Two Paths In Voice Therapy: Manual Therapy and Resonance
Author: Jesse Nerenberg, Reg. CASLPO, Speech-Language Pathologist
Date: Wednesday, September 17, 2025
Table of Contents
Introduction: Two Paths in Voice Therapy
When people think about voice therapy, they often imagine exercises that train the voice directly. While that is certainly one approach, voice therapy can also involve working with the body itself to release tension. This can involve improving posture, and directly releasing muscle tension, to create the right conditions for the voice to function more freely. As a speech-language pathologist (SLP) at Well Said, I often combine different strategies depending on the needs of the individual voice client. Two of the most well-studied and widely used approaches are manual therapy and resonant voice therapy (as well as conversation training therapy, also known at CTT).
Although these approaches may sound very different, they both aim toward the same outcome: helping people use their voices with more efficiency and less effort. Understanding the differences and similarities between them can help clients know what to expect in therapy.
Manual Therapy in Voice Care
Manual therapy refers to hands-on techniques that target the muscles and tissues involved in voice production. In some clinical settings, an SLP trained in this area might use gentle massage or stretching to release tension in the neck, jaw, larynx (voice box), and surrounding muscles. As a clinician who works virtually, the good news is that manual therapy can also be taught in that setting. In those cases, the SLP will guide the client in learning self-massage techniques. This allows the client to work with their own body, developing awareness of where tension sits and how to reduce it. The other advantage to this approach is that in self-massage the client can feel comfortable with how much or little pressure they apply.
The underlying idea is that the muscles around the larynx and jaw often hold more tension than we realize. This tension can interfere with the natural vibration of the vocal folds and create a voice that feels tight or pressed. Clients may notice symptoms such as soreness after speaking, a feeling of effort in the throat, or even pain that radiates up toward the jaw or down toward the chest. Manual therapy seeks to address these physical restrictions directly, rather than focusing only on sound.
A typical manual therapy session might begin with gentle stretches or guided breathing to help the client tune into their body. The clinician may then demonstrate how to use the fingers to massage the muscles just below the chin or along the sides of the larynx. Pressure is often gentle and is applied with the goal of softening tight muscles, not forcing them. Over time, clients often report that their voice feels freer and that the sensation of effort in the throat decreases. I have seen a client with Muscle Tension Dysphonia reduce the hoarseness in their voice after a session of manual therapy.
Self-massage has the added benefit of giving clients a tool they can use at home. When tension builds up after a long day of meetings or speaking, a short self-massage routine can restore comfort. This makes manual therapy not just a technique for the clinic, but a skill for daily life.
Resonant Voice Therapy and CTT
While manual therapy focuses on the physical muscles of the voice system, resonant voice therapy focuses on how sound is produced and shaped. Resonant therapy helps clients find a way of speaking that feels easy and clear. This is often described as having a "forward focus." This means that instead of feeling vibration mainly in the throat, clients learn to feel resonance in the mouth, lips, and face.
CTT, or conversation training therapy, is a structured version of resonant voice therapy. It uses everyday conversation as the main practice context, rather than isolated sounds or exercises. The idea is that clients should practice their healthiest voice in the situations that matter most, such as chatting with friends or family, speaking in meetings, or making phone calls.
In a session, I might guide a client through simple exercises to bring awareness to vibration in the lips or front of the mouth. Humming, chanting, or speaking short phrases can all help clients feel how their voice resonates when it is produced with less throat effort. Once that sensation is found, I encourage the client to carry it into longer sentences and eventually into free conversation.
The benefit of resonant therapy is that it trains the voice directly, helping clients experience a more efficient and less effortful way of speaking. Over time, this practice can reduce strain and increase stamina. Clients often describe it as learning to "let the voice out" rather than "push the voice out."
Comparing the Two Approaches
Both manual therapy and resonant voice therapy address the same problem from different angles. Manual therapy works outside-in, beginning with the muscles and structures that can restrict voice function. Resonant therapy works inside-out, beginning with the sound itself and training the system to produce voice in a more efficient way.
For some clients, manual therapy provides the key breakthrough. If muscles are so tight that they restrict vibration, no amount of resonant training will feel easy until that tension is released. For others, resonance work is the central piece. If the voice has developed habits of strain or pressed phonation, learning a new way of producing sound can transform comfort and endurance.
In practice, many clients benefit from a blend of both. Sometimes, I might begin with manual therapy to loosen tight muscles, then shift into resonance exercises once the voice feels freer. Or therapy might alternate between the two approaches depending on how the client’s voice feels on a given day. The combination allows for flexibility, ensuring that both the physical and functional aspects of voice are addressed. I recently used this approach with a client who had developed hoarseness due to muscle tension dysphonia (which had been impacting her voice for months).
What Clients Can Expect in Therapy
Clients sometimes wonder whether one approach is "better" than the other. The answer depends on the individual.
During manual therapy sessions, clients can expect to spend time learning about anatomy, practicing gentle self-massage, and noticing changes in comfort and ease. Progress may feel immediate, such as a release of tension after massage, but long-term benefits come from consistent practice and awareness.
During resonant voice sessions, clients can expect to spend time experimenting with sound. They may hum, chant, or speak simple words while paying close attention to sensations of vibration and ease. Therapy gradually builds toward real conversation, so that new voice patterns become part of daily communication. Progress may be gradual, but the long-term goal is for the healthy voice to become automatic.
Advantages of Manual Therapy
One of the strongest advantages of manual therapy is that it gives clients a direct way to release tension. Many people with voice difficulties have been told to "just relax" or "try not to strain," but without specific techniques those instructions can feel vague. Manual therapy offers concrete steps to identify where tension is and how to reduce it. As well, it is something you can physically feel.
It also promotes body awareness. Clients begin to notice patterns in their daily lives that contribute to voice strain, such as clenching the jaw, hunching the shoulders, or holding the breath. With awareness comes the possibility of change, and many clients find that their overall physical comfort improves along with their voice.
Advantages of Resonant Voice Therapy
Resonant voice therapy has the advantage of being directly connected to the act of speaking. Clients learn how to produce sound in a way that feels effortless, and they practice it in the exact contexts where they will use it. This makes transfer from therapy room to daily life smoother. CTT is especially good for this.
It also gives clients a positive model of what a healthy voice feels like. This positive focus can be motivating, because it is not only about avoiding discomfort but also about discovering a voice that feels good to use.
How the Two Work Together
Manual therapy and resonant therapy are not competing options, but complementary. Think of manual therapy as preparing the soil and resonant therapy as planting and growing the seeds. Manual therapy clears away restrictions and creates the conditions for healthy sound, while resonant therapy establishes the actual patterns of healthy sound production. By combining manual release with resonance training, therapy can address both root causes. Clients gain tools for immediate relief as well as long-term strategies for lasting change.
Looking Ahead
Voice therapy is not one-size-fits-all. Each client brings unique goals and challenges. Some may need more focus on manual release, while others may thrive with resonance training. Often, the most effective plan is one that draws from both. With the support of an SLP, clients can discover which techniques resonate most for them (pun intended!) and build a toolkit that supports their voice for years to come.
To speak with a psychotherapist or one of the speech-language pathologists at Well Said: Toronto Speech Therapy, schedule an initial consultation by clicking the link below or calling (647) 795-5277.
