James Loy:

This is Reframe, The podcast from the College of Education, Health and Society on the campus of Miami University. 

In this episode, we’re here with Dean Smith, an exercise science specialist, a senior clinical faculty member, and the latest recipient of the American Chiropractic Association’s 2018 Researcher of the Year Award. And alongside his award-winning research, Smith also hosts a podcast called Chiropractic Science, where he discusses new trends and findings with other leading researchers.

And today, he’s here to talk about his most recent work, some of the most common misconceptions still surrounding of chiropractic care, and about the untapped potential this field may ultimately hold.

So Dr. Smith thanks for your time today. Can you talk a bit about your research and what led to your ACA Researcher of the Year Award?

Dean Smith:

Yeah, so, it’s more than just research publications, or it could be more than just that. So that’s where I think the podcast, plus my research . . .  I’m guessing it’s both.

In terms of my research, I am interested in how people move, basically. And so specifically, I look to see how chiropractic care, as well as exercise, can influence the way in which we move. So that could be, for example, does exercise promote better speed by which we move? Can chiropractic treatment also do similar? Can it change the quality of our movements? So those are really just the major kind of questions that I have and that I am interested in.

So that led into the study that I think I got the award for, which came just this past year . . . The past 3 or 4 years. It was quite a long study. It was a study involving the military, and so the department of defense put out a call for proposals to ask for any chiropractic group to investigate whether chiropractic could affect special operation forces military personnel’s reaction times and movement times.

So what we did in that particular study, we looked at simple reactions times and more complicated reaction times. Choice reaction time, we would call it. We also had people . . . I don’t know if you’ve seen these big lighted boards, maybe at a gym or something, where you hit one panel that lights up and then something else lights up and you try and go as fast as you can. 

James Loy:

Yeah, I’ve seen something similar where you go as fast as you can between the two . . . yeah.

Dean Smith:

So we did something like that. And we had them do 100 button presses and we looked at how fast they could do them, again, before and after a series of treatments. And the results essentially showed that that particular task was the one that really seemed to show the effect, that people got faster doing this multi-button press more complicated motor reaction time.

James Loy:

So I imagine . . . I’m wondering if . . .  you’re talking about special forces so these are people who are already, you know, in peak physical condition and so I’m wondering if they are studying and looking at how chiropractic care can even give them an extra edge, you know, boost them even just . . . you know, a notch or two above and beyond where they are already at physically.

Dean Smith:

That’s exactly it. And the military has a long history of trying to find ways to make them better. And in the early 1900s and the middle 1900s . . .  Exercise. You know. There were fatigue labs created at Harvard, for example, how can we push our troops further and further? And so you are exactly right. That is my perception of why they put out this call for the proposals to do the study. 

James Loy:

And I love the work you are doing with your podcast as well. It is real interesting how you’re bringing this topic to a wider audience can you talk about your Chiropractic Science podcast and what led to that?

Dean Smith:

Yeah. So, it’s the same reason I got into research in general in chiropractic. And that was, when I was first in practice my first year, I had some interesting cases and I didn’t know how it worked to be honest with you. Especially things that didn’t involve pain. I didn’t know how they worked, but they seemed to  . . .  people seemed to get better. From . . . Their sporting performance improved. Their grip strength improved, that sort of thing. Their reaction times. People were telling me that they were faster and this sort of thing. 

And so, there was a lack of literature to suggest how we improve, but patients were saying they improved. It’s the same think for the podcast. So I got into research just because there was a lack of evidence out there and I got into the podcast for the same reason because when I look at the public perception and the public information that’s out there about chiropractic, I saw a big void. And so I wanted to do, I guess, my part to try and fill some of the void. I realize it wasn’t going to be completely filled by any one thing. But if I could just help a little bit, help chiropractors know that, hey, there is actually some really good research that we have.

James Loy:

I think this might be a good segue from  . . .  one of the things that I wanted to talk about is what are some of the common misconceptions around chiropractic care? Because I know my . . . A lot people, I don’t think they know more than what they see on TV. My wife goes to a chiropractor, she says she loves it, like, it really makes her feel better, you know, a couple of days later or whatever. But I think most people’s idea of . . .  and mine included, you know, you just  . . . the chiropractor cracks their spine or, you know, does some adjustment to the neck and calls it a day. So what are some of the more common myths or misconceptions around the practice?

Dean Smith:

Well, I think. . . . well, there are many. One is that perception that it is dangerous. A lot of people are . . . they are kind of scared when they come in. Even when they’ve decided to come in and have made the appointment, there’s still a little bit of, oh, I’m not sure what is going to happen. So I think there’s a conception that it somehow might hurt or that it’s unsafe. The reverse seems to be true because if you look at the side effects, shall we say, of chiropractic care compared to let’s say drugs or surgery, we’re significantly safer. That’s not to say people won’t have some side effects like soreness after an adjustment. But it’s the kind of thing you would expect also if you went to do a workout and you hadn’t worked out for a long time. You should expect maybe a little bit of soreness. So those sorts of things. 

The other thing is that I believe people consider chiropractors only when they have pain. But my patients were telling me how much better they could move. How much better their just daily life was. And maybe some of it had to do with pain. But maybe some of it was independent of pain. So I think pain is one aspect, but I think a lot of people don’t realize that chiropractors can help beyond pain. So that would be myth number two.

James Loy:

So if those are the two biggest misconceptions or myths, what are some of the things that chiropractic care can do that people might not even realize? Like, what are some of the potential applications that are beyond what are some of the common thoughts around the science? 

Dean Smith:

So, first of all let me say, as a research, where the bulk of the research is. And then we can go into some speculation. So the bulk of the research literature is on back pain, then neck pain, then headaches. Those are the 3 top reasons why people come to chiropractors.

Now, beyond that, what a person might experience -- we don’t have a ton of data on this -- but we have lots of surveys and anecdotes in this field. So people might come in for neck pain and they feel like they can move better in their back or their hips move better. Those are the kinds of things that I see that people describe to me. The evidence base is the strongest, certainly for pain. But we’ve seen a lot of people who either increase their athletic performance. We are starting to see some studies in that realm now. But again there are very few.

But if you look at the, for example, professional teams like NFL. Every NFL team has a chiropractor. So it’s one of those things where the research is not quite caught up to the practice. And what a lot of people have come to realize for their own bodies, is that, hey, this really helps me to function better. Not just with pain, but maybe that’s a part of it. Maybe that’s a way in their lifestyle they can reduce medication use if that’s something that they want to do. So I think that there are any number of reasons. I have some people come in that say after an adjustment they can see better. So it’s kind of an individualized thing at that point. 

Chiropractic actually, when it started, it didn’t really have anything to do with pain. The very first adjustment that was given by D.D. Palmer was for a janitor who had stooped over some years before and had lost his hearing. And so D.D. palmer . . . . chiropractic had not been invented yet, but he was the first chiropractor and he said, “Well, hey, let me check out your spine. You said you bend forward and you felt a little pop and you lost your hearing. So let me check that out there.”

So he did and he used some forces and he put a thrust through there and, as the story goes, he saw this janitor again the next couple of days. And 3 days later, essentially, he could hear again. And so, back in those days, in the late 1800s he was thinking, “Hey, you know, I am going to market this as I’ve got a cure for deafness.” Which is ridiculous. It is absolutely ridiculous.

But it does kind of go to show that some people experience effects for which we have difficulty describing. But for that person, it makes a big difference. So, again, it could be anything from gastrointestinal issues improving to headaches clearing up to the back pain or neck pain to moving better. All of these kinds of things. 

James Loy:

It’s interesting that so many of the stories do seem to be anecdotal and there are so many of them. So there . . . it has to have some sort of benefits that aren’t being researched yet, right? And it is interesting that there is not more of an emphasis on that because, as you mentioned, it’s widely, you know . . .  people go to chiropractors all the time and even major institutions and systems like the military and you talk about major sports teams like the NFL all have chiropractors on staff. So you’d think there would be more of a call for research to get to the bottom of what actually is the hard science behind it

Dean Smith:

Yeah. Amen! That’s what we’re shooting for. That’s what we need to do. So there just aren’t that many chiropractic researchers out there to be honest with you. Not as many as there are medicine. I mean, we have 80 . . . I think there are between 70 and 80 thousand practicing chiropractor in the United States. We have probably, I’m guessing 20 – 30 fulltime researchers. It’s not a lot. It’s not a lot. Now, there are probably more than that who are part-time contributing and even more that are just people in practice that are contributing case studies and things. But in terms of solid research programs, we have not many in the country.

Now, other countries have booming research. So Canada, as a part of their Canadian chiropractic association they’ve set up over the last 15 – 20 years, that when they get their dues, part of their dues fund research. We haven’t done that here in the United States. We really need to. Because of what you are saying. There is a disconnect between what’s happening in practice. We are seeing great results in practice. But that hasn’t carried over to the research yet. And I think it’s for all of these reasons. Probably funding is a big part of it. But then it’s just who is going to do it and how is it going to get done. 

James Loy:

Well, if nothing else, I think that it certainly means there is a lot of wide-open opportunities. 

Dean Smith:

There’s a ton of opportunities. And that’s why, you know, I could keep busy for 10 lifetimes just trying to answer some of my questions.