The Right TMCC pattern consists of the cervical spine oriented to the right while the cervical vertebrae side-bend and counter-rotate back to the left.
It’s the same concept as the thoracic spine remaining oriented to the right while the ribs are counter-rotating back to the left (right BC pattern) due to the rightward oriented pelvis underneath it (left AIC pattern).
It would look something like this:
In this situation, an individual with a left AIC, right BC, right TMCC pattern will likely have the three midline bones: sacrum (pelvis), sternum (ribcage), and sphenoid (cranium), all oriented to the right.
Remember, there is nothing wrong with this position, as long as you are on your right foot. These three patterns simply reflect proper muscle activity and bone position when you are in the right stance phase of gait. If you move your weight to your left foot, and your muscle activity and bone position don’t switch to reflect left stance phase of gait, you aren’t alternating. The inability to switch patterns, and thus the inability to turn off over-active chains of muscle, is the problem that PRI is attempting to address.
Sometimes due to visual issues, malocclusion, whiplash, or any type of trauma, this normal patterning of the right TMCC can get interrupted and become pathologic, just like the Left AIC and Right BC patterns can be pathologic.
In case you do not yet know what pathologic in the PRI sense means, it is this: your joints are doing things that they should not be able to do given the position the joints are in.
For example, if your have a pelvis that is anteriorly rotated on the left (left AIC pattern) as determined through the adduction drop test, you should not have the ability to fully extend your left hip. The boney arrangement of our femur and acetabulum don’t allow it.
If you can fully extend your hip, it means you have a range of motion that you should not have (unless someone is genetically hypermobile, I suppose), so your hip did something “pathological” to give you that range of motion. In this example, the anterior ligaments of your left hip have probably loosened.
This type of pathological event can happen in all three chains of muscle, including the neck’s right TMCC patterning.
Pain as an Indicator of Systemic Malfunction
In the beginning of the Impingement and Instability course manual, there is a page entitled “Unilateral Idiopathic Indicator”.
This reflects the PRI belief that one-sided pain (unilateral) of unknown origin (idiopathic) often stems from the body’s inability to shift fully into Left AF/IR with accompanying trunk rotation to the right. In this case, an individual is no longer alternating: they can not truly alternate their stance position between left and right sides of their body in the frontal plane.
They still walk and breathe, but they are forced to do it with compensation.
This inability to shift into Left AF/IR can lead to common pains such as:
- Plantar Fasciitis
- Shin Splints
- SI joint pain
- QL tightness
- Upper trap fatigue/tightness
This list is longer but I’ve specifically mentioned these because experienced them all during my adolescent years and early adult life (ages 14-35).
Resolving these painful conditions usually requires the ability to shift in-to and out-of left AF/IR while walking and breathing without compensation.
This theoretically enables the body to become fully alternating between the left and right sides.
Alas, if it were only as easy in practice as it is in theory. Remember, these painful idiopathic indicators tell us the body isn’t alternating from side to side. They don’t tell you why the body isn’t alternating. They don’t tell you where you are getting stuck. They don’t tell you what area of the body is preventing proper alternation.
And this is where PRI gets most frustrating if you don’t understand the right BC and right TMCC patterns.
For instance, the bi-lateral plantar fasciitis I experienced for four years straight, day after miserable day with no relief, was viewed by the podiatrist as a result of high arches. To him, plantar fasciitis was a foot problem.
I can state without any doubt that my plantar fasciitis was most certainly NOT a foot problem. My feet have not changed and yet I no longer have plantar fasciitis. I didn’t have high arches.
I had supinated feet that gave the appearance of high arches.
My feet were supinated because my anteriorly rotated pelvis was driving them into that position.
The important point is that while plantar fasciitis may indicate that your feet and ankles are likely locked up to one degree or another, the more significant source of our locked-up system could be elsewhere in the body.
This doesn’t go just for plantar fasciitis. This can be true for any number of any painful areas of the body.
Keep that in mind when you look at the pictures of my neck. This pathologic neck of mine more than likely played a role in the plantar fasciitis, SI joint dysfunction, and upper thoracic/neck spasms that plagued me so consistently through my life.
A Tale of Two Necks
The picture on the left is my old “pathologic” neck. That picture was taken in April of 2017. You can see that my head sits awkwardly upon my neck, my neck is shifted over to the right, my shoulder is higher on the left, and my right ear is lower than my left (it actually sits posterior to the ear on the left due to temporal bone position). Overall, there is a rightward tilt to my upper body.
The second picture is my current neck. Both my head and neck have shifted to the left so that I am more aligned with the midline of my body and my ears are more level. This picture was taken in January of 2018. There is still a slight misalignment but it’s much better. In truth, I don’t believe the misalignment will ever go away because I’m relatively sure I was born with cranial compression pattern that is called a lateral sheer.
(to understand the midline of the body and how we organize around it, I highly recommend Franklyn Sills books about Craniosacral Biodynamics. These books will also make PRI more understandable conceptually).
The third picture is my attempt to re-create what is going on with the bones of the occiput (base of the skull) and the atlas (top cervical vertebra). Unfortunately my skeleton model is not very maneuverable so I drew arrows to show the movement of the occiput (down) and atlas (up) on the right side. Keep in mind this is happening only on the right side of the cranium/neck. The blue circle indicates where potential compression can occur.
The fourth picture is a close-up of the OA joint. In the base of the occiput you have the foramen magnum. The foramen magnum is the large hole where the brainstem becomes the spinal cord and passes through. Clearly, keeping this area open and uncompressed is preferable. In fact, the Cervical Revolution seminar is largely about how to balance muscular tension in the neck so that the OA joint is able to move freely (hint: the OA joint requires 30 degree of cervical lordosis below it to keep it happy).
Furthermore, there are smaller holes beyond the foramen magnum where our cranial nerves exit the skull.
One of these nerves, the vagus nerve, passes through the jugular foramen created by the borders of the occiput and temporal bones. In a compression situation there is a strong possibility that the misposition of these bones, as well as misposition of the atlas can interfere with vagus nerve function. There are entire books written about the vagus nerve (Polyvagal Theory by Stephen Borges) because it plays such a large role in how our body self-regulates its autonomic nervous system.
Suffice to say, keeping a neck moving properly is important, and keeping it out of a pathological state is even more important since lack of proper neck movement is what can often lead to a pathological neck, called a right torsion.
Right torsion is a very difficult pattern to describe unless someone is very familiar with the head and neck bones and their movements. It is the second of two cranial lesions (as classically described in Osteopathic medicine) that the Cervical Revolution course addresses.
Never-the-less, if you don’t understand torsions, you’ll work with some clients/patients and struggle to figure out why they can’t get or stay neutral, or possibly even feel like crap after doing PRI work. Neck patterns are powerful!
As previously mentioned, the OA joint is an area where lots of important nerves pass through and around. These nerves rely on proper cranium and neck alignment so that they can pass through unobstructed. Any malpositioning, such as what you’ll find in a right torsion, can impinge and compress these nerves.
This occipital-atlas area is also tied together by numerous muscles whose actions are extremely important for proper functioning of your vestibular system (the system that balances you). These muscles will also influence the mechanics of your tempo-mandibular joint. So TMJ dysfunction can result from a neck and cranium that aren’t acting harmoniously.
These muscles, such as the SCM, will also restrict rib rotation when overactive and act as accessory muscles of respiration.
(As an aside, once I properly understood the importance of the SCMs my understanding of PRI increased greatly. Thanks Tommy Conway)
Alas, understanding the OA joint is not enough since you also need to understand what potentially influences the movement of the OA joint. From below you obviously have the thoracic spine and cervical spine (C7-C2). But influences can also arise from the other joint of the occiput. This joint could be thought of as where your face meets your cranium, and proper movement of this joint is vital for a well functioning body.
The Sphenoid-Basilar Joint
The study of this joint is largely confined to osteopathic and cranial-sacral fields, but its importance is well appreciated in PRI.
The sphenoid (yellow) and the occiput (purple) join together at a location in the cranial base called the sphenoid-basilar joint, or SBJ.
The word “basilar” indicates the anterior part of the occiput that sits just in front of the brainstem. It is this “basilar” part of the occiput that articulates with the sphenoid, thus it is called the SBJ. So the following list of facial/cranium linkage goes from anterior to posterior and then down the spinal column.
- Sphenoid – posterior aspect of face
- Sphenoid-Basilar Joint- joins posterior of face and anterior base of cranium
- Occiput- base of cranium
- Occipital-Atlas joint- joining base of cranium and top of neck (C1)
- C2 and down the spinal column.
It’s important to keep in mind that all human movement is bi-directional. So movement of the sphenoid can influence movement in the spinal column just like movement of the spinal column can influence movement of the sphenoid.
As mentioned, the SBJ is found at the base of the cranium, just anterior to the foramen magnum, the hole at the base of the skull from which the brainstem/spinal cord emerges.
The first picture shows the SBJ if you were looking up at the base of the skull from below. You are looking through the mandible (jaw) and up into the roof of the mouth. The most inferior part of the sphenoid is found at the back of the roof of the mouth. The maxilla is found just in front, or anterior to, the sphenoid.
The second picture shows the SBJ from behind and with the top half of the head removed. It is this view that I find the most useful since it is the same view as from which we examine the OA joint and cervical neck.
The third picture removes all the other bones and just shows the SBJ in a right torsion pattern from behind, the same view as picture 2.
The fourth picture is a side view. You can clearly see the sphenoid, temporal, occiput relationship but you can’t see the SBJ joint.
In the third picture of the right torsion, you’ll notice the sphenoid and occiput are rotating in opposite directions at the SBJ on a front-to-back axis. On the right side the occiput is rotating down while the sphenoid is rotating up. Under normal circumstances they should rotate the same direction: if the occiput is being pushed up by the atlas beneath it, it should move up as well. However, in a right torsion the occiput is moving down on an atlas that is moving up! Not a good state of affairs.
To add yet another layer of complexity, the temporal bones have a very intimate relationship with the SBJ since they articulate with both bones. The movements of the temporal bone, sphenoid, and occiput have to be harmonious for your cranium and neck to be harmonious.
If any of these structures get jammed cranial/neck movement will be impeded.
in other words, if the temporal-sphenoid-occiput complex loses some of its natural inherent movement, the neck can get jammed, too. This occurs due to the occiput’s position:
- it sits atop the neck at C1 (the atlas),
- in back of the sphenoid and
- it articulates with the temporal bones.
Aberrant temporal and/or sphenoid motion can be “directed” to the neck via the occiput (more on that at the end of the post)
The unique part of PRI is that its design empowers the individual to use their own healing power, in this case their own muscular power, to restore proper position of their own pelvis, ribcage, and neck.
However, in some intractable cases, manual intervention may be necessary. In my situation, the PRI exercise that was designed to restore the natural inherent movement of the temporal bones, sphenoid and occiput was not completely working.
My own muscular power (jaw muscles acting in concert with proper neck musculature and breathing) couldn’t seem to overcome the “stuckness” of my sphenoid-occiput-temporal bone complex.
This stuckness, and the compressive forces it created, prevented my atlas (C1) and cervical spine from being able to get out of its right oriented state. I was locked up at the sphenoid-occiput-temporal complex, OA joint, and my neck. This stuckness influenced all movement below it from my ribs all the way down to my feet.
It wasn’t until I experimented with some cranial-sacral techniques (from the books mentioned above) that I got my sphenoid-occiput-temporal sutures to loosen up a little. In cranial-sacral, the intention is to introduce “space” to cranial sutures that have become inert, or unmoving.
From there my own muscular power, via the Standing Alternating Cranial Expansion technique, finally “unlocked” my cranium and neck.
That is what you see in the pictures below. The first picture is the right torsion position of SBJ joint. The second is my “locked” neck (due to the right torsion) where everything looks shifted to the right, and the third picture is my unlocked neck where everything is more centered to the midline of my body.
The results of my new neck are fantastic: it seems my body is no longer living in an artificially elevated sympathetic state due to restriction and compression of structures at the level of the TMCC.
- The intensity of my tinnitus (ringing in the ears) that I have experienced since the age of 14 has decreased (fingers crossed)
- My flexibility has increased. I can now touch my toes without restriction.
- I can sidebend and rotate my neck without restriction and cracking. At the end range of motion I feel a soft “ending” rather than a hard ending.
- I can breathe deeper (meaning my ribs expand more) and I feel a “soft” end feeling at maximal inhalation. It feels almost elastic.
- My left foot lands on the ground differently.
- The food sensitivity that causes too much histamine to be released in response to certain cooking oils and food (resulting in hives) has been reduced considerably. I believe this is due to my vagus nerve no longer being compressed.
- My ability to stay asleep has been slowly increasing (fingers crossed)
- My ability to get more relaxed after prolonged athletic activity has increased.
As with all positive change the question that immediately follows is: will it last?
I don’t know for sure since I have some occlusion issues (my teeth don’t contact perfectly), but so far, so good.