Splenius Capitis Trigger Points

Introduction

The splenius capitis is a deep neck muscle responsible for head extension, rotation, and posture stabilization. When trigger points develop in this muscle, they can cause headaches, neck stiffness, and upper back tension, often mimicking cervicogenic headaches, migraines, or upper trapezius strain.

Name and Area

  • Name: Splenius Capitis

  • Area: Located in the posterior neck, running from the spinous processes of C7–T3 to the mastoid process of the skull.

Indications

Splenius capitis trigger points may contribute to:

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

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

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

  • Pain or tension in the upper back and shoulder region

  • Increased sensitivity to light and screens (common in chronic headache sufferers)

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

Pain from this muscle is often mistaken for cervical spine dysfunction, migraine headaches, or upper trapezius tension.

Muscle Action

  • Extends the Head and Neck: Tilts the head backward, important for postural control and gaze stability.

  • Rotates the Head to the Same Side: Allows turning the head and looking over the shoulder.

  • Supports Cervical and Upper Back Stability: Works with other deep neck muscles to maintain alignment and movement control.

The splenius capitis is crucial for head posture, neck function, and upper spinal mechanics.

Signs and Symptoms

Individuals with splenius capitis trigger points often report:

  • Pain at the base of the skull that spreads to the temples and forehead

  • Tension in the back of the neck that feels like a "tight band"

  • Headaches that start in the neck and extend to the temples or behind the eyes

  • Neck stiffness that makes it difficult to rotate or tilt the head

  • Pain that feels worse after long hours of sitting, driving, or reading

  • Discomfort that worsens with stress, poor posture, or heavy shoulder bags

Pain worsens with forward head posture, prolonged screen time, or repetitive neck movements.

Perpetuating Factors

Common causes of splenius capitis 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)

  • Sleeping in an awkward position (can cause morning stiffness and neck pain)

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

  • Whiplash injuries or sudden neck movements (can trigger or aggravate existing muscle tension)

Trigger Point Referral Pattern

Trigger points in the splenius capitis refer pain to:

  • The base of the skull and upper neck (Can Mimic Cervicogenic Headaches or Neck Stiffness)

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

  • The upper back and shoulder region (Can Resemble Upper Trapezius Strain or Postural Fatigue)

Pain from this muscle is often confused with tension headaches, migraine triggers, or cervical spine issues.

Differential Diagnosis

Splenius capitis trigger points may be mistaken for:

  • Tension headaches (dull, aching pain that wraps around the forehead and temples, worsens with stress)

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

  • Cervical radiculopathy (pain and nerve symptoms that radiate from the neck to the shoulder and arm)

  • Upper trapezius strain (shoulder and neck pain, common in postural dysfunction and overuse injuries)

  • Occipital neuralgia (sharp, shooting pain at the base of the skull, often related to nerve compression)

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

Associated Trigger Points

Splenius capitis trigger points often co-exist with:

  • Upper trapezius (neck and shoulder tension, common in forward head posture and chronic stress)

  • 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 chronic tension and poor posture)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Splenius Capitis Spinous processes of C7–T3 Mastoid process of the temporal bone, occipital bone Dorsal rami of cervical spinal nerves (C2–C4)

The splenius capitis is innervated by the dorsal rami of cervical spinal nerves (C2–C4), which also control head extension, neck movement, and postural stabilization.

Patient Examination

A comprehensive examination should include:

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

  • Resisted Neck Extension and Rotation Testing: Assess pain and stiffness when tilting the head backward or turning 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 splenius capitis, 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

  • Chin Tuck Stretch: Helps lengthen the splenius capitis and reduce forward head posture.

  • Neck Rotation Stretch: Rotate the head slowly side to side to improve mobility and reduce stiffness.

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

The splenius capitis plays a crucial role in head movement, postural control, and upper cervical stability, but trigger points in this muscle can cause significant headaches, neck stiffness, and upper back discomfort. By incorporating dry needling, manual therapy, stretching, and postural correction, individuals can reduce pain, improve mobility, and prevent chronic neck dysfunction.

➡️ 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.