A 25 year old singer on a health journey (documented on YouTube)

General
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Hi all,

First of all thank you for creating and maintaining this site as I also thought I was going a bit crazy, whilst a lot of family, friends, colleagues, health professionals doubted my symptoms too. Some validation is nice every once in a while, as it’s so exhausting and people can’t seem to understand how it can take all of your time, energy, and money to figure out what the heck is wrong with your body.

9 years ago as a 16-year old I fractured my right shoulder in a sporting injury. Then a couple of years later I also had a minor whiplash injury from a car accident. Whilst both incidents were painful (especially the first one) I quickly healed and moved on from both incidents. At the same time ever since this my right shoulder has hung lower than my left and my neck has naturally compensated as a result. I also became a terrible mouth breather with a narrow hard palette.

Fast forward another three years and I decide to become a singer-songwriter, I had trained to sing in mixed voice with heaps of resonance, but I noticed I had a much harder time of things than almost everyone. It was also my speaking voice, I couldn’t be heard in loud environments and even shouting wasn’t easy.

I went down all the acid reflux treatments and diets etc, same with allergy testing, massage, acupuncture, breathwork coach, osteopath, visceral osteopath, cranial osteopath, holistic dentist, ENTs, chiros, sports medicine consultants etc, tried yoga, freediving. Also went to my to multiple speech therapists and professional singers for coaching (including different styles i.e. opera & pop-rock). All my money, time, and energy has been spent on figuring this out. You can also see my journey on YouTube which shows me figuring out all this stuff!

As my journey has gone on it’s become less about singing and more about just waking up without a sore throat every morning. I’ve got tightness all around my jaw, my neck, my pecks, discomfort in my large intestine, sinus problems, feeling of something stuck in the throat, headaches, fatigue, not to mention stress from the depression and anxiety that comes from all of this. I also struggle to breathe deeply (despite consistent training) and always seem to be in a sympathetic (fight-or-flight) state.

I was introduced to the concept of eagle syndrome recently by a sports medicine practitioner (Dr Stephan Praet) here in Australia who does Prolotherapy as I came across Caring Medical’s videos on YouTube and thought I would give it a try.

I should also mention that I have had 2 surgeries on my nose (1st one in 2019: deviated septum, 2nd one in 2022: inferior turbinate reduction) and also a tongue tie and lower lip tie release. I also am wearing an ALF appliance which is helping to align my jaw properly (this has been by far the biggest help on my journey so far). In terms of signing specifically, a tight jaw is one of the worst culprits, so at least I’m seeing some improvement there.

The Prolotherapy after one session did help to release tightness in the tongue, so I think it would be worth going for a 2nd session.

My styloids are not elongated, but they are slightly retroverted, and I’ve got heavy compression on right and left jugular vein (as noted by radiologist Dr Malcolm Thompson). I saw Dr Michael Elliot in Sydney but he didn’t want to operate as he wasn’t convinced it would help and was too risky as could impact nerves and ultimately wreck my singing career (if I’m to actually have one). He did agree that jugular vein was compressed significantly on both sides, and thankfully didn’t dismiss my symptoms.

He has suggested a brain surgeon who deals with whiplash injuries to see if there’s anything he can do.

I have just come across Atlas Orthogonal as a chiropractic treatment for internal jugular vein (IJV) compression. Have booked in for a session at New Lambton Family Chiropractic as they seem to have brilliant reviews and use proper equipment for their work, rather than just their hands. And they do x-rays onsite.

I would be interested to know if you would think that would help me as I do feel I’m getting very close to the answer I’m looking for.

Thanks all, once again I’m very grateful for the opportunity to share my story and be heard.

God bless.

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One of the first thoughts from my side, try to get ultrasound Doppler examination of all the vascular system in the neck, including arteries and veins. Compressed IJVs might be symptomatic, but also some people don’t get significant symptoms even with compressed or one of the IJVs missing (esp. after specific surgeries, or congenitally). So it’s not always the absolute criteria to do the surgery.

However, I’m a bit surprised that AProf Elliot dismissed your case. Care to share the images indicating the compression?

As for the slightly (?) sagging right shoulder - from what I hear from physiotherapists, it’s extremely common to have one shoulder slightly lower, usually the dominant one. But obviously that could be a pathological reason, especially if you were into sports and fit in general, so that could be another area worth checking.

Have you had cervical (neck) MRI done? Any signs of degenerative changes, esp. on one side (bulging disc, osteophytes, facet joint arthropathy, Luschka/uncovertebral joint hypertrophy (https://www.physio-pedia.com/Uncovertebral_Joints) ?

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I will gladly look into the suggestions above, thank you for taking the time to respond. I had a CT and MRI done recently in Canberra which is how they discovered the IJV compression.

I should probably also mention this from Dr Elliot’s report: “there is significant compression of both internal jugular veins at the C1 transverse process level”.

If it’s at the C1, then that’s where the Atlas Orthogonal instrument could potentially come in handy?

Am also booked in to see another chiro for his opinion, as he’s got outstanding reviews. Will let you know what he says as well.

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I’m not sure if they mentioned, but did the report (MRI most likely) had anything about CXA or “clivoaxial angle”? Now that I think, the whiplash could have affected how the skull sits on the spine (basically cranium’s position on the first vertebrae, C1). That’s where significant amount of flexion occurs (I posted it earlier on the other thread about how much statistically the C0/C1 segment flexes/extends: List of my favourite resources on YouTube to learn anatomy - #76 by vdm ). I am not sure (yet) if that’s the mechanism, but I suspect that in some cases this craniocervical junction gets affected and “stuck” (or partially stuck losing range of motion). Maybe, just maybe, in your case it got “stuck” in the “flexed” position and that’s why the normal length styloid processes could now compress the IJVs.

As for the chiropractors… It’s everyone’s personal choice. Some swear by them, and claim they saved their lives. I personally am extremely sceptic as there are enough of horror stories when people get strokes, develop craniocervical instabilities and other life-damaging conditions. One of the things to be aware of, chiropractic manipulations can cause not only vertebral artery dissections (in typical “unfortunate” cases), but also internal carotid dissections (in cases with elongated styloid processes).

Perhaps nobody had run a study on possible IJV damage caused by chiros, as that’s very likely is way less symptomatic than arterial dissection, thus any weird symptoms after the manipulations could be brushed under the carpet by saying “detoxification” or some other obscurity.

Ah, what’s so special about CXA:

Basically it is the angle between one specific landmark in skull and the odontoid (part of the second vertebra, C2). It can help to indicate potential brainstem compression, happening either due to injury or craniocervical instability.

Also by comparing how much CXA changes between flexion/extension (often can be measured on plane x-rays, though flexion/extension MRI in upright position is much more accurate), one can predict whether the C0-C1 junction is properly working, too loose, too tight etc.

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No it didn’t mention that, but also they weren’t necessarily looking for it.

I have long had a forward head posture with limited range of motion, especially to the right.

I am most definitely skeptic of chriopractors as have had bad experiences in the past, but also I guess what choice do I have but keep searching for a brilliant one.

I feel like I’m armed with more information under my belt so am better equipped for their questions this time around.

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I guess someone else can comment more on the remaining aspects of your case, especially how the styloids might affect the voice etc.

But as for chiros… I’d say, avoiding any sort of neck manipulation with the styloids compressing the IJVs might be the best (though I’m not a doctor so my advice isn’t necessarily perfect). Think of that like this: any forceful rapid motion beyond the range the body has, means some soft tissue has to give up. When it’s stretched slowly, multiple times, over the time the tissue remodels itself (My Favourite List of Research/Educational Resources). But when the rapid, sudden manipulation is performed pushing some joint beyond the range, it means something may break. And that could be anything from microtears in tendons, membranes, ligaments, or in your case the styloid processes might completely crush the veins. Not trying to say it will happen, but it’s very heartbreaking to read all the stories on various patient support groups where people develop neck instabilities after chiro manipulations… Neck instability is something I don’t wish anyone to acquire.

Also read this:

Ah, I missed this one:

Perhaps. But not necessarily.

I’ve heard some success stories of people getting help from atlas orthogonal chiropractors.

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Completely agree that those high-energy, forceful manipulations in that area should always be avoided, even without having styloid and IJV problems. I think mentioning people having great success with adjustments are going to chiropractors that are using non-forceful techniques without popping and cracking. They use more gentle methods and sometimes devices like vibrating ones, but that is only secondhand information as I’ve never been there myself. These specialized chiropractors are called NUCCA or another subtype, atlas orthogonal (as Raphael already mentioned) chiropractors. But to be sure you will need to have a talk beforehand what he is exactly doing.

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Noted, I’ll be sure to not allow for any sudden adjustments due to the dangers outlined in the above posts. The atlas orthogonal itself is meant to be a somewhat gentle adjustment. They also do X-rays onsite as aforementioned which tells me they’ll be very precise, and probably can’t be classed as dodgy chiropractors.

The actual vocal cords are fine but it’s more the extremely tight jaw and the sense that something is stuck in the throat at all times. Also always getting sore throats which makes for some discomfort - I imagine potentially from reflux due to a heightened sympathetic state which messes with my digestion. Additionally, the inability to use my full breath capacity makes a tremendous difference when speaking and singing.

It will be like every once in a while everything works as God intended and I can sing effortlessly throughout my whole range, but the rest of the time I’m so tight and tender everywhere. So I know for sure that my body shouldn’t be behaving in this way.

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I do think you are on the right track regarding your symptoms. I also experience voice changes (but I don’t sing, which is probably better). On some days, my voice is much clearer, and on some days, it’s more fragile. I am also pretty convinced that my cervical spine/styloid/hyoid region is to blame, and that posture plays a big role. You also mentioned that you have or had forward head posture, and that can also play a role in your voice. Being mindful of your posture is probably not only good for your voice but also for potential jugular vein compression problems. Also, the heightened sympathetic state probably also influences it, as I could bet on it, you probably need to have a relaxed voice for good vocal control.
By the way, you mentioned that your journey is documented on YouTube, but I didn’t see any link or name. Did you share it anywhere here already?

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Absolutely, I know there’s a big difference when I’m in a state for singing (extremely loose and relaxed) and during 99% of the time when everything is super active and tight. Not sure if I mentioned, but swallowing is also difficult in the sense that there always feels like there’s something I can’t quite swallow down. In the immediate aftermath of my tongue tie release swallowing was significantly easier, and singing easier as a result, but that was quite temporary and swiftly came and went.

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@komok’s point about the posture is very valid, from what I more and more learn/experiment on myself.

Also the fact you mentioned about the jaw appliance helping a lot, may suggest that it might be a bit multidimensional issue.

Might be worth getting TMJ MRI (specialised protocol with jaw open, closed) and see if there are no issues with the TMJ and its motion.

A while ago I was quite “on the fence” if not completely sceptical about the connection between the jaw issues and neck stability, but after reading more and more, also experimenting on myself, I started to strongly lean towards the possibility of jaw playing some role in neck’s stability. Clenching the jaw contributes to immobilisation of the neck, and if the jaw is uneven or some other problems occur, I think it’s logical that this motion, repeated hundreds of not thousands times every day, eventually may shift neck muscles out of balance as they are trying to counterbalance the neck to the opposite side than the uneven jaw muscles pull (perhaps with platysma muscle playing quite a role).

That’s quite an observation. From the muscular perspective, there are two ways of breathing. Diaphragmatic and rib-cage. Ideally, taking a deep breath makes diaphragm to go down, thus making more space at the lower part of the ribcage, and the first/second ribs to go up (scalene muscles do that) so that the ribcage expands from the upper part too and lungs can fully expand. Exhaling does opposite.
If diaphragm can’t move properly (contract/relax) or scalene muscles can move properly, the breathing isn’t “full”. But this can happen due to many reasons… If there are any issues with phrenic nerve (C3-C5), the diaphragm can be affected. Meanwhile, scalene muscles are controlled by a bunch of nerve fibres coming from everywhere between C3 and C8.

So incorrect posture and other neck-related issues obviously may affect the breathing, and not always, but only at those times when the nerve is, for example, impinged. You change the posture, the neck vertebrae move, and the nerve might be released - and after a while, recover.

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I’m trying to add a link for YouTube but can’t seem to post it here as website not letting me put links in the post.

Definitely a diaphragm c3 issue in there, I remember going to a kinesiologist who by applying pressure only to that part on my neck managed to ‘activate’ my diaphragm and I could suddenly take bigger breaths. (Again a temporary, but noticeable help).

As some of the other singers on this forum have alluded to, it’s easy to tell instinctively when there’s something wrong with your instrument. I know the difference between when it’s an issue of technique or when there’s something actually impeding your ability to make good quality sound.

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@RaphaelPitys - I don’t think this has been mentioned yet & maybe you already know this - the vagus nerve is one of the nerves often irritated by ES. It’s the largest & most comprehensive in what it helps control in the body. Among the things it influences are gastrointestinal function, breathing, vocalization, heart rate, blood pressure, body temperature control, & anxiety levels. It’s possible that once your styloid(s) is/are removed (hopefully the neurosurgeon is willing to do that surgery for you), you may notice improvement of many if not all of the symptoms that are vagus nerve related.

I don’t know why our system didn’t upgrade your account once you posted, but I just did it manually. You should be able to post your YouTube link now.

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@RaphaelPitys you might find a discussion one of our ‘older’ members started @MusicGeek a while back, as she was a professional singer, here’s a link:
Are there any saxophonist or wind musicians out there? - General - Living with Eagle
She also posted somewhere on here about an article written by a professor who lost her voice due to ES, I can’t find MusicGeek’s post about that, but I think this is the article:
Hours after a massage, a professor was wildly dizzy and deaf in one ear - The Washington Post
The others have given you good info about chiropractors, so I won’t comment on that, just to say that the research paper @vdm posted a link to was written by one of our members so worth a read.

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Here is my YouTube: https://youtube.com/@raphpitts?si=ICo4iDDU-ZJTTWuk where I document my health journey - have come a long way since the start, that’s for sure.

Thank you for the above suggestions - I think given the expertise of Dr Michael Elliot who deals specifically with styloids, I’m probably best placed to stay away from surgery, though definitely happy to still consider it should another ENT suggest otherwise.

I have just had a first appointment with chiropractor and network care specialist Dr. Euan McMillan from WellWellWellSydney. He very quickly established that my body is in a perpetual fight or flight state (as I’ve long suspected) and that everything is sort of bunched together, with C1 tilted to the right and C2 tilted to the left (which explains the compression at the internal jugular vein. Rather amazingly, he is actually a singer himself so I feel like I’m in very good hands. (See diagram - everything marked is what’s wrong with my body!)

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IMG_62983024×4032 3.81 MB

I don’t suppose anyone here has had success with network spine/network care treatment, because that’s how he’s intending to sort me out. The basic premise is that your body starts to unwind and heal itself once I come out of my fight or flight (sympathetic) state. Who knows how many session it will take to sort that out, but I guess I’m here for life so may as well get started with it. First adjustment is tomorrow.

Thank you for your continued support guys, it really means a lot.

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It’s great you got through assessment, and if this type/style of chiropractic adjustments is more like a physiotherapeutical stretch/strengthening, it might be helpful to stretch the muscles.

Just, as always I say, be extra careful.

If you feel any dizziness, increased or new ringing in the ears/tinnitus, feeling “drunk”, “disoriented”, “lost” or confused afterwards, develop any new weird problems - don’t wait a blink, go to the emergency room. It very well might be not “toxins leaving the body” as many chiropractors like to say, but much more serious condition. Any delays may lead to irreversible changes in brain, mild or serious.

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No, it’s not a case of just do stretches - I’ve already been there and done that many times with different chiros and osteopaths etc. Network spinal is a different type of treatment. Very skeptical, but he has convinced me this type of treatment will sort me out. I’m too far in to think it’s something as simple as stretching that will do the trick for me.

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