:
vii. With in each position attend to where you feel the stretch.
Where do you feel the stretch as you gradually lift your arms? Where do you
feel it as you reach for the sky during exhalation? Where do you feel it as you
slowing bring your palms back to your sides? You do not need to explain
verbally what you feel I just want you to notice it for yourself [too much talking
breaks up the rhythm of the exercises and slows the session]
viii. How does lifting your arms change your breathing. Notice where you feel
the expansion.
ix. Try shifting your balance from the balls of your feet to your heels (rocking back
and forth) as you are doing the exercises. Does anything feel different when
you adjust your balance? (This distraction sometimes helps them relax /drop
their shoulders slightly).
x. Moves arm slightly forward, move arms slightly back. How does stretch
change? Which position feels more beneficial to you?
xi. [Note: Listen for noisy breathing. Clients can slow the breath by increasing
resistance at the larynx or in the oral cavity (by saying a /s/ for example).
Using the /s/ is preferable to using vocal fold adduction but the ultimate goal
would be slow quiet exhalation since this requires more “inspiratory checking”
and makes the inspiratory muscle work harder. If they are adducting their vocal
folds to control airflow they will start to get a sore throat. Check to make sure
this is not happening. If it is go to the /s/ on exhalation and have them
periodically sip water to avoid excess tension in laryngeal and neck muscles]
Intro to Voice 2006
Deactivation Stretches
2. Chest stretch: arms in “V” at sides. Press forearms back.
i. Put your hands on your hips/waist and rotate your elbows back to a
comfortable position.
ii. Take in a nice slow deep breathe in through your nose and then slowly let the
air flow out your mouth with a relaxed wide open throat.
iii. Again take a nice deep breath in through the nose and out through the mouth
[your instructions should be timed to the clients breathing. You don’t want to
disrupt their performance of the exercises because you are too early or too late
with your instructions].
iv. As your breathe in through your nose and point your elbow toward the back
wall, notice the expansion of the upper chest as it fills with air.
v. Different instructions you could give during subsequent sessions:
a. During the exhalation, gently press you elbow a little closer together and
maintain that position during the next two breaths.
b. This time instead of pressing your elbows together think about contracting
the muscles on either side of spine between your shoulders (this will tend
to draw your elbows together).
c. I also like to do this one sitting in a chair with arms. I put my hands on
the arms (which raises my shoulders a bit) and the push against arms of
chair to rotate my elbows together. This exercises emphasizes stretch
rather than breathing ( do not always have to do every thing)
3. Back stretch: clasp hands in front. Reach. (turn wedding ring around so it does
not dig into the other hand)
i. Similar instructions as above.
ii. Where do you feel the stretch (back, shoulders, arm…) As you breath in,
where do you fee expansion (chest is collapsed in this exercises forcing air
into lower part of lungs. May feel expansion in back as well)
B. Neck:
1. side stretch
i. L hand on right side of head, R hand distended to the side
ii. R hand on right side of head, L hand distended to the side
iii. Similar instructions as above.
iv. Gradually (and mindfully) lift left hand and place on right side of head. As you
breathe in, do you feel one side of the lungs fill more than the other side?
v. As you exhale through your mouth, let your head drop toward your shoulder.
Feel the weight of your hand on your head. (do not pull your head to your
should, let it relax toward your shoulder)
vi. As you exhale through your mouth, extend your right arm (and the fingers of
your right hand) toward the floor.
Intro to Voice 2006
Deactivation Stretches
2. Head rolls
i. Chin to chest
a. Roll to right side – hold
b. Roll to right side – hold
c. Similar instructions as above.
ii. Massage back of neck
a. Similar instructions as above.
b. Do you feel any tender areas? Identify these areas (neck, shoulder,
right or left, how far does it extend?) Work gently to help release the
excess tension in these areas. Try different massage techniques
(does it help to massage with circular movements or to press firmly
and concentrate on breathing…)
C. Jaw
1. Masseter stretch
i. Use of heels of hands to massage downwards over the masseter muscles, to
lengthen then
ii. Use V between thumb and forefinger to pull jaw down and back
D. Lips
1. Labial rolls (If difficult, very loose, repeated “papapapa” can be used, “blowing
out” lips)
2. Spanish “r’ (tongue roll)
For the rest of the stretches make your own instructions based on
 the examples gives so far,
 your own experience doing these exercises,
 your patients experiences and comments regarding the exercises
 and, of course, your knowledge of normal and pathophysiology;-)
Did the exercises address the problem areas? If not how should the stretches be altered?
In some cases, maximal contraction to fatigue a muscle may also be a useful way to relax the
muscle. Do not invest in the exercises. Invest in achieving the purpose of the exercises. Use
your observations and your knowledge of anatomy /physiology and your hypothesis testing
and problem solving abilities to develop the best series of exercises for your client (knowing
that these may change over time)
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