Facial & Neck Asymmetry Patterns: Right TMCC Relationships To The Left AIC

The Right TMCC Pattern - Overview

The Right TMCC pattern is the portion of the Postural Restoration Institute (PRI)  Left AIC and Right BC pattern from the neck to the cranium.

First let me start by saying that the neck and cranium are complex. Very complex. So I will try to simplify this as much as I realistically can, but keep in mind not all the details are included in this.

I am also not recommend by any means that you use this article to diagnose or treat yourself. Please, please do not think you can solve your neck or cranial issues alone. If you are experiencing these issues, go to posturalrestoration.com and click "Find a Provider" to find someone qualified to address these issues.

The following information is for educational purposes only.

If you would rather watch than read, see below:

Overview of Cranial Bones

Let's start by breaking down some basic anatomy of these areas so we can be on the same page going forward.

The important bones/landmarks we will be discussing are the:

• Occiput

• Temporal Bones

• Sphenoid

• Maxilla

• Mandible (Jaw)

Left Cranial Sidebend

This is the most common presentation that is associated with the Left AIC. PRI refers to this as the Right TMCC pattern.

What we have is a neck that is side-bent to the left and turned slightly left.

This is essentially what happens when we are in "right stance" in gait.

The muscles that are the main players in this pattern are primarily the right Sternocleidomastoid and the right Scalenes:

Notice where they attach. The right Sternocleidomastoid is a significant rotator of the head to the left in the context of the Right TMCC.

Remember that in the Right BC pattern, the right chest wall is depressed and unable to expand as easily upon inhalation relative to the left. So in order to pull air in, we kick on these muscles to elevate the first couple of ribs on the right, which if significant, results in over-activity of these muscles.

The right Sternocleidomastoid helps turn the head left and pulls the temporal bone into internal rotation.

So the cervical spine is pushed up on the right side which tilts the head to the left. This causes a cascade of the following bones:

• The Occiput is higher on the right and turned left and the Atlas (the first cervical vertebrae) is rotated relatively to the right

• The temporal bones are externally rotated on the left, and internally rotated on the right (just like the pelvis!!). You can think of these as your pelvic innominate bones. This pulls the jaw left.

• Sphenoid is rotated right and lower on the left

• Maxilla rotates right

• Mandible moves left because of the temporal bone external rotation on the left

The result of this creates a common facial presentation where:

• The left eye is lower
• Left ear is more prominent from a straight-on view
• Chin going left
• Face is more "compressed" on the left (a "counterclockwise face")

Those with a R TMCC pattern will present with:

• Limited right sidebending (cervical lateral flexion)
• Limited left rotation (cervical axial rotation)
• A harder time moving their jaw to the right 

Exercises For The Right TMCC Pattern

The goals to restore a more neutral cervical spine in the Right TMCC are:

1. Restore a more neutral cervical spine - restore cervical flexion to the right and cervical rotation to the left
2. Bring the occiput down on the right
3. Restore temporal bone internal rotation on the left and external rotation on the right

We can accomplish these goals with an exercise like below. Again, do not do this without guidance from a qualified physical therapist. This is for educational purposes only:

Technique used with permission. Copyright © Postural Restoration Institute®2022. www.posturalrestoration.com

The reason why we rotate the jaw left despite the jaw already being oriented left is because we are keeping the cranium and cervical spine neutral and getting the muscles of the cranium to pull the right temporal bone into external rotation and left into internal rotation.

We also want to usually improve the ability for the neck to flex and relax while promoting expansion of the ribcage via the diaphragm rather than the neck. Here are examples:

Technique used with permission. Copyright © Postural Restoration Institute®2022. www.posturalrestoration.com

Technique used with permission. Copyright © Postural Restoration Institute®2022. www.posturalrestoration.com

Right Cranial Torsion

This occurs as an additional layer of compensation from the Right TMCC pattern. This can occur for a lot of different reasons beyond the scope of this article.

The difference here is that the occiput is now sidebent to the right and moving down, as opposed to the left in the Right TMCC. The sphenoid is still rotating up.

This is theorized to occur via the influence and help of the right upper trap, which can help accomplish that pull of the back of the head to the right.

This additional layer of compensation usually occurs in people who have a PEC pattern and are very extended in their neck on both sides, so they need to learn how to flex their neck and decompress it.

We still have a sphenoid rotated right and higher on the left. Normally we see the sphenoid and occiput rotate in the same direction, but in this case, it's not, which makes it a bit more complex.

Because of the additional bend of the occiput to the right, we tend to see:

• A lower left eye
• Chin going right (a "clockwise face")
• The left ear is often still more prominent, but not always

If a Right Torsion is present, it is even more imperative that the individual seek help of a physical therapist.

Summary

If you have an asymmetrical face or neck, it's not always a problem. It's easy to read this content and think that something is wrong with you, become self-conscious, and/or feel like this needs to be fixed. In the overwhelming, huge majority of people, that isn't the case.

These are the two most common presentations, but there are other variations. However, this is a brief introduction to these concepts and how some people need to work with a qualified practitioner to improve their entire body's movement options. I am suspicious if someone needs cervical/cranial intervention when I am seeing someone who is consistently unable to get changes through your typical PRI drills, or they have a very hard time holding on to adaptations from them.