Many doctors of chiropractic today work in integrative environments, collaborating with other types of providers while contributing to patient care and cutting-edge science. One such person is ACA member Kenneth Weber, DC, PhD, who was appointed this year to the faculty of Stanford School of Medicine as an assistant professor of anesthesiology, perioperative and pain medicine and, by courtesy, neurosurgery. “I am pleased to announce that I am now directing the Neuromuscular Insight Lab,” Dr. Weber reported. “Our multidisciplinary team includes expertise in pain, spinal conditions, neuroscience, biomedical imaging, machine-learning, physical therapy, and chiropractic.”
The ACA Blog caught up recently with Dr. Weber, who says he wants to use his opportunities to help other chiropractors interested in research careers. If that sounds like you, read on.
The last time we spoke, you were working on two major NIH-funded studies: “MRI-Derived Neuromuscular Signatures to Predict Surgical Response in Degenerative Cervical Myelopathy” and “Dermatomal Mapping with Spinal Cord Functional Magnetic Resonance Imaging.” Any updates on those studies?
We are just starting year three of five for both grants and are still heavy into recruitment and data collection. We have three manuscripts at varying stages of review that focus on the technological development components of the studies. We developed and validated a functional MRI experiment to assess brain and spinal cord activity underlying hand dexterity and strength. The preprint is available here.
We also developed an analysis technique that aligns people’s cervical spine MRI’s using the location of their nerve roots. This improves the correspondence in neuroanatomy across people, and we show that this improves the analysis of spinal cord functional MRI data. The preprint is also available here.
Finally, we have made significant gains in quantitative muscle imaging. We released the MuscleMap Toolbox, a free and open-source set of software tools for the analysis of muscle health from MRI and CT (https://github.com/MuscleMap/MuscleMap). We have computer-vision models available for the lumbar spine, pelvis, thighs, and legs, which identify individual muscles in images to assess muscle size and composition. We have begun to expand this work to the upper limb to study the effect of cervical myelopathy and radiculopathy on upper limb muscle health and its relationship to hand dexterity and strength.
One of the shared goals of the NIH research was to make MRI more quantitative and less reliant on just a technician reading the images. Explain why that is important.
In general, the current use of MRI is more qualitative than quantitative. A radiologist reads an image and provides a narrative report on what they see. This report may include the approximate location of pathology and a crude grading of severity such as mild, moderate, or severe. If measurements are taken, they are usually limited in number and two-dimensional. It is too time consuming and challenging to do more than that, but there is a lot more information in the images that is not assessed in the traditional radiology workflow. Recent advancements in MRI and computer-vision techniques are permitting higher resolution imaging and the automated three-dimensional assessment of the body as not previously possible, and we are applying these techniques to the spine.
Together with collaborators across the globe, we can now accurately identify spinal anatomy and quantify pathology on MRI and CT. For example, we have methods to automatically identify vertebrae, intervertebral discs, and neural tissues as well as track degenerative changes, spinal cord compression, and muscle health. With a more comprehensive picture of the spine, I believe quantitative MRI techniques will better connect a patient’s imaging findings to their clinical presentation and usher in a new era of precision spine care.
One of your goals was also to build a chiropractic research team and to help nurture future chiropractic researchers. How is that going?
As an academic researcher, training researchers is a main part of my job, and the bulk of my teaching effort is through the one-on-one mentorship of researchers. My department has been very supportive of my efforts to foster chiropractic research and train chiropractic researchers. A main hurdle for many chiropractors interested in research is just getting their foot in the door. Therefore, I strive to help reduce these barriers to research training, and I have been able to continuously have a chiropractic research intern on our team. Dr. Javier Muñoz Laguna is one of my success stories. Javier started his chiropractic research training with our team and is now completing a PhD with Dr. Cesar Hincapié at the University of Zurich. I hope to help many other chiropractors similarly kickstart their research careers.
Is there still an opportunity for chiropractors to join your team?
Yes, there are certainly opportunities to join our team. Now that I am faculty, I am working to more formalize the training opportunities available to chiropractors. In collaboration with the Chiropractic Residency Program at the VA Palo Alto directed by Dr. Robert Walsh, we established a research elective in interdisciplinary pain research for chiropractic residents. The chiropractic resident dedicates a portion of their week to research training with our team and spends the year completing their own independent research project.
Our first resident, Dr. Dean Dennis, has just completed the elective, and our second resident, Dr. Thomas Fermor, has just started training with us. If we can obtain funding, I am hoping to develop a two- to three-year full-time postdoctoral research fellowship for chiropractors, which will also include a clinical component in multidisciplinary pain management. If any chiropractic students or practicing chiropractors are interested in learning more about a research career and opportunities for training with our team, please send me an email. I am here to help, and I will respond.
Have you started working on something new that you can share with us?
Most of our work has focused on cervical spine conditions, but we are starting to extend this work to the lumbar spine. Last year we published the largest study investigating muscle health and back pain in about 10,000 participants from the UK Biobank. This year we developed a new method that permits the three-dimensional study of muscle composition changes, and we are excited to see how we can apply this technique to better understand where muscle health is changing in back pain.
We are currently collaborating with Dr. Nathan Schilaty at the University of South Florida to incorporate these muscle and spinal quantitative MRI techniques into a randomized controlled trial to uncover mechanisms of traction for back pain. This will include the quantitative assessment of spinal canal metrics and intervertebral discs. I am very excited about the momentum in this space and to expand our tools to the entire spine.
Was research the path you always intended to take in your career?
When I started my chiropractic training, I was planning to devote my career to clinical practice, but early in my training, I had too many questions that lacked adequate answers, and I found a lot of enjoyment in trying to find these answers. From there, my passion for research just continued to grow, and I also saw a need within the profession for more researchers. With help from my mentors, I decided early on in my clinical training that I wanted to become a chiropractic researcher, and I started taking the steps to enter a PhD program. I am happy to discuss my career path more with anyone considering a research career. Please reach out.
How does your background in chiropractic contribute to your work as a neuroscientist and researcher?
First, the neuroanatomy and neurophysiology training I received during my chiropractic education made my neuroscience training a lot easier—I came into my PhD training already having a solid neuroscience foundation. Second, being a chiropractor gives me the clinical foundation to identify critical knowledge gaps and guide my research so the findings can have the greatest impact on spine care. Being able to communicate with other healthcare professionals has also helped foster interdisciplinary research collaborations, and knowledge of the clinical workflow helps me identify and overcome challenges to clinical translation.
There is a tremendous need for more dually trained clinician-scientists. Having both bedside and bench experience helps build bridges between research and clinical practice. The National Institutes of Health recognizes this need and has several training programs available to grow the nation’s pool of clinician-scientists. These include postdoctoral training fellowships, career development awards, and programs to help pay off student loan debt for clinician-scientists working in non-profit research. I have been successful at obtaining these awards, and I can provide guidance on these programs to anyone interested in a chiropractic research career. I am even willing to share examples of successful grant applications.
How did you land at Stanford?
I came to Stanford in 2016 for a postdoctoral research fellowship, which is like a research residency that provides you with an additional two to three years of research training. During this time, you learn new research skills, broaden your research network, and build your resume in a mentored training environment.
During my postdoctoral fellowship, I expanded my expertise in spinal cord MRI to include training in brain and muscle MRI, and I began to learn machine-learning and how to develop computer-vision models. In 2018, I was awarded a five-year career development award from the National Institutes of Health and was promoted to instructor, and I have continued to move up the academic ranks. Stanford University, the Stanford School of Medicine, and the Department of Anesthesiology, Perioperative and Pain Medicine have provided a very supportive and collaborative environment for me to grow as a researcher, and I am looking forward to giving back as a member of the faculty.
You just finished your term as a CARL II fellow. What did you gain from that experience?
During my PhD and postdoctoral training, I began to feel somewhat disconnected from the chiropractic research community. The CARL program was key to helping me regain that connection and grow personally and professionally with a talented group of chiropractic researchers, who have now become close friends. The CARL program has been the most unique and inspiring part of my research career. Over the past three years, my research career path at times was unclear. The CARL mentors and fellows provided me with community and invaluable support as I navigated through the faculty hiring process. As a Senior CARL Fellow, I am looking forward to contributing to the CARL III cohort and the CARL program as a whole. CARL is building momentum for chiropractic research and worth the investment. The CARL fellows will pay it forward.
Is there something else you would like to share?
I have seen so much growth in chiropractic research since I entered the profession 20 years ago. There are many more opportunities today for chiropractors to train in research and contribute to the profession’s research output. This growth in chiropractic research has not happened by chance. It has taken decades of work and investment to be where we are today. I am an output of that investment, and I have benefited from those chiropractors who paved the path for me. The future of scientific funding in the United States is uncertain, and any reduction in funding will set chiropractic research back. We need to come together to keep this momentum going, and I encourage everyone to donate to organizations that support chiropractic research and let your legislators know that you support funding science.
Dr. Weber can be reached at [email protected].
