Vocal Cord Dysfunction (long, but important post for swimmers who suffer)

I got a surprise phone call from a resourceful swim mom seeking help for her 16-year-old daugther, who suffers from Vocal Cord Dysfunction. Her mother googled enough to find my article online.

Vocal Cord Dysfunction, simply and quickly, is a breathing disorder where the vocal cords close off partially when they should be open and so restrict air on the inhale, inhibiting a full inhale and often producing a high whistle as air squeezes through the tight space to get to the lungs.

This woman's daughter fits the typical profile; she's an overacheiver (in other words, one who strives to do the best she can in everything and usually excels), she's female, and she tries to use her will to deal with her disorder.

I know what it's like. I've been there. I fit that profile, too, and I swam in practice and races struggling for air, making loud whistling noises that pierced across the long course pool clear to the other side, and worried many people I wished would just ignore it. I simply wanted to work hard and swim fast...and not worry about if I was going to have enough air to finish the race. My worst memory of it was taking out my 200 meter freestyle in a championship final exactly where I wanted to, a blazing 1:01 for the 1st 100, and then instead of my typical 2-3 second split difference between the 100's, I ran out of air going into the second 100 and fell off my pace to a 1:11. Anyone watching might have thought I gave up or choked under pressure, but those who knew me saw my purple shoulders and blue lips. This is the worst, because the finals of a championships is where an overachiever performs, where all that hard work pays off. So this memory hurts worse emotionally than the times I had to be pulled out of practice, swim sets slower than I wanted to, passed out while swimming, and generally gasped for air every stroke of the way.

There's no telling when episodes are going to hit, though they are frequently worse around the time of a woman's menstrual cycle. I say this with confidence, though I have never seen research to substantiate it, because I kept a journal every day of my swimming career and recorded such information. The data lends evidence to the theory, and the mother who called said she definately noticed the same pattern. So much so, that as irregular as her daughter's menstrual cycle is as a young lady, her difficulty breathing can predict its onset. I hypothesized that the reason for this is the tightening of muscles (especially in thin, fit young athletes) during this period also tightens the vocal cords. This mother shared my theory with a voice doctor in her area, and he gave credence to the idea, saying it makes sense to him since the larynx (vocal cords) hold more fluid during a woman's menstrual cycle. If I had the subjects, I would be interested in researching this. Perhaps he will.

Although my article gives many good ideas for management, there are a few I have thought of that are not mentioned:

1. Swimmers are trained to automatically hold their breath or blow out underwater. When having trouble, it can help to do a 50 or so (it sometimes takes a 400) of under/overs using the lane line and concentrating on exhaling fully underwater and relaxing the neck and shoulders. Going underwater facilitates blowing out by counteracting the tendency to hyperventilate when out of air (which, in this case, only tightens the opening more).
2. Exhale fully! When swimming, all the time, exhale immediately after taking a breath. This is probably not the way you usually swim - breath, hold, exhale, breath - but it will help get all the air out and relax the cords for a better inhale. Swimmers, cut out holding your breath!
3. Use a front-mounted snorkel to promote smoothe inhale and exhale without holding your breath. This can help a swimmer keep practicing during a mild episode. Have her use the snorkel even if all the other swimmers are not using one.
4. Mentioned in my article is the importance of keeping the neck in line with the spine (top of the head forward, not eyes). The snorkel is meant to help learn this position.
5. The coach needs to spend time analyzing and looking at the breathing, body alignment, muscle use (neck, chest, shoulders, jaw, traps) while the swimmer is swimming. Swimmers need to learn to focus on relaxing the throat and jaw especially during back and fly, and the shoulders and neck during free (jaw as well, but not as much as in back and fly).
6. When in an episode, a swimmer can relax by lying down and lifting the rib cage to open the lungs. Maybe roll up a towel and lie with the roll width-wise just under the shoulder blades.
7. If running or otherwise out of the water, the athlete may want to stand up during recovery to open the lungs. However, if she is dizzy, it may be better to hunch over. I recommend lying down or, if in the water, doing under/overs and bobs for recovery.
8. The coach may need to watch for when to pull the swimmer out. The reason for this is that the typical stricken swimmer is one who will keep going no matter what, one who is determined to fight through the pain. Stopping will feel like giving up. Swimmers with VCD are not often the weak ones who stop at any excuse. So giving her encouragement, but making her stop when it is bad may be necessary.
9. Upon cessation of the exercise, the symptoms will clear up on their own. The duration of the symptoms varies. Unfortunately, once the symptoms start in an exercise session, they rarely go away, so when the swimmer tries to resume exercising, the symptoms will likely return.
10. Sets may need to be modified. Fins (with a snorkel) can be helpful in giving the swimmer a feel for speed. Broken distances are probably the most effective way to train (i.e. 200's broken at the 50 for 5 seconds or at the 75, 75, and 50 for 5 or 10 seconds). Sprints or fast swimming might require more recovery time to regain breath control (symptom recovery) before the next sprint. Sets with varied strokes can help. Fast swimming mixed with kicking might help. Just kick on your back rather than with a board. Kicking with a board puts the neck in a crooked position that makes it harder to breathe.
11. Don't panic! Panicing excites the sympathetic nervous system - the "fight or flight" response. That means it speeds up the heart rate and...increases respiration due to a need for more oxygen. Those with VCD are already short of breath and short on oxygen. Panic compounds the issue. As scary as it is when the throat closes and there is not enough air, those with VCD must learn to remain calm and have confidence that the cords will open again.
12. Try not to cry. This is an emotional, hard thing to deal with, but crying makes it harder to breathe.

The 16-year-old whom I got the call about has VCD so bad that she has had to quit swimming for a month while her mother seeks advice from anyone she can find. Speech therapists, through recommended in the literature, are baffled by this, as she confirmed. She did get some interesting hope from a doctor who suggested Botox injected directly into her vocal cords. I looked into this, and apparently it is used for treating spasmodic dysphonia rather than VCD. However, on principle it looks promising, and it is not used for VCD only because VCD is not considered as severe. That's not the case when it comes to competitive swimmers. If I get an update, I will share. Until then, I sure hope this young lady finds a successful way to manage her symptoms, if not a cure!