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lets begin by talking about the primary respiratory mechanism also known as the prm there are five components of the prm that you need to memorize for comlex the first is the fluctuation of the cerebrospinal fluid the second is the inherent motion of the brain and spinal cord the third is the articular mobility of the cranial bones the fourth is the tension of the dora which is referred to as the reciprocal tension membrane and the fifth and final element is the motion of the sacrum between the ilia now dont get confused here because a lot of medical students fail to conceptualize what the prm really is but big the big picture here is that between the cranium and the sacrum and everything that connects them you can have the flow of cerebrospinal fluid the movement of certain bodily fluids and the movement of the individual bones that make up the cranium and that make up the sacrum so that if theres somatic dysfunction at the cranium it affects the sacrum if theres somatic dysfunct