Touring performers should treat their voices the way professional athletes treat their bodies, but many of them don't until it's too late.

Towards the end of April, T-Pain uploaded a video to Instagram, announcing the medically mandated postponement or cancelation of all the upcoming performances he had scheduled for the foreseeable future. Appearing truly distraught to reveal this news, the artist issued the following statement:

“I just got off tour. Sometimes I was doing two shows a day, entertaining the people, going to after parties, and just working, working, working, working, working. The truth of the matter is: I just haven’t been taking care of myself. So, after my last couple of shows, I started getting a few pains in my throat, so I went to the doctor. He basically told me that I had to get off the road immediately or I was going to start doing permanent damage to my voice. And, if you know what I do, you know that’s the most important part of what I’ve got going on.” —T-Pain

Watching T-Pain make this announcement, I couldn’t help but think back to this time last year, when R&B songstress SZA had to take a similar leave of absence from the TDE Championship Tour, citing analogous factors.

“My voice is permanently injured. I jus[t] wanna be left alone, my priorities are fucked up,” she wrote in an emotional series of since-deleted tweets.

When TDE issued a clarifying statement on Instagram, stating “her vocal cords are swollen, and she [has] to rest her voice to prevent any permanent damage,” SZA re-posted this statement to her own account, adding: “I’ve been touring for 11 months. This didn’t happen overnight. I’ve been troubleshooting for a while now, and usually steroids and pushing through help [...] I’m not sick; my voice just won’t fucking work. If I don’t pause now I’ll be forced to pause permanently.”

More than just a pair of anomalous incidents, these struggles documented by T-Pain and SZA appear to be indicative of an increasingly noticeable trend within the music industry at large. Performers may not necessarily think of permanent vocal damage as an occupational hazard of their craft, but anecdotes such as these suggest that vocal injuries can have a profound impact on their careers nonetheless.

Inevitably, as they embark on grueling tours—on which they’re forced to stretch their voices to the brinks of their respective limits each night—it’s important for artists to keep a keen eye towards the diligent preservation of their vocal health, lest they risk losing the one tool that is most central to maintaining their livelihoods.

To learn more about the nature of these risks and the various steps artists should take to minimize them, DJBooth spoke to Dane Chalfin, a decorated vocal coach and vocal rehabilitation expert based in the U.K.

DJBooth’s conversation with Chalfin, edited for content and clarity, follows below.

Photo Credit: Rudy and Peter Skitterians

DJBooth: As you may know, our focus here at DJBooth is primarily on rap and R&B, so I was wondering if there are any particular genres of music where performers face greater risks of damaging their voices than others?

Dane Chalfin: That’s a common myth, actually. Whenever we look at the numbers of singers who come through our voice clinic, we see an equal amount of opera singers, musical theatre singers, pop/rock/R&B singers, and other professional voice users, like rappers, spoken word performers, lecturers, public speakers, etc. We don’t see any trends that are genre or style specific.

Can you give me a high-level overview of what’s going on vocally, from a medical perspective, that’s causing so many artists today to have to cancel or postpone their tours?

If you’ve ever broken in a new pair of shoes, you’ll know that, if you don’t do it gradually, the shoe will rub on the foot, causing inflammation that will eventually lead to a blister. Then, if you keep rubbing, that blister will turn into a callous. It’s not the exact same thing with the vocal cords, but it’s probably the easiest way to explain [it].

One of the big risks for performers these days is that this inflammation, which you get from having to use your voice more than the average person, can also be caused by the dryness of airplanes, the dryness of hotel rooms, the smoke that’s on the stage, etc.

It’s not just the hour a performer’s on stage, either. It’s the press they do in the morning; it’s their soundcheck; it’s their meet and greet afterward. Eventually, the inflammation in their vocal cords will reach a critical mass, where it becomes unmanageable. And that’s the number one reason we see people needing to take a break [...] If a performer keeps performing while their larynx is already inflamed, they start running the risk of developing hemorrhages, where they burst blood vessels. And they also run the risk of creating other problems, like nodules and polyps.

Have you noticed an uptick of these sorts of problems occurring as touring schedules have grown progressively more intense?

Absolutely. There’s two factors here. The first, and probably most important one is that our ability to consume information is really changing how much information we’re seeing. So, I’m not sure if more performers are experiencing these problems than in the past, or if we’re just being exposed to it more.

Having said that, touring conditions have become increasingly difficult, and the recording industry is not spending the kind of money they used to on artist development and artist care. There was a time where a record label would pick up the bill for a certain amount of training, to ensure that an artist they were about to launch would be equipped to go out and tour the way they needed to be. There was also a time when they might have had vocal coaches in the recording studio or access to good voice care while they were on tour, but those days are pretty much over.

In terms of best practices, are there certain guidelines artists should follow in order to minimize the risk of vocal damage. For example, what’s the optimal amount of time artists should allow for between tour dates?

It varies on the individual. But, there are certain things [performers] want to avoid. Performing immediately after long-haul flights will increase the risk of certain types of problems. We usually advise allocating at least 24 hours rest between a long-haul flight and a performance. We also recommend minimizing dehydration during traveling—trying to keep the humidity quite high, either in the tour bus or the hotel room. We recommend steam inhalation, in order to keep the larynx and the vocal folds moist. We also ask singers to avoid things that dehydrate them, like caffeine and alcohol, or at least moderate that behavior.

We also try to ensure our performers are following a very strict regimen, like an athlete would, of specific stretching exercises for the muscles that contribute to their voice. [This means regularly engaging in] specific types of warming up and cooling down exercises to make sure they are getting their voices the optimal muscular configuration before they perform, but then also cooling it back down to neutral after.

In terms of [behavior to avoid]: don’t smoke! Smoking is the single most stupid thing you can do to your voice. And [artists] have to be very careful with cannabis, because it burns at a much higher temperature than tobacco and causes inflammation much more quickly. I often have to have discussions with my clients who feel like they do want to engage in these kinds of recreational activities, about safer delivery systems.

What are the indicators performers should be looking out for to assess whether a problem is fast approaching?

The gold standard advice is: if the voice is abnormal for more than three weeks, then the performer should be consulting a specialized voice clinic. And, when we say "abnormal," what we mean is a change in range, timbre, stamina, agility, tone, etc. And it’s very important they be seen in a specialized voice clinic that has the proper equipment, and staff with the right expertise to assess the needs of a professional singer. General [ear, nose, and throat] clinics will often not have that equipment or experience.

What’s the typical turnaround time between a performer noticing a problem and successfully reversing the damage through rest or treatment?

You bring up an interesting point about rest. There’s really only two times we advise singers to have voice rest. The first one is if they have laryngitis, and the second one is if they’ve had a hemorrhage—if they’ve burst a blood vessel. For both of those situations, we would recommend certain amounts of rest. For just about every other problem that a professional voice user faces, we recommend therapy, not rest. You have to change the muscular behavior in the body that’s contributing to the problem, not just rest the symptoms.

At what point does this damage become more permanent, rather than something that can be treated with therapy?

That’s hard to say. It depends on the kind of problems the singer is facing. Particularly with the case of nodules. If they’re left untreated, they can go from soft and pliable to hard and fibrous. Once they become hard and fibrous, they need to be removed surgically. Other types of lesions, like polyps or cysts, can be improved with therapy, but sometimes they need to be removed. And unfortunately, when you do any kind of removal, you also run the risk of leaving scar tissue.

How do these sorts of injuries affect performers vocal abilities going forward?

It depends on the nature of the damage. Sometimes it affects their vocal abilities and sometimes it doesn’t. Interestingly, if a performer did not have fantastic technique before they experienced a problem, when they rehabilitate, they often find that their voice is actually in better shape than it had been previously. You’d be surprised by how many singers I work with who’ve told me their voice injury is actually one of the best things that’s ever happened to them because it forced them to learn how to look after themselves and use better technique.

There are actually many factors that contribute to a voice deteriorating over time. Lifestyle, environmental things, mental health—which is a huge issue in the performing arts community—etc.

Can you elaborate a little more on that last point? How is it that mental health impacts the vocal health of performers?

It has a huge impact! There’s actually a lot of science to back it up, even though it sounds slightly nebulous. The vocal mechanism is highly susceptible to stress and emotion, and that’s because our voice muscles have two big motorways that go into the brain. One goes into fine motor control and the other goes right into the middle of the emotional system.

We know this, experientially, because if we do feel stress or we do become emotional, we often feel a lump in our throat. And that lump we feel is localized muscle tension. It can cause the voice to become quite rigid and inflexible, which means things will not vibrate as freely, ultimately increasing inflammation. Thus, looking after your mental health, having good emotional support, and having access to a good psychotherapist, are also integral components of keeping artists in good performing condition.

In your experience, what percentage of performers typically adopt anywhere near this level of precautionary care?

The majority of [artists] who have a problem do because it can often be a make or break career situation. Unfortunately, it often takes a crisis to create an athlete.

In an ideal world, the singer wouldn’t end up with a problem in the first place, because they would be well educated on things like vocal hygiene, how they should be using their voice, etc. Unfortunately, most singers—particularly in the contemporary singing industry—don’t learn these things until they experience a problem.