Splenius Cervicis Trigger Points

Introduction

The splenius cervicis is a deep neck and upper back muscle responsible for head and neck extension, rotation, and postural stability. When trigger points develop in this muscle, they can cause neck pain, headaches, and upper back stiffness, often mimicking cervicogenic headaches, tension headaches, or cervical radiculopathy.

Name and Area

  • Name: Splenius Cervicis

  • Area: Located in the posterior neck and upper back, running from the thoracic vertebrae (T3–T6) to the transverse processes of the cervical vertebrae (C1–C3).

Indications

Splenius cervicis trigger points may contribute to:

  • Pain in the Neck and Upper Back (Mistaken for Trapezius Strain or Thoracic Spine Dysfunction)

  • Pain That Radiates to the Side of the Neck and Behind the Eyes (Can Mimic Migraines or Tension Headaches)

  • Neck Stiffness and Limited Rotation (Difficulty Turning the Head or Looking Up)

  • Pain or Tension That Worsens with Stress, Forward Head Posture, or Long Hours at a Desk

  • Discomfort in the Shoulder Blade Area (Can Feel Like a "Knot" Between the Shoulder Blades)

  • Pain That Worsens with Sudden Head Movements or Sleeping in an Awkward Position

Pain from this muscle is often mistaken for cervical radiculopathy, tension headaches, or thoracic spine dysfunction.

Muscle Action

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

  • Rotates the Head to the Same Side: Assists in 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 cervicis is crucial for neck function, spinal alignment, and upper back stability.

Signs and Symptoms

Individuals with splenius cervicis trigger points often report:

  • Pain That Starts in the Neck and Travels to the Shoulder Blade and Upper Back

  • Headaches That Originate from the Neck and Extend to the Temples or Behind the Eyes

  • Stiffness That Makes It Difficult to Rotate the Head or Tilt the Neck Back

  • Pain That Worsens After Long Periods of Computer Work, Driving, or Reading

  • A "Burning" Sensation in the Upper Back or Shoulder Blade Region

  • Pain That Feels Worse in the Morning or After Sleeping in an Awkward Position

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

Perpetuating Factors

Common causes of splenius cervicis trigger points include:

  • Forward Head Posture (Common in Desk Workers, Gamers, and Smartphone Users)

  • Chronic Stress or Anxiety (Leads to Increased Neck and Shoulder Tension)

  • Sleeping in an Awkward Position (Can Cause Morning Stiffness and Neck Pain)

  • Frequent Overhead Movements (Repetitive Neck Extension Can Strain the Splenius Cervicis)

  • Weak Upper Back and Shoulder Muscles (Can Force the Splenius Cervicis to Overcompensate for Stability)

Trigger Point Referral Pattern

Trigger points in the splenius cervicis refer pain to:

  • The upper neck and behind the eyes (Can Mimic Tension Headaches or Cervicogenic Pain)

  • The shoulder blade and upper back (Mistaken for Trapezius or Rhomboid Dysfunction)

  • The side of the neck (Can Resemble SCM Dysfunction or Thoracic Outlet Syndrome)

Pain from this muscle is often confused with tension headaches, cervical spine dysfunction, or nerve compression.

Differential Diagnosis

Splenius cervicis trigger points may be mistaken for:

  • Cervicogenic Headaches (Headaches That Originate in the Neck and Travel to the Temples and Forehead)

  • Tension Headaches (Dull, Aching Pain That Wraps Around the Head, Worsens with Stress or Poor Posture)

  • Cervical Radiculopathy (Neck Pain with Radiating Symptoms Into the Shoulder and Arm, Due to Nerve Compression)

  • Thoracic Outlet Syndrome (Pain, Numbness, or Weakness in the Shoulder and Arm Due to Nerve or Vascular Compression)

  • Trapezius or Rhomboid Strain (Upper Back and Shoulder Blade Pain, Common in Poor Posture and Overuse Injuries)

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

Associated Trigger Points

Splenius cervicis trigger points often co-exist with:

  • Splenius Capitis (Headaches and Neck Pain, Common in Postural Strain and Chronic Stress)

  • Upper Trapezius (Neck and Shoulder Tension, Contributes to Forward Head Posture and Upper Back Pain)

  • Sternocleidomastoid (SCM) (Neck and Head Pain, Can Mimic Migraines or Sinus Pressure)

  • Levator Scapulae (Neck and Shoulder Blade Stiffness, Common in Forward Head Posture and Chronic Tension)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Splenius Cervicis Spinous processes of T3–T6 Transverse processes of C1–C3 Dorsal rami of cervical spinal nerves (C2–C6)

The splenius cervicis is innervated by the dorsal rami of cervical spinal nerves (C2–C6), which also control head rotation, neck extension, and postural stabilization.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the posterior neck, upper back, and shoulder blade.

  • 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 cervicis, reducing neck stiffness and improving head mobility.

Manual Therapy

  • Trigger Point Release: Apply gentle sustained pressure along the posterior neck and upper back.

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

Stretching

  • Neck Extension Stretch: Helps lengthen the splenius cervicis and reduce forward head posture.

  • Seated 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 cervicis plays a crucial role in neck function, postural control, and upper cervical stability, but trigger points in this muscle can cause significant neck pain, headaches, and upper back tension. 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.