The research has been conducted by academics from Bishop Grosseteste University, UK; Birkbeck, University of London, UK and Bowling Green State University, Ohio, USA.

Joint hypermobility describes a condition in which joints move beyond a typical range of motion and it estimated that 1 in 500 people have Hypermobile Spectrum Disorder (HSD) or Hypermobile Ehlers-Danlos Syndrome (h-EDS), with females being disproportionately affected.

Symptoms of both disorders include joint instability, joint dislocations, partial joint dislocations (subluxations), early osteoarthritis, weak muscles, stretchy and fragile skin, and widespread pain. Diagnosis requires assessment of nine joints (knees, elbows, little fingers, thumb to wrist and lower back); however, any joint or collagen-based tissue in the body including the vocal tract can potentially be affected.

Hypermobility may be more prevalent in musicians and performers as the condition can be an asset as well as a liability. Singers with hypermobility disorders may have a higher vocal dexterity or range, with many participants describing their voices as having beneficial qualities such as an unusual or interesting tone, enhanced flexibility or a wide range for singing and speaking. However, singing across their full range or in specific parts could trigger symptoms of voice dysfunction.

Most participants had no medically confirmed explanations for their vocal difficulties, but some had received confirmation of organic voice issues such as vocal polyps, oedema, vocal ulcers and vocal folds that failed to close fully, as well as functional disorders such as vocal cord disfunction.

Due to the lack of diagnosis for most singers, many participants reported they struggled to get support from medical professionals and vocal coaches, with their difficulties in performing attributed to anxiety, poor vocal technique, the effort of social interaction or a virus.

Singers in the study described the unpredictability of their symptoms as being the most problematic, with participants describing difficulties in accessing their full range, transitioning between registers, producing and sustaining a desired pitch and achieving power of volume. For many, this resultedin them stopping singing, or pushing themselves beyond their limit.

Hypermobility related health conditions such as fatigue, lack of strength and associated health conditions also negatively affected participants’ abilities to sing and perform. Thisimpacted their professional and personal opportunities, communication, relationships and wellbeing, which often led to a feeling of ‘profound loss’ for participants who had lost their singing voice or singing potential.

Dr Tracy Jeffery, Senior Lecturer in Special Educational Needs and Inclusion at Bishop Grosseteste University, said: “Most of the participants (95%) in this study told us they still enjoy singing, but nearly three-quarters (74.6%) reported that they experience voice difficulties. For many of our participants, their struggles to understand and find solutions to unpredictable voice disorders were as debilitating as their voice difficulties and other health needs.

“Our findings show that singers with HSD and h-ESD may be at increased risk of voice difficulties and early assessment and tailored support are paramount to reducing the impact it can have.

“More awareness needs to be raised about hypermobility and voice issues amongst health care providers, music teachers and training schools, with intervention tailored and family centred. Singers and their vocal coaches may need to make necessary pragmatic adaptions during training, rehearsal and performance to offer further support.”

The full research article, published in Journal of Voice, can be viewed online until 17 February 2022 at:

19th January 2022