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Course Review: Cervical Revolution

Written by Kento Kamiyama PT, DPT

TMCC photo

“I want to penetrate your corpus callosum” – Ron Hruska

In late September, I took the advanced course from PRI called Cervical Revolution with Ron Hruska the founder of Postural Restoration Institute (PRI).  In one word, WOW.   Ron Hruska saw something we did not a long time ago.  He has such a different way of thinking that it was difficult to keep up that weekend but somehow…I feel like I came out of it a tad smarter.  To be honest, this course was a little over my head once they went into the cranium and occlusions so I wanted to review a little more before posting a course review.

Cervical Revolution is a relatively new course because it used to be called Craniocervical-mandibular course.  These notes are something I could gather up with a course that needs to be retaken several times to get a good grasp on it.  Anyway…here we go.

**NOTE:  As any course review, the material here does not have comprehensive information.  For further understanding of the course please visit the postural restoration.com website and take the course**

In the beginning of the course some introductory remarks of the cervical cranial complex were reviewed.  Instead of boring you with all the little facts I’ll try to make it as simple as possible.

Some Osteokinematics:

  • Normal C2-7 lordosis is 30-35 degrees
    • Our goal with Cervical revolution is to gain back normal C/S Lordosis
  • Normal C2-7 flexion is 35-40 degrees
  • Normal C2-7 extension is 55-60 degrees
  • Normal Spinal Coupling in the C/S produces ipsilateral spinal coupling in rotation and sidebending. The OA joint, on the other hand, couples contra laterally.  When rotation and side bending is opposite in the C/S it is considered pathological as per the course.
  • C2 serves as an automatic shifting fulcrum or balance point for the mandible.  Hence, C2 stability is crucial for jaw.

C2 stability

 

Cervical Spine Examination Tests:

With any other PRI courses, you learn how to make some orthopedic tests.  In the cervical pattern, the most common pattern is the R TMCC pattern where it usually correlates with a L AIC and R BC pattern.  Here were some of the new tests:

  • Horizontal Abduction Test
    • This is to test HG (Humeralgleno) horizontal abduction test.  In a R TMCC pattern the left is commonly restricted
  • Cervical Extension Test
    • This is a test to check C/S Lordosis.  Its surprising how many necks lost its lordosis when you test it.
  • Cervical Axial Rotation
    • You are looking at lower C/S rotation.   This is cool because I never really thought of just looking at lower C/S Rotation more specifically.  In supine, left lower C/S is more limited due to the positioning we are in with R TMCC/R BC patterns
  • Cervical Lateral Flexion
  • Cervical OA Lateral Flexion

The R TMCC Patterns:

The most common R TMCC patterns include Left side bending and R torsion as per the course.  They do point out that other patterns exists but this is the most common.  After 6 weeks of the course, clinically it seems to be true.

L Side bending

left sidebending

I don’t want to go into too much osteokinematics because… I’m still not certain with some of the mechanics.  I’m getting there but not quite yet.  Simply put it is named when the the left greater wing of the sphenoid is lower.  With these individuals, it is common to see their mandible lateral shifted to the left.

Gary Busey-SGG-082569

Gary Busey seems to be an easy one to see here.  Check his mandible shifted to the left and how his eye line is slanted down to his left.

R Torsion

right torsion

R torsion is when the greater wing is higher on the R while the occiput and sphenoid rotate around an sagittal axis in the opposite direction.  This is usually a pattern that has a history of whiplash, visual instability, significant malocclusions, chronic anteriorly repositioned TMD discs, head trauma and dysautonomia.  For these individuals, usually interdisciplinary work is necessary such as dental or visual work.

http://www.ncbi.nlm.nih.gov/pubmed/16617884
http://www.ncbi.nlm.nih.gov/pubmed/16617884

Note this individuals mandible shifted to the right.  You may see more of this in a PEC/B TMCC patients.  It is recommended to gain neutrality first then get multidisciplinary work to achieve long term results.

Use of a Dentist

ALF appliance

Out of the 2 patterns, R torsions are likely to need this type of work.  One of the greatest thing about this course was learning when it is good to refer out.  I strongly believe in working inter-professionally to improve one’s health.  With all the PRI work, you may get the individual to be neutral.  However, if they have visual disturbances or poor occlusion they may continue to go back to their dysfunctional state.  Utilizing other disciplines can make the process much better.  Good occlusion = good proprioceptive input.

Also try to avoid invisalign products with braces.  Since they try to group the teeth together, they tend to cause dysfunctions.  Who knew?

Miscellaneous Information I enjoyed:

  • There are 200 muscle spindles per gram of muscle in the sub occipital region compared to only 16 muscle spindles per gram in the 1st lumbrical of the hand
  • Most C/S dysfunction is associated with TMD (70%) than TMD alone (29%)
  • The average chewing rate is 79.2 cycles/min.  The slower the chewing rate, the better the masticatory performance and the smaller the food particles achieved (this is more important than you may think).
  • Breathing and TMD is highly correlated such as mouth breathing.  During mouth breathing, the mandible must be lowered, decreasing the tension in the supra hyoid muscles and allowing the hyoid downwards and backwards leading the pharyngeal air passage reducing.  Therefore, to get adequate airflow, one will create forward head posture to bring the hyoid forward and back upwards.
  • Tongue position is important!  It is our more important orthodontic appliance we have.  To maintain good maxilla shape, it is important to keep your tongue up on the roof of the mouth and sitting behind the front teeth
  • If tongue is in the right position, every time you swallow the tongue spreads against the maxilla contributing to good cranial motion
  • When giving PRI correctives, try to keep it as simple as possible.   This is PT 101.  The PRI correctives can be very complicated but if you are a experienced PRI practitioner or clinician, you’ll know how to keep the cueing very simple.  The instructors tend to know how to do that.
  • With corrections of the cervical, it include TMJ, Eyes, Cervical and breathing coordination.  All the rest of the correctives you learned in Postural/Pelvis/Myokin are important because it ultimately needs to be performed with….yes good breathing.

There was SO much depth to this course I definitely need to take it again.

Happy Monday!

 

 

 

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