Where are all the People?
I recently made the trek to Vermont for the first rendition of PRI’s Cervical Revolution course; a course in which the attendees doubled the population of the entire state.
It was nice to go to the class with a bunch of old friends. You always learn better that way, and I couldn’t have been more excited to get the band back together.
And even more so, I got to meet a lot of good folks for the first time. It was a real treat.
This course was meant to update the former craniocervical mandibular restoration course (which I reviewed here and here), with extra emphasis on the cervical spine and OA joint.
In this blog however, I will not touch much on the cervical spine positioning. I still have several questions regarding the mechanics. Some spots within the manual seemed to be conflicting; the blessing and curse of a first run-through. I will update this piece once I get these points figured out.
That said, the revolution helped fine tune the dental integration process for me. I have been working a bit with a dentist, and I have a bit more insight in terms of what devices they are using for whom.
Let’s go through my big a-ha moments.
The human body is symmetrically asymmetrical. When we have capacity to alternate and reciprocate, we are able to separate the body into parts to form a whole.
If you lack integration, then there are no parts. You have an it. This is how somatosensory smudging works. Lacking parts creates a pattern. A pattern could create a threat to the system, or a threat to the system could create a pattern.
We need to be able to differentiate our parts.
Neck Problems Do Not Exist
The craniocervical region is incredibly mobile for a reason. That reason is to create precision for our sensors: vision, audition, olfaction, respiration, and vestibular sensation. This precision occurs reflexively, whereas other appendages act proprioceptively.
These sensors drive the neck. Losing the ability to sense is what can increase the need for a neck to become stable. And when you can’t move a stable neck, teeth may be one thing you try to use.
In this course, the sensors we focus on are our canines and molars. Canines are transverse-plane antennae; necessary for lateral guidance. Molars, on the other hand, let us know what side we are on (frontal shifting).
Two TMCC Possibilities
Ron spent a much greater amount of time discussing two patterns that were briefly mentioned in previous courses: the left sidebend and right torsion.
These two patterns are possibilities that can occur at the cranium in a right TMCC pattern; and it all depends on what happens at the sphenoid.
The Left Sidebend
The left sidebend pattern is typically what we think of with the RTMCC. The atlas is rotated to the right, the occiput rotated to the left, the sphenoid oriented to the right, and the mandible oriented to the left. This positioning cants the mouth left and upward; creating a counterclockwise facial rotation.
It looks like this:
Test-wise, these individuals are limited in cervical sidebending to the right and axial rotation to the left.
Treatment will consist of developing left sided awareness, especially of occlusion. We want left abs to coactivate with a right SCM to establish neutrality. Here is the base repositioner to do that:
Here is where things get a little crazy. In these individuals the atlas, sphenoid, and mandible are right oriented; with variable positions occurring at the remaining cranial bones. This creates a right mouth cant and a subsequent clockwise facial rotation. This cant begets an over-referenced right sided occlusion which can become difficult to move out of.
It looks like this:
Test-wise these individuals will have bilateral limitations in lateral flexion, yet left axial rotation alone shall be limited.
These individuals will likely need some dental integration due to the over-right lateralized cranial positioning; many of these folks have had craniocervical trauma.
Therapy treatment will involve alternating activity, and here is our repositioner for that:
Splints on Splints
One of the big reasons I took this course again (aside from having a con ed problem) is because I wanted to really iron out who ought to get what splints. I definitely learned a much better appreciation for each splint type PRI recommends, and it was nice to see what new stuff they are using. Here are the big ones.
The PRI MOOO
This splint is the new one PRI is making, which is similar to your typical flat plane splint. The big difference is the anterior portion of the splint is built up to allow for better canine reference. Canines are what allow an individual to twist and turn, so the better we can feel these guys the better triplanar capabilities we will have
Who gets it: RTMCC folks; those who have a hard time finding teeth, more neurologically unstable folks.
The Gelb Splint
This guy is the one I was given. This splint helps bring the mandible slightly forward, creating better craniocervical mobility. There is also a lingual bar to reduce tone on folks with active tongues.
Who gets it: Individuals with narrow bites, active tongues, people who talk a lot throughout the day, one who can protrude the jaw forward, disc issues. Generally people who are fairly stable will get these, as they allow for much more movement freedom compared to the MOOO. Makes sense now why I was given this as I had no patho-compensatory patterns.
This device helps retrude the cranium to improve an airway and is usually worn only at night.
Who gets it: Right torsion patients, those with discal compression, individuals with sleep apnea, prophylactically.
These are the expensive beasts. It is an appliance that is worn around the maxillary and mandibular teeth to promote maxilla expansion and cranial flexion. You will likely need orthodontics after this one, as the teeth have a tendency to move.
Who gets it: Individuals with high palates (bilateral or unilateral), individuals who are very neurologically unstable, excessive disc popping.
So there it is. While it had the first-run bumps, this course’s information is priceless; necessary to truly integrate PRI to it’s fullest potential. Attend, find yourself a dentist, and help some people.
Infamous Ron Quotes
- “There is a lot of feet in your mouth.”
- “Foramen magnum is life.”
- “Upper trap is a thermostat.”
- “I want to twist the hell out of you so you can untwist and enjoy life.”
- “You will never develop abdominal obliques without lateral pterygoids.”
- “Dysautonomia is a bad ebola.”
- “I’m no different than your protoplasm.”
- “If you like feet you gotta like neck.”
- “That’s called vagal sciatica.”
- “Is it okay if I produce and Arnold Chiari syndrome on you?”
- “The best physical therapists are ones who integrate with other disciplines.”
- “The best sensory organ you have is your teeth.”
- “Cervical revolution is a gift.”
- “If you don’t like your spouse give them a NTI.”
- “A hyoid that’s high is a cranium that’s forward.”
- “You stretching out a neck is not going to get a cranium to go back.”
- “The worst thing you can say to a patient is don’t do it.”
- “There is no effectiveness in treating a symptom.”
- “If you have lateral occlusion you poop better.”
Awesome review, I can’t wait to study PRI myself, it seems to answer all the questions I had the traditonal PT cannot account for. I was at the dentist not long ago and I told him about having TMJ problems due to my neck and apparently everything down below…he said it is the other way ’round…that my TMJ is messing with my spine…nah…Whatever…I hope the splint he can make will do at least some good…it’s for the night to sleep…But I was planning to wear it during strength training as well…I saw some bodybuilders do that, I guess they wore it for teeth protection, but it’s a good idea to achieve more neutrality during activities.
Love your blog. Was fortunate enough to work with Doug K and Pat D this past spring up at Peak and see firsthand the effects of PRI with those monsters.
I do have a question regarding the alf appliance and my understanding of it. How does it promote cranial flexion? Does the maxilla expansion allow for further positioning of the mandible, promoting a better airway, allowing for greater cranial flexion?
Appreciate your time.
Appreciate your kind words and glad you got to work with two wonderful people.
The ALF, to my limited understanding, basically decreases tone to the craniofacial complex. That alone can reduce cranial extension. You then use nonmanual techniques to “drive” a different cranial position. But again, I am not the biggest expert on ALF.
Thank you for your readership,