Richard Jacobs: Hello, this is Richard Jacobs, a serial entrepreneur who’s had 20 years’ experience building companies and after the same 20 years of bed sleep I started interviewing hundreds of sleep experts and health experts to find out what it really takes to get a good night’s sleep. And I share those tips and strategies on the show because consistently getting a good night’s sleep and keeping your health in the right shape can radically improve your health, happiness, and productivity. So before we begin this podcast is sponsored by the good night’s sleep project. They offer the world’s first patented custom-tailored pillow designed to finally put it into restless nights and bed sleep. So if you’re struggling to get the sleep you need deserve, meet your new best friend, the custom tailored pillow is created to support your body’s unique measurements using machine vision. So simply take your picture using your smartphone. It can be ordered for you. It is goodnightsleepproject.com for more info. So today’s guests on the podcast is Dr. Ty Carzoli. His clinic is called the Denver Upper Cervical Center. He’s passionate about providing advanced chiropractic care. These are patients and people that want to eliminate their pain and optimize their wellness and live a better life. So they see all members of a family from babies to children to parents and grandparents, and they emphasize a gentle and a research based approach to health care with a particular emphasis on chiropractic works phonology. So Ty thanks for coming. How are you doing?

Dr. Ty Carzoli: Thanks for having me, Richard. I really appreciate it. I’m doing very well.

Richard Jacobs: Good. So I’ve heard a little bit about upper cervical versus a traditional chiropractic. But first tell people a little bit about chiropractic in general, and then let’s talk about what’s the differences in your clinic.

Dr. Ty Carzoli: Yeah, absolutely. So to kind of paint with broad strokes, chiropractic really functions to strengthen the host, really improve the health of the system through what we call like a salutogenic approach. So rather than focusing on what’s going wrong with the body focus more on normal physiology and restoring that to the body so that it can function optimally without things interfering with that normal physiology. Now, upper cervical specifically, we focus largely around C1 Atlas, the first cervical vertebra, occiput and C2 or access. So that upper cervical complex, those three bones and their relationship to each other and their proximity to the brainstem or why it’s a particularly relevant area.

Richard Jacobs: Yeah, I’ve had many adjustments. So typically they’ll adjust the mid back, lower back, and then neck. But upper cervical, do you focus mainly on a neck adjustment or do you adjust the whole back or what’s your philosophy there?

Dr. Ty Carzoli: Yeah, that’s a great question. So I do analyze and treat in the entire spine. A lot of upper cervical doctors sometimes will only focus on the upper cervical spine, but we get a pretty wide spectrum of conditions that come to our office. Typically a lot of the same stuff that might go to a traditional chiropractor, but the people that seek out upper cervical work uniquely often have things like post-concussion syndrome, migraines, headaches vertigo, dizziness, disequilibrium type issues. We get a lot of people with many years trigeminal and occipital neuralgia, of course, neck pain, back pain, sometimes seizures, tremors or motor ticks. And very frequently these people have kind of been through the standard of care, maybe seen a half a dozen other different specialists first before they find their way in here. And this unique approach, again with its proximity to the brainstem and the kind of uniquely vulnerable upper cervical spine is I think why we see such powerful improvements in that area.

Richard Jacobs: So when people come to their first visits, are there things that you’ll do and that you won’t do? And so they are ready, you know, maybe a few visits down the road. And what’s it like for the first experience?

Dr. Ty Carzoli: Yeah, so we do a really comprehensive exam. We like to look at both kind of the hardware and the software. So we do a really comprehensive digital x-ray analysis to get a kind of pulse on the structure, position and motion of that. Both the upper cervical spine and the full spine. We test motor function fine motor skills, grip strength. We do a number of different things to kind of cast a wide net and get a really detailed look on both the function of the spine and the output of the nervous system as well as the structure of the spine. So when someone comes in, they go through all that, we’d of course screen and make sure they are a good candidate for this type of care. And if they do look like they’re good eligible candidate they would receive their first adjustment, almost always going to be an Atlas adjustment in this practice for the first one and kind of then we’ll post x-ray and see how, what types of changes we’ve made measure, changes in function and then kind of progress as necessary. It really depends on the state of the person coming in. We get people that are coming in for wellness and then we just got a call about someone who’s been in the coma since October after being thrown off a horse. So it’s really case by case. But generally speaking, I always say the Atlas is the alligator closest to your boat. So we almost always start there.

Richard Jacobs: So do you use x-rays first when someone comes in or do you use them after each visit? How they are strategically used to help people?

Dr. Ty Carzoli: Yeah, so I would need to take x-rays before doing any adjusting in that area. That’s what’s really going to guide our adjusting is those digital x-rays. And then we use an instrument to deliver the adjustment. There are other upper cervical specialties that do manual adjustments by hand. But a number of the kind of more modern upper cervicals specialties will use an instrument.

Richard Jacobs: But after the first visit, I come, I get x-rayed and get adjusted, then maybe do a post x-ray. How often do patients come back and what kind of frequency? I know it depends on the person, but on average, what happens then?

Dr. Ty Carzoli: Yeah. And again, this is going to be a little different in every clinic you go to. But in ours we typically see people no more than once a week. If we see them more than once a week, there’s probably something going pretty wrong with them. But that’s kind of the average patient certainly is coming in about that frequently. And we see people for about three months before we do a re-examine. At that re exam, we’d be retesting everything we tested on the front end to get a kind of updated look at structurally what types of changes we’ve made physiologically, what type of functional improvements we’ve made. Of course subjectively checking in with the patient and seeing how things have improved since starting care.

Richard Jacobs: And then after three months. Is it typical that, I mean, what kind of changes would you see in someone physically that’s a three month or working on,

Dr. Ty Carzoli: Yeah, well, it’s really fun. We’re actually collecting a lot of debt on that now. So I forgot to mention before, but we also do cognitive testing both before people start care and at their re exams. And really across the board we’re seeing improvements in everything I’ve mentioned so far. Most all of these statistically significant depending on the condition in question, right? So if someone comes in with somewhat acute back pain, well, I’m not anticipating they’re going to show remarkable cognitive and improvement, but if someone has had chronic pain or migraines or post-concussion syndrome then we are measuring pretty awesome improvements in cognitive function and physiological function. And of course their subjective changes that they’ve experienced with care.

Richard Jacobs: Has anyone done this in chiropractic? I mean, I’m not a chiropractor, but I haven’t heard of scientific papers with these, I don’t know if you can even do double blind studies and things like that, like clinical trials to demonstrate changes in cognitive function.

Dr. Ty Carzoli: Yeah, and that’s a great question. So there are a number of clinics that collect out on this type of thing. Historically the profession has not done such a spectacular job in collecting that data and publishing their findings. But that’s definitely something that I think a kind of younger cohort of doctors is working to correct. There’s some literature out there, but by and large, I think we are a pretty under-researched profession and that’s a shame because I think we have a really powerful service to offer people that people typically don’t find out about it until they’re kind of at the end of their rope. And then looking outside of the medical model for other solutions.

So hopefully that’s something that we will be changing in the near future.

Richard Jacobs: So what, again, what have you noticed on average? You may test and say, all right, the person’s cognitive functions group. What are the people say the patients anecdotally, how do they tell that they’re also feeling something different?

Dr. Ty Carzoli: Yeah, so I mean we use a lot of outcomes assessment tools, so different things like in a Western disability index, we use something called the Tampa scale of kinesiophobia. This is basically a self-assessment that lets us know kind of this patient’s relationship with their pain and their activity levels. You know, are they fearful that being active or exercising or moving is going to worsen their problem? Cause then we know we have to spend a lot of time kind of reeducating them on the reality of that. So there’s plenty of different tools that have been validated in the literature and we try to kind of cherry pick those that might fit the patient and the conditioning questions so that we can kind of track in their own words how they’ve progressed in in both feel and function.

Richard Jacobs: But I mean, in the words of patients you know, in layperson’s words, what are they saying is different?

Dr. Ty Carzoli: Oh, sure. Things like sleeping better, less brain fog, irritability and to hunker down on like post-concussion syndrome. These are ones that come up a lot. Their ability to focus their mood. I mean, it can show up in all sorts of different ways in their life too. I mean, we have people that notice their relationships are going better because they’re not as anxious or irritable as they were before. So it can be all sorts of different subjective changes. I mean obviously things like migraines and headaches, well, someone’s getting hospitalized for their migraines and then they undergo care and then suddenly, not only are they having any episodes that bad, but they’re not missing work or they’re not canceling vacations and stuff. Then you can see how it really shows up in people’s lives in a big way.

Richard Jacobs: It’s weird I’ve always wondered this, something will be out of a bone OB, subluxated et cetera, you know, get adjusted. Now it’s in place. And just general living, moving around, sitting, standing, et cetera, picking things up. How does the body keep you aligned versus not align? Like when does it need help to become realigned and why would it stay aligned? Why wouldn’t it either always be out of alignment or always in alignment?

Dr. Ty Carzoli: That’s another really good question. And it’s tough because we have to remember we are subjected to so many unnatural forces in the 21st century. Meanwhile we’ve sort of sacrificed a lot of really healthy stressors that would have kind of shown shaped our development. So, until not so long ago, we weren’t traveling much faster than you could travel on horseback and couple hundred thousand years before that, we weren’t really on horses to my knowledge. So you think of the opportunity for things like high impact collisions that are uniquely available in the last century or so. That’s obviously a major stressor now alongside that, things like sitting all day looking down at your screen all day. So we’re doing these things that are damaging our bodies. Kind of left and right. And meanwhile, sure people go to the gym and are active and exercise or try to, but a lot of people are sedentary. A lot of people don’t do those things. And you used to have to hunt for all your food and now you can get it through the window of your car from a clown. Right? So it’s kind of the the swapping of healthy stresses in the now insertion of unnatural, unhealthy stresses that makes for a particularly vulnerable state of the spine. Now that said, well, there might be limited mechanisms for the brain or spine to correct these things on its own. Which is where we come in. That’s not to say that it wouldn’t prefer to be in a more aligned state. In some cases it can even be as a matter of metabolism, right? So if you think you lose your cervical curve and your head kind of sticks way out in front that kind of forehead posture you might sometimes see with like an elderly person, well you’re not going to walk around with your head sticking way out in front, moving your whole center of mass forward. You’re then going to compensate by rounding out your lumbar curve to bring the center of mass back. So sometimes the body will make these longer term compensations to try to preserve itself from either burning up too much energy or damaging something else. But in some cases you kind of borrow from Peter to pay Paul. It’s not necessarily always a net positive as much as it is trying to work around the damage that’s been done. But once you can restore some normalcy to those issues, the body can often be in a healthier state and function in a healthier state because of it. So it will, like I said, might not have the ability to correct that itself, but it certainly has a proclivity to try to hold that as well as it can. And there is a time and repetition component to this. It’s not like one adjustment’s going to make someone’s dreams come true and fix all their woes.

It’s going to take time. Healing process takes time. There’s going to be repetition component to it.

Richard Jacobs: Yeah, that’s just what I was going to ask you. So I’ve noticed myself, I get adjusted and I’ll feel good, for a little while, maybe a week or a week or something like that. And then my fogginess or something will come back and I’ll go get adjusted again and then I’ll feel good. So I call it the adjustment holding. It’ll hold for a few days, a week, et cetera. And some people, it seems like they only need to go once a month and there’s holds longer and mine holds less, et cetera. Why does it just on hold at all and why does it undo itself and we need to be adjusted again?

Dr. Ty Carzoli: Yeah. So it’s not perfectly well understood. However, the kind of working hypothesis or maybe the, I should say the analogy to help people conceptualize it would be if you think of a machine that’s sort of one grooves into itself after it’s run for two, three decades long, well that machine is going to kind of naturally follow those grooves. And when we have these misalignments involve soft tissue changes and sometimes osseous or bone changes there is a natural tendency to kind of slump back into that position. It’s been in for a long time. So we see with again, enough time and repetition and the kind of removal of these stressors that causes the problem. People do tend to hold for extended periods of time. Now things like stress, lifestyle again, kind of work environment. However, if you’re sitting all day these things, again, while honestly work against it, but that’s why It’s about a lot more than just what I’m doing in here. But what is the patient doing the rest of their day? What are they aware of and how well do they understand their condition? Especially when you’re going into the topic of chronic pain, patient education I think is vitally important. So they understand kind of their relationship with their pain and how to modify that to heal better.

Richard Jacobs: Yeah. I guess, have you been slumping in your office chair eight hours a day for years. You get adjusted, it’ll help you, but of course you keep slumping in that chair just like you were, your body’s going to go back and compensate the way it did. So maybe that’s an answer to why. Unless you change your day to day activity that caused the problem, why would it magically be fix forever?

Dr. Ty Carzoli: Yeah, certainly. I mean, it definitely, like we said, it takes work on the patient’s part too, exercise, yoga, lifting weights. These things can have a real, really powerful effect and combating some of those others life stressors. So, and then kind of think too about things like Wolff’s law. So we’ll saw States at essentially bone adapts in accordance with the stresses placed on it. So these degenerative changes we see over time. Sure there are some age-related degenerative changes, but those are accelerated when we lose normal spinal alignment and those types of things. If we catch someone in that stage where they have severe degeneration, well there might be a lower ceiling on their ability to restore a normal function and physiology to things. So it’s really good. People address it when they’re young. There’s some phrase or quote that says, the best time to plant a tree was 20 years ago, the second best time is now. So it’s one of those things, get on it when it starts bothering you. Why this practice is filled with people in their forties and fifties suffering from debilitating problems that were kind of longer term consequences of injuries they sustained in their twenties that at the time maybe they didn’t feel were that serious. The pain came and went and I understand that I don’t fault anyone for kind of mistakenly thinking that way, but when it comes to these degenerative changes secondary injuries, you really, it’s best to get out in front of those and address them on the front end before they do snowball into that type of state.

Richard Jacobs: Oh, so that’s interesting. So you see commonly people that have had an injury in their twenties and then in their forties and 50s it starts really manifesting and hurting them?

Dr. Ty Carzoli: Absolutely all the time. And it’s a tough cause sometimes people come in and say, okay, I was in a car accident earlier this year and this, all this pain started from that. And then you look at their X-Ray and you’re like, well no. It turns out you probably had a pretty severe trauma 20, 25 years ago. And then they start thinking like, Oh yeah, you know what I did? And I felt okay, so I didn’t do anything about it then. And sure enough that catches up with him down the road. And I think part of that is, you know, in traditional medicine we sometimes mistakenly think that if there’s not a symptom, there’s not a problem. But that’s a little flawed, right? Because the first symptom of heart disease is usually a heart attack and 50% of heart attacks are first started to fatal. So realistically that person had a problem for 20, 30 years before they had that first symptom show up.

Richard Jacobs: Interesting. Yeah. So what do you think happens in someone that you know is in their twenties and gets an injury? I guess most of their body is pretty strong, so they’re able to compensate without really noticing and then maybe as they get older they have more and more compensations, which eventually pile up and it caused them to now not feel well.

Dr. Ty Carzoli: Yeah and again, it’s tough. This is debated. There are a lot of different kind of theories on why some of these things are, but we’re certainly resilient when we’re young and well, we know there are acute injuries that take place. Some of those, the symptomatically will resolve well, that injury might have catalyzed things to start moving in a bad direction. So down the road that newer injury might be the straw that broke the camel’s back. But it can be kinda tough to say and a lot of times we’re not even necessarily talking about pain. A lot of people, like I said, they come in here with neurological conditions. So whether or not they have pain from some injury or pain from degeneration, which is not always a part of degeneration we know that they are compromising kind of the integrity and function of the nervous system in a series of different ways. So sometimes what might have started as a mechanical asymptomatic issue down the road will show up as a neurological, very symptomatic issue, but it has kind of its origins in both the detrimental effects of that injury fit both the physical trauma and the associated neurological changes that we see.

Richard Jacobs: Okay. And when people come to your office, do you tend to inherit them from other chiropractors? Let’s say I’m a new patient, like versus one that’s come from another chiropractor and what does it tell you about what you guys do differently from other offices, let’s say?

Dr. Ty Carzoli: Yeah, we do get a lot of referrals from other chiropractors. We get a lot of referrals from medical doctors and then we get patients, like I said, who’ve kind of been through the medical gamut and start doing their own research and find people that have had great success with upper cervical. So it nice in a lot of ways because especially if they come from the medical community because the medical community is going to rule out all the really scary and nefarious stuff that would not be my wheel house. So if they almost always, if they’ve been through all of that and had somewhat lackluster outcomes when they do come here, this is very frequently a great fit for them because we’re looking at the one thing that nobody else is quite screening with this level of detail and specificity and certainly not addressing with this level of precision. And so as far as if they’ve visited other chiropractors and that can be a case by case type of thing. They’re chiropractors that might function in a really agreeable objective, kind of rooted in an objective measurable analysis type of way. And they just needed someone to focus on this one area that we specialize in. Or sometimes they might not really commit themselves to most objective criteria to guide what they’re doing. And so there might just naturally be a lower ceiling because they don’t have quite the vision or window to address things that I think you do or you are granted when you are a little more specific in the analysis.

Richard Jacobs: Okay. Well very good. What areas do you serve in Denver? Like how far away do people come from?

Dr. Ty Carzoli: We collect data on this too. We have about 20% of our patients are out of state patients. So a lot of people travel in for care here. And even those around town, I mean we get people to drive down from the mountains. We have people from East Colorado, so we cast a pretty wide net when it comes to people coming in. We even had a guy fly up from Puerto Rico last year for care. So part of that is because there are not too many upper cervical specialists in the area. And I think part of that is because we’re doing pretty good work here and so our patients are spreading the word for us.

Richard Jacobs: Well that’s excellent. So Ty what’s the best way for people to get in touch if they’re in the area or they want to come see you? Where to find you?

Dr. Ty Carzoli: Yeah. So go on our website, denveruppercervical.

com, giving us a call, I’m usually fairly available if people especially if they’re out of state patients, I like to do a little phone consult before they book a trip. But there’s information on there. They can always reach out, check in, and see if whatever they’re suffering from is something that we tend to help with. Read our reviews, people, our patients speak pretty highly of us and run a mission to have the happiest, healthiest, most phone form patients in the country. So we’re fiercely committed to making sure our patients understand their condition, their health, and their relationship with it.

Richard Jacobs: You should get a license plate for your car that says “Upper C”. It’ll be pretty cool.

Dr. Ty Carzoli: That’d be great. I’ll check into that.

Richard Jacobs: Well, very good Ty. Thanks for coming on the podcast. I learned some really interesting, useful stuff about chiropractic, so it was good. Thank you.

Dr. Ty Carzoli: Awesome. Thanks a lot for having me, Richard