Stage Fright (Performance Anxiety) and the effect on Vocal Muscles

Stage Fright (Performance Anxiety) and the effect on Vocal Muscles

Sweaty palms, racing heart, dilated pupils, shaky voice… performance anxiety is about as common as performance itself. 

For professional speakers, singers, and actors, performance anxiety is crippling to their craft and livelihood. Using a “get over it” mentality has resulted in artists resorting to rituals (i.e. teas, elixirs, etc), alcohol, or drugs to tame this reaction. Newer research helps us understand performance anxiety as a physiological, uncontrollable, and repetitive condition that must be approached with more empathy and a deliberate, holistic approach.

What is stage fright?

Performance anxiety, or stage fright, is an occurrence where a rush of adrenaline in anticipation of a stressful event (in this case performance) results in symptoms. These symptoms make performance harder but are grounded in human physiology as part of the “fight or flight” response that helps us avoid danger. Symptoms include:

  • Dry mouth
  • Sweating
  • Dizziness
  • Elevated heart rate
  • Shortness of breath
  • Gastrointestinal activation (vomiting and diarrhea)1-3

…in all, not a great experience going into a performance. No wonder so many performers dread live performance. Newer research adds to this list of symptoms, demonstrating a previously underestimated effect: laryngeal tension.

What does this mean?

It means that vocal performers experience tightness in the muscles they need to perform, resulting in less vocal control and function. Performance is more difficult and more prone to vocal error, leading to more stress and more tightness. This entraps the performer in a vicious cycle where they don’t perform their best due to muscular tension from anxiety and stress. They then fear their next performance will be bad. This produces anxiety and stress about the next performance. The muscle reactions are then triggered, which make the next performance more likely to go poorly. This cycle just repeats itself.

Laryngeal muscle tension

Larynx and vocal muscle tension occur as a result of performance anxiety. Muscular tension and ligament tightening occur around the larynx. The vocal apparatus can become “misaligned” with imbalances and loss of flexibility. This often produces vocal fatigue, inefficiency, and loss of range. 

A new study found that:

  • laryngeal muscles tighten and contract in response to stress
  • vocal muscle activity remains elevated even after heart rate returns to normal4

This means that even if the stress response decreases and the artist’s heart rate returns to normal, their vocal muscles remain tight.

Implications for Performance and Beyond

  • Unless stage fright is addressed, the performer will never be able to access their best voice during performance.
  • Tight laryngeal muscles must be addressed after performance because the tightness will likely persist and affect the next performance.
  • Manual therapy techniques to address laryngeal tension are important to include in a post-performance cooldown.

Manual therapy techniques should include whole body work, to fully reset the muscular tension that can be affecting performance. However, for a “quick fix” a laryngeal manipulation session can be helpful to ease the tension in the muscles and resolve pain. We will summarize more of the literature regarding strategies for dealing with stage fright in our next article.




  1. Gates G, Saegert J,Wilson N, Johnson L, Shepherd A, Hearne E III. Effect of beta blockade on singing performance. Ann Otol Rhinol Laryngol. 1985;94:570-574.
  2. Cirigliano M, Lynn L. Diagnosis and treatment of stage fright. Hosp Pract.1992;27:58-62.
  3. Gates G, Montalbo P. The effect of low-dose beta-adrenergic blockade on performance anxiety in singers. J Voice. 1987;1:105-108.
  4. Helou LB; Wang W; Ashmore R; Rosen C; Verdolini Abbott K. Intrinsic Laryngeal Muscle Activity in Response to Autonomic Nervous System Activation. Laryngoscope 123: November 2013: 2756-2765