The Right TMCC Pattern

Okay, this one has been a long time coming. I don't think enough is really written about this pattern, so I'll do my best to fill in some of the gaps that I think are out there.
The Temporal Mandibular Cervical Chain (TMCC) pattern is described by the Postural Restoration Institute™ (PRI) somewhat more abstractly than the Left AIC Pattern or the Brachial Chain patterns, and there's no description of it in the primary course manuals. In fact, it wasn't until my 11th (wow) PRI course taken that I even saw a description of it in the front of a manual. This is deliberate, because it shouldn't be the first place for a therapist to run to and attempt to make changes. For the vast majority of people, repositioning and repatterning the bigger, lower chains makes all the difference. Why would you try to straighten the Leaning Tower of Pisa by renovating the top floor? With that said, the neurology of posture really does start up here so it's worth having a look-over.

There are 8 muscles in this chain: longus capitis, obliquus capitis, rectus capitus posterior major, rectus capitus anterior, temporalis, masseter and medial pterygoid. All the capitus muscles attach the neck to the occiput and control Occiput on Atlas (OA) position. The temporalis, masseter and medial pterygoid attach the mandible and temporal bones to each other. Between the two sets, they stabilise the head & neck through the jaw and control the pressure in the cranium and sinuses. A stabilised head and neck allows for compensatory speech, shoulder movement, breathing and chewing patterns - at the expense of neck freedom, clenching and grinding teeth and neurological issues at the face, neck or shoulder. I think it goes without saying that humans do much better in their lives when they have the ability to turn this muscle chain off as needed.

Effects on Posture

By far the most common overuse of the TMCC pattern is on the right side. It can show up a few ways posturally, but most often I see it as an asymmetrical or torsioned face. The face is supposed to be asymmetrical, and our face-recognition neurology doesn't tend to make judgements on the position of things like eyes and cheek bones, and in a well-functioning human the asymmetry should reverse a little when switching the stance leg. So on the right leg, the right eye socket is a little higher and the jaw shifts left creating a kind of clockwise rotation of the face. On the left leg, the left eye socket would be a little higher and the jaw shifts right creating a counter-clockwise rotation of the facial features. Commonly when this pattern doesn't shut off, the face doesn't rotate when the body shifts. So one eye will stay higher than the other regardless of what leg is supporting the body. If the eye sockets are doing different things than the jaw or mouth, that's a torsion which is a 'broken' or bilateral version of the Right Brachial Chain Pattern. Torsions are more difficult to address and usually require integration with a dentist to get the teeth to support the skull properly using a mouthguard or splint.

Effects on Range of Motion

ROM testing in as relaxed a position as possible - ideally supine - is the best way to check these patterns. It's important to test the motion of the neck without allowing the movement of the head to 'make up for' limitations in neck motion. This pattern will tend to show up as

• Limited rotation of the base of the neck
• Limited side-flexion of the mid-neck (C4)
• Unable to extend the mid-neck (C4) without the head extending also (the head and neck are locked together)
• Limited side-flexion of the occiput on the atlas
• Actively shifting the lower jaw side-to-side is more limited in one direction

Treatment

There are a few ways that the TMCC gets addressed, and I'd only look at it if either

1. We'd done a repositioning of the pelvis AND of the thorax and the neck was still not neutral
2. The repositioning of the pelvis didn't work AND the repositioning of the thorax didn't work
3. The history and story someone was coming in with suggested that this chain would get in the way of treatment (They've had canines or molars removed, LASIK, autonomic issues or dysautonomia, dizziness or vestibular issues etc.)

In my experience, once we start working with the TMCC weird things can happen. Letting a TMCC go can change your voice, make you dizzy, alter your vision and more. Sometimes a manual cranial technique is required, or for a more complex torsion a visit to an osteopathic manual practitioner. If the changes don't stick, it's often because the sensations from the way the teeth touch (occlusion) are overriding everything. An integration session or two with a dentist to create and fit a splint or mouthguard that rearranges the way the teeth touch can be required to keep this chain in a place where it can shut off.

Once the TMCC knows how to shut off, upright movement with arm reaching and shoulder blade movement is needed to reprogram and repattern this chain, as well as re-patterning the movement of the lower jaw from side to side and the ability for the head and neck to remain free while the body moves underneath it. For this reason, we'll usually address repatterning the neck and jaw only AFTER the pelvis and ribcage have learned to repattern themselves.

If you think you might have some TMCC stuff going on, AND you've had a try of repositioning or repatterning some of the other patterns without success, you can always reach out and apply to work with me and get my thoughts on what could help.