Understanding the Four Quadrants: The Foundation of Dystonia Recovery

This article is based on a video originally published on the Hope for Dystonia YouTube channel.

If you're living with dystonia—particularly in your head, neck, or face—you've probably felt overwhelmed by how complex and mysterious your symptoms seem. There are anatomical factors, emotional dimensions, neurological patterns, and countless questions about where to even begin.

What if there was a framework that could help you make sense of it all? A way to understand the intricate interplay of your cranial nerves and how your brainstem distributes muscle tone throughout your body?

The four quadrants framework is exactly that: the ABCs of understanding dystonia patterns. It's a practical, empowering lens that transforms confusion into clarity—and clarity into the possibility of change.

Watch the Full Video

How to Decode Cervical Dystonia: Neck, Jaw & Eye Quadrants Explained

Why the Four Quadrants Matter for Your Dystonia

The four quadrants framework is particularly relevant if you have:

• Cervical dystonia (neck pulling or twisting)
• Oromandibular dystonia (jaw dystonia)
• Facial dystonia (facial muscle spasms)
• Generalized dystonia (affecting multiple body areas)

These forms of dystonia all share a common underlying mechanism: chronic dysregulation of your cranial nerves—the fundamental pathways that help you perceive and regulate your body, understand your place in space, and maintain balance.

When dystonia affects your head, neck, or entire body, the cranial nerves are the first systems to become chronically imbalanced. Understanding how these nerves interact through the lens of the four quadrants gives you a roadmap for recovery.

What Are the Four Quadrants?

The four quadrants framework simplifies the complex interplay of cranial nerves and how your brainstem decides to distribute neural activity, muscle tone, and movement throughout your head, neck, and body.

The Basic Division:

We divide the head and neck into four sections:

• Front right
• Front left
• Back right
• Back left

This quadrant pattern appears in three interconnected areas:

1. The Neck Quadrants

Back quadrants: Trapezius muscles and posterior neck musculature Front quadrants: Sternocleidomastoid (SCM) muscles and anterior neck structures Side areas: Lateral neck muscles connecting front and back

These quadrants help you orient to what's overused versus underused in your neck. They show you where chronic tension concentrates and where activation is absent.

2. The Jaw Quadrants

Your occlusal force—the biting pressure your jaw creates—distributes across four quadrants:

• Front right and front left (anterior teeth)
• Back right and back left (molars and posterior teeth)

Understanding this distribution reveals which areas of your jaw are working excessively and which have essentially "gone to sleep."

3. The Eye Movement Quadrants

As your eyes track movement through space, four quadrants emerge:

• Top right and top left (superior gaze)
• Bottom right and bottom left (inferior gaze)

Certain quadrants will feel smooth and easy to track through. Others will feel rigid, skipping, or nearly impossible to access.

The Cranial Nerves Behind the Quadrants

The four quadrants framework works because it maps directly onto how your cranial nerves function:

11th Cranial Nerve (Accessory Nerve): Innervates the major neck muscles responsible for turning and tilting your head

5th Cranial Nerve (Trigeminal Nerve): Controls jaw muscle tone, bite distribution, and jaw position

3rd, 4th, and 6th Cranial Nerves (Oculomotor, Trochlear, Abducens): Govern eye movements in all directions

All these cranial nerves connect to your brainstem—the fundamental part of your central nervous system responsible for:

• Regulating your sense of safety
• Maintaining basic physiological functions
• Coordinating sensory and motor information
• Managing overall nervous system balance

How Cranial Nerve Imbalances Create Dystonia Patterns

When one set of cranial nerves encounters difficulty, other cranial nerves compensate to maintain function and balance. This compensation pattern has a tendency to spread.

The Compensation Cascade

Here's a typical progression:

Stage 1: Jaw Imbalance One side of your jaw develops excessive tension. The condyle (end of the jawbone) presses asymmetrically into the temporomandibular joint (TMJ) on that side.

Stage 2: Neck Compensation Your brain notices the jaw asymmetry and attempts to compensate by adjusting neck muscle tone. The SCM muscle on the same side becomes overactive to balance the system.

Stage 3: Eye Pattern Involvement The same asymmetry pattern reflects in your eye movements. Certain quadrants become rigid while others remain relatively free.

Stage 4: Whole-Body Effects As the pattern becomes more entrenched, it influences posture, gait, and muscle tone throughout your body.

This cascade happens because cranial nerves essentially "steal electricity" from each other when the brainstem determines that one side needs more support than the other.

Mapping Your Own Four Quadrants: A Practical Guide

Understanding your unique quadrant pattern is the first step toward creating change. Here's how to assess each area systematically.

Mapping Your Neck Quadrants

What You'll Do: Use your hands to feel patterns of tension and muscle development in your neck.

Back Quadrants Assessment:

• Place your hands on the back of your neck
• Feel into the trapezius and posterior muscles
• Notice which side feels bulkier, tighter, or more developed
• Identify if you tend to overuse these muscles to tilt your head back

Front Quadrants Assessment:

• Locate your SCM muscles (the prominent muscles running from behind your ear down to your collarbone)
• Feel for differences between right and left
• Notice if one pulls you forward or turns your head more than the other

Side Quadrants Assessment:

• Check the lateral neck muscles on both sides
• Identify if something is tilting your head toward one shoulder
• Notice patterns of holding or bracing

What You're Looking For:

• Muscles that feel bulkier than their counterparts
• Areas of chronic tension or hardness
• Patterns that pull your head in specific directions
• Asymmetries in muscle tone and development

Mapping Your Jaw Quadrants

What You'll Do: Use your hands and simple proprioceptive testing to identify bite pressure distribution.

Hand Palpation:

1. Gently bring your teeth together
2. Place your hands on your jaw muscles (masseter muscles on the sides of your face)
3. Feel for:
• Which side feels bulkier or more developed
• Areas of increased tension or hardness
• Warmth (indicating overuse)
• Asymmetry between right and left

Paper Test:

1. Take a small piece of paper (or paper towel)
2. Place it between different areas of your teeth
3. Bite down gently
4. Notice where you feel the strongest pressure
5. Identify which quadrants are working hardest

What You're Looking For:

• Where your occlusal force concentrates
• Which quadrants feel "active" versus "sleeping"
• Asymmetries in how your teeth meet
• Areas of chronic clenching or grinding

Mapping Your Eye Movement Quadrants

What You'll Do: Track smooth eye movements through all four quadrants to identify restrictions.

The Circle Test:

1. Ask a friend to help or film yourself with your phone
2. Keep your head completely still
3. Follow a finger (or pen) as it traces a large circle
4. Go all the way to the edges of your visual field
5. Complete one circle per eye
6. Move slowly and deliberately

What You're Looking For:

• Rigid spots: Areas where your eyes feel stuck or resistant
• Skipping: Places where your eyes can't smoothly track and jump instead
• Restrictions: Quadrants that feel like hitting a wall
• Neck involvement: Places where your neck wants to turn to help your eyes
• Asymmetry: Differences between right and left eye tracking

Recording Your Findings:

Note which quadrants show:

• Rigidity (overactive, tight, resistant)
• Weakness (skipping, uncertain, difficult to access)
• Smoothness (relatively balanced and functional)

Understanding Your Quadrant Matrix

Once you've mapped all three areas—neck, jaw, and eyes—you'll notice something remarkable: correspondences emerge.

Common Correspondence Patterns

Example Pattern 1:

• Jaw: Excessive pressure in back right quadrant
• Neck: Significant tension in back right trapezius and upper neck
• Eyes: Rigidity in top right quadrant, especially with the right eye

Example Pattern 2:

• Jaw: Overactive left side with prominent masseter muscle
• Neck: Left SCM pulls head into slight rotation
• Eyes: Difficulty tracking smoothly to the left side

These correspondences aren't coincidental. They reflect how your brainstem is organizing muscle tone and neural activation across interconnected systems.

Your quadrant matrix reveals:

• Which patterns are driving your dystonia
• Where compensation is happening
• Which areas need rebalancing
• Where to focus your retraining efforts

From Understanding to Action: Retraining Your Quadrants

Once you have clarity about your patterns, you can begin the heart of the Hope for Dystonia method: awakening sleeping pathways and making new patterns your default.

The Retraining Principle

Current Pattern: Certain quadrants are chronically overactive (rigid, tight, dominant) while others are underactive (weak, sleeping, forgotten).

Goal: Balance activation across all four quadrants by:

• Engaging sleeping pathways
• Releasing overactive patterns
• Teaching your brain new distribution options

Practical Retraining Examples

Jaw Quadrant Rebalancing:

If you notice you clench primarily on the right side and barely use the left:

1. Practice chewing intentionally on the underused (left) side
2. Use paper towel pads to create space on the overactive side
3. Apply gentle pressure on the underused side to "wake it up"
4. Use tools like beeswax, folded paper towels, or pharmacy appliances to redistribute bite pressure

The goal isn't to force your jaw into a new position, but to give your brain the proprioceptive input it needs to explore new patterns.

Eye Quadrant Rebalancing:

If certain quadrants feel rigid or skip:

1. Release jaw tension first (jaw and eyes are deeply connected)
2. Practice slow, deliberate tracking through restricted quadrants
3. Use your finger as a target and move it slowly through difficult areas
4. Notice when your neck wants to compensate and gently return to using just your eyes
5. Celebrate small improvements in smoothness and range

Neck Quadrant Rebalancing:

If you habitually turn your head one direction and can't easily access the other:

1. Start with jaw and eye rebalancing (these influence neck patterns)
2. Approach neck work from a place of regulation and presence
3. Practice bringing gentle "aliveness" to sleeping SCM or other underused muscles
4. Use proprioceptive supports:
• Hand massage on forgotten areas
• Gentle vibration to increase awareness
• Kinesiology tape to enhance sensory feedback
5. Explore what it feels like to engage underused quadrants playfully, not forcefully

The Synergistic Effect: How the Three Areas Support Each Other

One of the most powerful aspects of the four quadrants framework is that progress in one area facilitates progress in the others.

Starting Where It's Easiest

You don't have to work on all three areas simultaneously. Start with whichever feels most accessible:

If your eyes are easiest: Begin with eye movement retraining. As you bring more balance to eye quadrants, you'll often notice:

• Your jaw spontaneously releases some tension
• Your neck feels more open and mobile
• Movements that seemed impossible become available

If your jaw is most accessible: Focus on jaw quadrant balancing first. Jaw work often has profound effects on:

• Neck muscle tone distribution
• Eye tracking smoothness
• Overall sense of grounding and safety

If your neck is less affected: Use neck quadrant work as your entry point. As you bring symmetry to neck patterns:

• Jaw clenching may naturally reduce
• Eye movements can become smoother
• The whole system finds more ease

The key is that all three areas are interconnected through your brainstem. Progress in one area creates ripples of change throughout the system.

The Cranial Quadrant Balancing (CQB) Exercise

In the Hope for Dystonia Self-Healers Academy, the Cranial Quadrant Balancing (CQB) exercise is a foundational practice that integrates all three quadrant areas into a comprehensive retraining protocol.

The CQB teaches you to:

• Systematically assess all quadrants in real time
• Practice redistributing activation across jaw, eyes, and neck
• Develop deep proprioceptive awareness
• Create new default patterns through repetition
• Monitor your progress over time

This isn't about forcing your body into an "ideal" position. It's about giving your nervous system the information and practice it needs to reorganize around more balanced patterns.

Key Principles for Successful Quadrant Retraining

1. Approach from Regulation, Not Force

Retraining works best when you're in a regulated, curious state—not when you're forcing yourself through exercises while dysregulated.

Before practicing:

• Ground yourself in your body
• Take several deep breaths
• Connect with an intention of exploration and play
• Release the urgency to "fix" yourself

2. Small Changes Matter

Even a 5% shift in quadrant balance is meaningful progress. Your nervous system learns through gradual accumulation of new experiences—not through dramatic overnight transformations.

Celebrate subtle improvements:

• Slightly less tension in an overactive area
• Brief moments of accessing a sleeping quadrant
• Increased awareness of your patterns

3. Proprioceptive Input Is Your Friend

Use external supports to help your brain understand new patterns:

• Paper towel pads to create space in overactive jaw quadrants
• Popsicle sticks or chopsticks to engage underused areas
• Hand palpation to increase awareness
• Vibration tools to wake up sleeping muscles
• Kinesiology tape to enhance sensory feedback

These aren't crutches—they're teaching tools that accelerate learning.

4. Consistency Over Intensity

Regular, gentle practice is far more effective than occasional intense sessions. Your brain learns new patterns through repetition in safe, regulated states—not through exhausting effort.

5. Trust the Interconnection

You don't have to work on all three areas equally. Trust that progress in one area will support the others. Follow what feels most accessible and let the synergy unfold naturally.

Common Quadrant Patterns in Different Forms of Dystonia

While each person's pattern is unique, certain tendencies emerge for specific dystonia types:

Cervical Dystonia Patterns

Typical Presentation:

• Back right or back left jaw quadrant dominance
• Corresponding posterior neck quadrant tension
• Rigidity in top quadrants of eye movement (especially on the dominant side)

What This Reveals: The pulling pattern often originates from jaw asymmetry that cascades into neck compensation.

Oromandibular Dystonia Patterns

Typical Presentation:

• Extreme asymmetry in jaw quadrants (one or two quadrants doing almost all the work)
• Variable neck involvement depending on severity
• Eye tracking difficulties that mirror jaw imbalances

What This Reveals: The jaw is the primary driver, but whole-system rebalancing supports more sustainable recovery.

Generalized Dystonia Patterns

Typical Presentation:

• Multiple quadrant imbalances across all three areas
• Complex compensation patterns
• Whole-body postural and movement effects

What This Reveals: Comprehensive work across jaw, eyes, and neck becomes essential, with careful attention to regulation and pacing.

Beyond Mechanics: The Nervous System Context

While the four quadrants framework is highly practical and mechanical, it exists within a larger nervous system context.

Why Quadrants Become Imbalanced

Quadrant imbalances don't emerge in a vacuum. Common contributing factors include:

Anatomical/Physical:

• Dental work that altered bite patterns
• Jaw injuries or TMJ disorders
• Visual imbalances or eye strain
• Postural habits and compensation patterns

Developmental/Relational:

• Chronic stress and anxiety in childhood
• Teeth grinding as a nervous system outlet
• Lack of safe regulation in early relationships
• Perfectionism and high achievement pressure

Traumatic:

• Physical injuries to head, neck, or jaw
• Medical procedures or surgeries
• Accidents or impacts
• Prolonged pain or medical stress

Understanding these contexts doesn't change the retraining work, but it helps you approach yourself with compassion and recognize that your dystonia pattern made sense given what your nervous system encountered.

The Hope for Dystonia Method: Comprehensive Recovery

The four quadrants framework is one piece of a larger, integrated approach to dystonia recovery that includes:

1. Cranial Nerve Understanding Deep knowledge of how your 12 pairs of cranial nerves function and interact
2. Biomechanical Retraining Practical tools for rebalancing jaw, eye, and neck patterns
3. Nervous System Regulation Building capacity for safety, rest, and parasympathetic recovery
4. Embodied Attachment Work Addressing developmental patterns that contribute to chronic activation
5. Sovereignty and Self-Direction Learning to trust your own felt sense and guide your healing

This integrated approach recognizes that lasting recovery addresses multiple levels simultaneously—not just the mechanics, but the whole person.

Who Is the Four Quadrants Framework For?

This framework is particularly valuable if:

Your Dystonia Involves:

• Cervical (neck) symptoms
• Oromandibular (jaw) symptoms
• Facial dystonia or spasms
• Blepharospasm (eyelid involvement)
• Generalized dystonia affecting multiple areas

Your Approach to Healing:

• You want practical tools for understanding your patterns
• You value clarity over mystery
• You're willing to develop embodied awareness
• You prefer self-direction over passive treatment
• You recognize that recovery is a process, not an event

Your Current Experience:

• Dystonia feels overwhelming and confusing
• You don't know where to start
• Previous treatments haven't addressed root patterns
• You sense your symptoms are interconnected but don't understand how

Getting Started: Your First Steps with the Four Quadrants

Step 1: Map Your Patterns

Using the assessment protocols in this article:

• Map your neck quadrants with hand palpation
• Map your jaw quadrants with teeth together and paper testing
• Map your eye quadrants with the circle tracking test
• Record your findings in detail

Step 2: Identify Correspondences

Look for patterns across all three areas:

• Which quadrants are consistently overactive?
• Which are consistently underactive?
• What connections do you notice?

Step 3: Choose Your Entry Point

Decide which area feels most accessible:

• Eyes (often easiest to access consciously)
• Jaw (highly effective for cervical dystonia)
• Neck (good if it's less severely affected)

Step 4: Begin Gentle Retraining

Start with small, exploratory practices:

• 5-10 minutes daily of quadrant awareness
• Use proprioceptive supports (paper, hands, etc.)
• Approach from curiosity, not force
• Notice even subtle changes

Step 5: Track Your Progress

Keep notes on:

• Changes in tension patterns
• Moments of accessing sleeping quadrants
• Improvements in symmetry
• Overall sense of regulation

Deepening Your Practice: The Self-Healers Academy

The four quadrants framework is introductory material—a taste of what becomes possible with deeper training.

The Hope for Dystonia Self-Healers Academy provides:

Comprehensive Quadrant Training:

• Full Cranial Quadrant Balancing (CQB) exercise protocol
• Video demonstrations and guided practices
• Progressive retraining sequences
• Detailed troubleshooting

Integration with Other Methods:

• Occlusal adjustment guidance
• Eye movement retraining protocols
• Neck proprioception practices
• Nervous system regulation tools

Ongoing Support:

• Community of others doing this work
• Coaching and guidance
• Resources for navigating challenges
• Accountability and encouragement

This is work for people who want to take their healing into their own hands—who want to understand deeply and practice consistently.

Your Next Step: The Free Recovery Roadmap

If the four quadrants framework resonates with you—if you're ready to move from confusion to clarity about your dystonia patterns—we invite you to download the Hope for Dystonia Recovery Roadmap.

This free resource includes:

• The eight steps of dystonia recovery
• Introduction to the four quadrants and cranial nerve mapping
• Overview of the Self-Healers Academy
• Free preview of core exercises including the CQB

Download the Free Recovery Roadmap →

There's no pressure or urgency. Just an invitation to explore whether this path of understanding, embodiment, and self-directed healing feels right for you.