Semispinalis Capitis & Cervicis Trigger Points

Introduction

The semispinalis capitis and cervicis are deep spinal muscles responsible for head and neck extension, rotation, and posture stabilization. When trigger points develop in these muscles, they can cause headaches, neck stiffness, and upper back tension, often mimicking tension headaches, migraines, or cervical spine dysfunction.

Name and Area

  • Name: Semispinalis Capitis & Semispinalis Cervicis

  • Area:

    • Semispinalis Capitis: Located in the posterior neck and upper back, running from the thoracic and cervical vertebrae to the occipital bone (base of the skull).

    • Semispinalis Cervicis: Located beneath the semispinalis capitis, spanning from the thoracic vertebrae to the cervical spine.

Indications

Semispinalis capitis & cervicis trigger points may contribute to:

  • Pain in the back of the head and neck (mistaken for tension headaches or migraines)

  • Pain that radiates to the temples and behind the eyes (can mimic sinus headaches or trigeminal neuralgia)

  • Neck stiffness and limited rotation (difficulty turning the head or looking up)

  • Pain or tension in the upper back and between the shoulder blades

  • Sensitivity to light and screens (common in those with chronic headaches or migraines)

  • Pain that increases with stress, poor posture, or long periods of desk work

Pain from these muscles is often mistaken for cervical radiculopathy, tension headaches, or upper trapezius dysfunction.

Muscle Action

  • Extends the Head and Neck: Lifts the head upward, essential for postural control and gaze stability.

  • Rotates the Neck: Assists in turning the head from side to side.

  • Supports Cervical and Thoracic Stability: Works with other deep neck muscles to maintain posture and control movement.

The semispinalis muscles are crucial for neck function, spinal alignment, and head posture.

Signs and Symptoms

Individuals with semispinalis capitis & cervicis trigger points often report:

  • Pain at the base of the skull that spreads to the temples and forehead (can feel like a "band" around the head).

  • Neck stiffness and limited head rotation (difficulty looking over the shoulder or tilting the head back).

  • Pain behind the eyes or on one side of the head (can resemble migraines or sinus pressure).

  • Headaches that are worse in the morning or after long hours of sitting.

  • Pain or tightness in the upper back and between the shoulder blades.

  • Discomfort that worsens with forward head posture, computer work, or reading.

Pain worsens with prolonged screen time, poor posture, or high levels of stress.

Perpetuating Factors

Common causes of semispinalis capitis & cervicis trigger points include:

  • Forward head posture (common in desk workers, gamers, and smartphone users)

  • Chronic stress or anxiety (can lead to increased neck and shoulder tension)

  • Excessive screen use without proper breaks (strains the neck and upper back muscles)

  • Sleeping in a poor position (can cause neck stiffness and increased tension in the semispinalis muscles)

  • Frequent looking up or down (can cause overuse in certain sports or professions, such as painters or surgeons)

Trigger Point Referral Pattern

Trigger points in the semispinalis capitis & cervicis refer pain to:

  • The back of the head and neck (Can Mimic Tension Headaches or Cervicogenic Pain)

  • The forehead and behind the eyes (Mistaken for Migraines or Sinus Headaches)

  • The upper back and between the shoulder blades (Can Resemble Upper Trapezius or Rhomboid Strain)

Pain from these muscles is often confused with cervical spine dysfunction, migraine headaches, or nerve irritation.

Differential Diagnosis

Semispinalis capitis & cervicis trigger points may be mistaken for:

  • Tension headaches (dull, aching pain that wraps around the head, often worse with stress or poor posture)

  • Migraines (severe, pulsating headaches that may include light sensitivity and nausea)

  • Cervical radiculopathy (pain and numbness that radiates from the neck to the shoulder and arm)

  • Upper trapezius strain (shoulder and neck pain, common in postural strain and stress-related tension)

  • Occipital neuralgia (sharp, shooting pain at the base of the skull that can resemble nerve compression)

A thorough cervical spine, head, and postural assessment is necessary to rule out these conditions.

Associated Trigger Points

Semispinalis capitis & cervicis trigger points often co-exist with:

  • Upper trapezius (neck and shoulder tension, common in postural strain and stress-related pain)

  • Sternocleidomastoid (SCM) (neck and head pain, can mimic migraines or sinus issues)

  • Suboccipital muscles (base of the skull pain, contributes to tension headaches and upper neck stiffness)

  • Levator scapulae (neck and shoulder blade stiffness, common in forward head posture and chronic tension)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Semispinalis Capitis Transverse processes of C4–T6 vertebrae Occipital bone Dorsal rami of spinal nerves (C1–C5)
Semispinalis Cervicis Transverse processes of T1–T6 vertebrae Spinous processes of C2–C5 vertebrae Dorsal rami of spinal nerves (C2–C8)

The semispinalis muscles are innervated by the dorsal rami of cervical spinal nerves, which also control neck extension, rotation, and stability.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the posterior neck, base of the skull, and upper back.

  • Resisted Neck Extension and Rotation Testing: Assess pain and stiffness when tilting the head backward or rotating the head against resistance.

  • Postural Analysis: Look for forward head posture, rounded shoulders, or excessive thoracic kyphosis.

  • Cervical and Occipital Mobility Testing: Rule out nerve compression, cervical spine misalignment, or muscular imbalances.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the semispinalis capitis & cervicis, reducing neck stiffness and improving head mobility.

Manual Therapy

  • Trigger Point Release: Apply gentle sustained pressure along the posterior neck and base of the skull.

  • Myofascial Release: Helps improve circulation and reduce muscle tension in the upper cervical region.

Stretching

  • Neck Extension Stretch: Tilt the head backward gently to relieve tension in the semispinalis muscles.

  • Seated Neck Rotation Stretch: Rotate the head slowly side to side to improve neck mobility.

Strengthening Exercises

  • Chin Tucks (Neck Postural Training): Helps reduce forward head posture and improve cervical alignment.

  • Scapular Retraction Drills: Strengthens the upper back to counteract excessive neck strain.

Postural and Behavioral Adjustments

  • Avoid prolonged forward head posture (keep screens at eye level to reduce neck strain).

  • Use proper ergonomics while sitting (ensure good posture and shoulder alignment).

  • Practice deep diaphragmatic breathing (reduces chronic neck and upper back tension).

Conclusion

Trigger points in the semispinalis capitis and cervicis muscles can significantly contribute to headaches, neck stiffness, and upper back tension. By incorporating dry needling, manual therapy, stretching, and strengthening exercises, individuals can effectively alleviate discomfort from semispinalis trigger points, restore neck mobility, and reduce the frequency of associated headaches and upper back tension.

➡️ Learn more about Trigger Points

➡️ Explore our Trigger Point Index

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.