MD, PhD, FMedSci, FSB, FRCP, FRCPEd

In the realm of alternative medicine, we encounter many therapeutic claims that beggar belief. This is true for most modalities but perhaps for none more than chiropractic. Many chiropractors still adhere to Palmer’s gospel of the ‘inate’, ‘subluxation’ etc. and thus they believe that their ‘adjustments’ are a cure all. Readers of this blog will know all that, of course, but even they might be surprised by the notion that a chiropractic adjustment improves the voice of a choir singer.

This, however, is precisely the ‘hypothesis’ that was recently submitted to an RCT. To be precise, the study investigated the effect of spinal manipulative therapy (SMT) on the singing voice of male individuals.

Twenty-nine subjects were selected among male members of a local choir. Participants were randomly assigned to two groups: (A) a single session of chiropractic SMT and (B) a single session of non-therapeutic transcutaneous electrical nerve stimulation (TENS). Recordings of the singing voice of each participant were taken immediately before and after the procedures. After a 14-day wash-out period, procedures were switched between groups: participants who underwent SMT on the first occasion were now subjected to TENS and vice versa. Recordings were assessed via perceptual audio and acoustic evaluations. The same recording segment of each participant was selected. Perceptual audio evaluation was performed by a specialist panel (SP). Recordings of each participant were randomly presented thus making the SP blind to intervention type and recording session (before/after intervention). Recordings compiled in a randomized order were also subjected to acoustic evaluation.

No differences in the quality of the singing on perceptual audio evaluation were observed between TENS and SMT.

The authors concluded that no differences in the quality of the singing voice of asymptomatic male singers were observed on perceptual audio evaluation or acoustic evaluation after a single spinal manipulative intervention of the thoracic and cervical spine.

Laughable? Yes!

There is nevertheless an important point to be made here, I feel: some claims are just too silly to waste resources on. Or, to put it in more scientific terms, hypotheses require much more than a vague notion or hunch.

To set up, conduct and eventually publish an RCT as above requires expertise, commitment, time and money. All of this is entirely wasted, if the prior probability of a relevant result approaches zero. In the realm of alternative medicine, this is depressingly often the case. In the final analysis, this suggests that all too often research in this area achieves nothing other than giving science a bad name.

29 Responses to Chiropractic: not every crazy claim needs scientific testing

  • In a recent posting, Steve Novella also mentioned that testing quackery has also been used as an excuse for hurting lab animals:http://theness.com/neurologicablog/index.php/another-study-that-doesnt-show-how-acupuncture-works/. Is’nt this how some serial killers got their start? I know – a bit of hyperbole but I am fond of some rats. They have been experimentally shown to exhibit more empathy than most of the current crop of presidential candidates here in the US.

  • I’m surprised they would even publish such nonsense. I’d be embarrassed to have my name attached to this “study”.

  • EE, In reading your criticism, one must then conclude that you believe in the unethical practice of “publication bias”, https://en.wikipedia.org/wiki/Publication_bias

    That is great coming from a person (EE) who claims impartiality, honesty and ethical research behaviour. Just another flaw in your argument.

  • Author Information:
    1Faculty of Chiropractic., Universidade Anhembi Morumbi, São Paulo, São Paulo, Brasil.
    2Department of Otolaryngology – Medical Science Faculty of Santa Casa de São Paulo Hospital, São Paulo, São Paulo, Brazil. Electronic address: adcduprat@gmail.com.
    3Faculty of Santa Casa de São Paulo Hospital, São Paulo, São Paulo, Brasil.
    4Clinic Axis Column Clinic, São Paulo, São Paulo, Brasil.
    Hmmmmm Hospitals wasting money including specialist department! Facepalm!

  • The full articles introduction, Not the abstract states:
    “The singing voice is the result of the interaction between the
    source of the sound (the vocal folds) and the transformation
    of the sound that occurs in the resonance cavities (the region
    above the glottis, also known as filter). The intensity of the
    sound, tone, musical genre, and the interpretative style of
    each singer are determined by adjustments made to this system,
    which includes the vocal tract, sound source, and filter.1
    Muscle tension and postural changes directly relate to voice
    quality. Increased muscle tone around the neck, torso, shoulders,
    and thorax may compromise the quality of the singing
    voice.2–5 The compromise of voice quality can be partially
    explained by the action of laryngeal mechanoreceptors, which
    trigger reflex adaptations in the vocal cords when stimulated
    by minute changes in body position.2 Thus, a good posture
    and appropriate muscle tone are required for producing a voice
    of good quality, whereas excessive muscle tension during
    singing, especially around the neck, is detrimental to voice
    quality.6
    Voice quality may be influenced by several postural aspects.7
    The position of the head relative to the torso may alter the diameter
    of the pharyngeal cavity.8 The position of the head and
    cervical spine has been associated with specific voice types.
    Johnson and Skinner9 observed that singers tend to project their
    heads forward during singing, thus changing the position of the
    hyoid bone and increasing the pharyngeal space in the region of
    the third cervical vertebra (C3). Thus, maneuvers that facilitate
    those postures may improve the emission of sound.
    Several techniques such as stretching and strengthening exercises
    have been developed to modify and improve posture.2
    These techniques may be time consuming and costly and
    require appropriate physical space and materials. Chiropractic
    therapy, a relatively simple therapeutic method, may be an
    adequate alternative for improving posture and normalizing
    muscle tone before using the singing voice professionally.
    Chiropractic is a health care specialty that uses spinal manipulative
    techniques to reduce pain and motion restriction. Spinal
    manipulation is a low-amplitude high-velocity manual procedure
    aimed at vertebral segments with restricted motion whose
    main purpose is to restitute normal joint mobility. Spinal
    manipulation has been shown to increase range of motion and
    reduce muscle tension in the lumbar and cervical spine
    and pain sensitivity in previously painful areas.12 When performed
    by qualified professionals, manipulative procedures
    are simple, fast, and efficient.
    There is strong evidence of the efficacy of spinal manipulative
    therapy (SMT) for spinal pain.13,14 Physiological
    mechanisms that mediate this activity may include changes to the inflow of sensory information to the nervous system such as
    stimulation of muscle spindle afferents and Golgi tendon
    organs, increased central pain threshold, and changes in
    neural output to visceral and muscular organs.15 Chiropractic
    manipulation may also result in normalization of nociceptive
    and synesthetic reflex pathways, sympathetic activity, and muscle
    tone. Several studies have reported an immediate change in
    pain threshold, range of motion, and muscle tone after spinal
    manipulation.9,10,16 These findings show that SMT has a
    positive effect on posture and muscle tension and suggest that
    it may improve voice quality.
    A previous study has shown the effect of spinal manipulation
    and voice quality, in which a 46-year-old man with a main
    complaint of spasmodic dysphonia had voice quality improved
    after 2 weeks of treatment with manipulation of the atlantoaxial
    segment of the upper cervical spine.17 Additionally, Waddell18
    reported the case of a 25-year-old female patient who presented
    with dysfunction in the first and fifth cervical vertebrae after a
    car accident whose singing voice significantly improved after
    10 sessions of SMT.
    This study investigated the effect of SMT on the singing
    voice of 29 selected individuals among male members of the
    Heralds of the Gospel (HG), which is an international association
    of the faithful of Pontifical Right.”
    I cannot see the words “inate”, “subluxation” or “cure all” anywhere above!
    Yet you stated “This, however, is precisely the ‘hypothesis’ that was recently submitted to an RCT”.
    After reading the full article and not the abstract alone and your above blog I am less than impressed!

    • @TC,
      You have the same problem as all alt-meds; you don’t process text very well. The Prof did not say these were involved. PLEASE, read the words, think about it, and then try to process the prose in a logical manner, without reading into it something that was not said.

      “In the realm of alternative medicine, we encounter many therapeutic claims that beggar belief. This is true for most modalities but perhaps for none more than chiropractic. Many chiropractors still adhere to Palmer’s gospel of the ‘inate’, ‘subluxation’ etc. and thus they believe that their ‘adjustments’ are a cure all. Readers of this blog will know all that, of course, but even they might be surprised by the notion that a chiropractic adjustment improves the voice of a choir singer.”

      To quote you; “‘facepalm”. Seriously, you are a dill. (Prof, if that last sentence is over the top, please delete it. Nonetheless, he is a dill.)

  • To quote Edzards positioning statement AND the followed hypothisis:
    “Many chiropractors still adhere to Palmer’s gospel of the ‘inate’, ‘subluxation’ etc. and thus they believe that their ‘adjustments’ are a cure all. Readers of this blog will know all that, of course, but even they might be surprised by the notion that a chiropractic adjustment improves the voice of a choir singer.
    This, however, is precisely the ‘hypothesis’ that was recently submitted to an RCT.”
    What was said is “presisely” clear if you also quote the next line!
    I actually processed the whole article, not just the abstract and cited the full introduction to make it clear. As you can see there were two case studies that were then tested with a RCT in collaboration with experts in that field within a hospital! Good science!

    • “Readers of this blog will know all that, of course, but even they might be surprised by the notion that a chiropractic adjustment improves the voice of a choir singer.

      This, however, is precisely the ‘hypothesis’ that was recently submitted to an RCT. To be precise, the study investigated the effect of spinal manipulative therapy (SMT) on the singing voice of male individuals.”

      Right, let’s run through this again. The prof didn’t say that “‘inate’, ‘subluxation’ etc. and thus they believe that their ‘adjustments’ are a cure all” was submitted in the abstract; he said “the notion that a chiropractic adjustment improves the voice of a choir singer” was. Just because some words appear before others does not automatically link them inextricably forever. The prof was making a point about chiropractic claims and added, “Readers of this blog will know all that, of course”, and then went on to say about another absurd claim made by chiropractic.

      As I said above, alt-meds have difficulty in processing prose, so it would come as no surprise they have difficulty with the fallacy, post hoc ergo propter hoc.

      • I don’t see posture, muscle tone etc influencing voice! The full introduction is cited to give a “precise” account of what the paper set out to test and it is not “inate, subluxation and cure all”. It is called a positioning statement to frame what comes next and “This, however, is precisely the ‘hypothesis’ that was recently submitted to an RCT” to use Edzards own words!

        • “Many chiropractors still adhere to Palmer’s gospel of the ‘inate’, ‘subluxation’ etc. and thus they believe that their ‘adjustments’ are a cure all.
           
          Readers of this blog will know all that, of course, but even they might be surprised by the notion that a chiropractic adjustment improves the voice of a choir singer. This, however, is precisely the ‘hypothesis’ that was recently submitted to an RCT. To be precise, the study investigated the effect of spinal manipulative therapy (SMT) on the singing voice of male individuals.”
           
          Clearer now with the sentences spaced differently? The hypothesis is precisely the notion that a chiropractic adjustment improves the voice of a choir singer.

          • Positioned with inate, subluxation and cure all! All off an abstract without reading the full article!

          • @TC,
            I give up on you.

            If you can’t understand something so simple, I can’t see the point of engaging with you again. Both FrankO and I have tried to point out the problem with your lack of understanding, to no avail. It wasn’t a “positioning statement”; it was an introduction of the subject matter

            Is it any wonder I cannot understand the thinking of chiropractors? I had one living across the road from me for a few years and he has moved out, thankfully. He was off with the fairies too.

  • EE, you have scored an “own goal” in this post. Like any good minion, Frank is supporting you, by ensuring the ball stays well behind the line, in your own goal. Well done both of you

    • “As I said above, alt-meds have difficulty in processing prose, so it would come as no surprise they have difficulty with the fallacy, post hoc ergo propter hoc.”

      GibleyGibley (and what an appropriate pejorative for its bearer), I don’t “support” the prof; I “support” science, logic, reason, and considered thought; attributes the prof displays and you …………….. don’t, and probably never will. That is why you resort to ad hominems in the absence of anything approaching intellect. Haven’t you got a rock to crawl under, with another cockroach? (An ad hominem, I know, but you don’t understand anything else.)

      • FrankC, perhaps you could elaborate on your expertise on understanding science. You have made gross, sarcastic and incorrect comments about my ability to understand “science”, without outlining your expertise in it. Apart from that, this blog by EE and the two “Franks” is still an “own goal”. TC, keep the logic coming.

        • @GG,
          “FrankC, perhaps you could elaborate on your expertise on understanding science.”
          Why? Have an instance where my understanding is incorrect? This isn’t a Red Herring, or is it? From you of all people, surely not? (That was sarcasm.)

          “You have made gross, sarcastic and incorrect comments about my ability to understand “science”, without outlining your expertise in it.”
          “Gross’ as in large, or as in unpleasant? “Sarcastic”? I didn’t think sarcastic, more like caustic. “Incorrect”? Yes, because you made assertions contrary to science. Please, by all means elaborate, but the onus rests on you, remember.

          “Apart from that, this blog by EE and the two “Franks” is still an “own goal”. TC, keep the logic coming.”
          Only you and your ilk would think so. A puerile diversionary tactic, better suited to a playground, but who knows who you are.

          As for logic from TC, would you care to point me to some? He has problems with basic language comprehension, as well as the gross (as in large) deficiencies in logic.

        • The last time.
          “In the realm of alternative medicine, we encounter many therapeutic claims that beggar belief(full stop) (New sentence) This is true for most modalities but perhaps for none more than chiropractic(full stop) (New sentence) Many chiropractors still adhere to Palmer’s gospel of the ‘inate’, ‘subluxation’ etc. and thus they believe that their ‘adjustments’ are a cure all(full stop) (New sentence) Readers of this blog will know all that(comma) of course(comma)(secondary proposition following the introductory comment) but even they might be surprised by the notion that a chiropractic adjustment improves the voice of a choir singer.

          This (meaning – but even they might be surprised by the notion that a chiropractic adjustment improves the voice of a choir singer), however, is precisely the ‘hypothesis’ that was recently submitted to an RCT. To be precise, the study investigated the effect of spinal manipulative therapy (SMT) on the singing voice of male individuals..

          I cannot see why it is so hard to understand written language that most 12 year olds would grasp. Oh, except that you are an alt-med, where you “understand” in you own unique way.

  • In reply to Frank Collins:
    If it was an introduction to the subject matter would it not discuss the actual contents of the paper? Instead it introduces “inate, subluxation and cure all” which are not in the article which are then followed by “This, however, is precisely the ‘hypothesis’ that was recently submitted to an RCT.” The wording was rather precise!

  • I understand that you are jumping to Edzards defence. He made a mistake! It happens and we debate it! He cited an abstract incorrectly instead of reading the full paper, you jumped to his defence and are now forced to defend your comments. Differing perspectives and bias! We are all biased towards what we do and say! I look forward to our next encounter!

    • The last time.
      “In the realm of alternative medicine, we encounter many therapeutic claims that beggar belief(full stop) (New sentence) This is true for most modalities but perhaps for none more than chiropractic(full stop) (New sentence) Many chiropractors still adhere to Palmer’s gospel of the ‘inate’, ‘subluxation’ etc. and thus they believe that their ‘adjustments’ are a cure all(full stop) (New sentence) Readers of this blog will know all that(comma) of course(comma)(secondary proposition following the introductory comment) but even they might be surprised by the notion that a chiropractic adjustment improves the voice of a choir singer.

      This (meaning – but even they might be surprised by the notion that a chiropractic adjustment improves the voice of a choir singer), however, is precisely the ‘hypothesis’ that was recently submitted to an RCT. To be precise, the study investigated the effect of spinal manipulative therapy (SMT) on the singing voice of male individuals..

      I cannot see why it is so hard to understand written language that most 12 year olds would grasp. Oh, except that you are an alt-med, where you “understand” in you own unique way.

      As for you assertions in the post, more complete crap. Do you have any understanding of Logical Fallacies? FFO.

  • To say that fringe chiropractors who adhere to “inate, subluxation and cure all” would be surprised positions the paper further out there in the fringe. The intended meaning is clear! We are going in circles here!

    “I cannot see why it is so hard to understand written language that most 12 year olds would grasp. Oh, except that you are an alt-med, where you “understand” in you own unique way.” Does “Ad hominem” ring a bell!

    • TC
      “To say that fringe chiropractors who adhere to “inate, subluxation and cure all” would be surprised positions the paper further out there in the fringe. The intended meaning is clear! We are going in circles here!”
      The prof didn’t say that either, but it is pointless trying to explain basic English to you.

      ““I cannot see why it is so hard to understand written language that most 12 year olds would grasp. Oh, except that you are an alt-med, where you “understand” in you own unique way.” Does “Ad hominem” ring a bell!”
      OMFG, you can’t even get a question correct. The question should end with a question mark (one of these; ?).

      That wasn’t so much of an ad hominem as when I called you a dill; that was a direct ad hominem. I am way past that now; I am now of the view, through your numerous examples of stupidity, that you are, indeed, stupid. If the post above is not ample evidence, I cannot think what else would be.

      It is pointless trying to explain anything to you. You grasp at logical fallacies and when you think you can “tu quoque”, you even manage to stuff that up. I, like many others, have given the benefit of the doubt to your “reform” mantra, however, you are displaying the same characteristics of any other chiropractor; a lack of understanding of basic science and an inability to comprehend it. Sorry, but you are plainly and unequivocally stupid.

  • Differing perspectives!
    Your post hoc ergo propter hoc point is good! What rules out the connection that I have made that you say is not there?

  • I have often stated that both the vocal critics and chiropractic fringe can be deeply, obstinately entrenched, yet looking back over this comments section that is exactly what I have just done. I pig headedly dug my heels in and deserved the boxing around my head. Lesson learnt!

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