Shedding Light on the Sub-Occipital Muscles

Anatomists Corner By Thomas Myers Illustrations by Andrew Mannie Originally published in Massage & Bodywork magazine, October/November 2002. Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved. This issue we begin a series of columns in which we will explore topics related to the Anatomy Trains Myofascial Meridians concept, something I've coined and explored in my book, Anatomy Trains. To begin, let's examine a crucial area of the myofascial meridian called the Superficial Back Line (SBL). The SBL is a ribbon of fascial and muscular continuity that begins with the plantar fascia and short toe flexors beneath the arches of the foot, wrapping around the heel to the soleus and gastrocnemii of the lower leg. The gastrocs interlock with the hamstrings, which are in turn continuous with the sacrotuberous ligament, which feeds into the sacral fascia. The sacral fascia is the fascial anchor for the back muscles that traverse the spine, and it is the very top muscles of this group to which we will turn our attention in this column. The SBL, however, continues on beyond the occipital ridge, up along the top of the skull with the epicranial fascia, including both the occipitalis and frontalis muscles, until it attaches at its other end, the brow ridge just above the eye socket.

The Superficial Back Line (SBL) is a continuous line of myofascial connections which run up the back of the body from the underside of the toes to the forehead.

While the sacral fascia may be the structural center of the SBL halfway between the foot's sole and eyebrow, the functional center is really just beneath the skull in the suboccipital muscles. Generally, the muscles that span the spine can be divided into the erector spinae, which are more superficial and cover many segments of spinal movement, and the transversospinalis muscles, which are shorter and deeper and are generally used more for orientation and stability rather than brute strength. Our focus for this column is a set of four muscles at the very top of the transversospinalis -- tiny, hard to reach and differentiate, but mighty in their effect on posture and movement. As we approach the back of the neck, we must first work our way through the more superficial levels of musculature. Most superficial is the trapezius, which sweeps down and out from the occiput and the nuchal ligament at the top of the neck. I am sure everyone can feel this muscle (and all its trigger points) easily (Fig 2).

The most superficial muscle of the back of the

neck, the trapezius, runs at this level like the branches of

The second layer in holds the splenius capitis and cervicis, which sweeps down and in from the mastoid processes to the spinous processes of the lower neck, acting on the skull like the reins on a horse to turn it right and left (Fig 3).

The erector spinae are three sets of muscles which together span the entire spine from the sacrum to the occiput, designed to resist the body's tendency to trunk flexion.The spinalis is the most medial, a thin little series running from spinous process to spinous process. The middle ones, the longissimus, form the cables you can feel on anyone's back. The most lateral, the iliocostalis, run from the hip bone to each of the ribs.

To feel this level of muscle, have your client lie supine and let your fingers sink into the tissue just behind and below the mastoid process on both sides. Let your thumbs go up the side of the client's skull so that when he turns his head, it comes against your thumb's gentle resistance. Have him rotate right and left, and you will feel the splenii tense under your fingertips. If you don't give resistance to the motion, it will be hard to separate out the muscles. Just slightly deeper is the semipinalis, a straight up-and-down cable that can be easily felt through the trapezius by strumming across the back of the neck about an inch below the occiput and an inch or so out from the midline (Fig 4).

The transversospinalis are smaller and deeper than the erector spinae.Taken together, they form a small rope that runs up the gully called the laminar groove, right between the spinous processes and the transverse processes.

General traction and stretching of these neck tissues, as well as muscle specific techniques for cervical musculature are all very useful and have been well-documented elsewhere. Any of these techniques -- NMT, deep tissue, muscle energy, etc. -

- can be effectively used to lengthen and ease this section of the SBL. Whatever techniques are used, this is all good preparation for reaching the muscles we are about to examine in more detail. The deepest layers of muscles (the suboccipital "star") are crucial to opening up and obtaining the most integrated function in the entire SBL. The high number of stretch receptors in these tissues, and their connection from the eye movements to coordination of the rest of the back musculature ensure their central role. These muscles have been shown to have 36 muscle spindles/ gram of muscle tissue. The gluteus maximus, by comparison, has .7 spindles/gram.1 That is a 50-fold difference. To feel their connection to eye movements for yourself, put your hands up on either side of your head with your thumbs just under your skull in back. Work your thumbs gently in past the superficial muscles so you can feel the ones deep under the occipital ridge. Close your eyes. Now, turn your eyes to the right and left, while your other fingers keep your head from moving, as we did with our client before. Can you feel those little muscles changing tonus under your thumbs? Even though your head is not moving, these little primary muscles are responding to your eye movements. Look up and down and you will feel other muscles within this set engage in a similar way. Try to move your eyes without these muscles moving and you will find that it is impossible. They are so fundamentally connected that any eye movement will produce a change in tonus in these suboccipitals. The rest of the spinal muscles "listen" to the suboccipitals and tend to go the way they are going. The adage, "a cat always lands on its feet" is also an illustration of this concept. When a cat finds itself in the air, it uses its eyes and inner ear to orient its head horizontally. This puts certain tensions into these suboccipital muscles, which the brain "reads" from the stretch receptors. Based on this reading the brain "unwinds" the spinal muscles to organize the entire spine from the neck down, so that the cat's feet are under it before it ever hits the carpet. Though we are upright, our head-neck-upper back relationship functions in much the same way. Thus, how you use your eyes, and more particularly, how you use your neck, determines the tonus pattern for the rest of your back musculature. This plays into myriad postural patterns we see every day in our practice: loosening the neck is often key to intransigent problems between the shoulder blades, in the lower back and even in the hips. Retraction in this area often also constitutes part of a fundamental fear response. Most animals respond to fear with a retraction of the head, and humans are no exception. Since most of us do not get out of childhood without some unresolved fear, this retraction, either as a habit before we begin a movement or as a permanent postural state, becomes built into our movement as a socially acceptable, unobserved, but ever-so-damaging habit of being. It is not easy to root out, being so deep and of such long-standing, but it is worth the effort for the psychological and physical feeling of freedom it brings. Such freedom is the basis for the Alexander technique. Now let's get specific about these muscles. The four suboccipital muscles which are a part of the SBL are the rectus capitis posterior minor (RCPM), the rectus capitis posterior major (RCPMaj), the obliquus capitis superior (OCS) and obliquus capitis inferior (OCI) (See Figs 5-8. They run among the occiput, the atlas (C1) and the axis (C2), so first we need to get familiar with some features of these bones. The transverse processes (TPs) of C1 are quite large, while the spinous process (SP) is quite small. Try feeling below your occiput -- I'll bet the first spinous process you feel is actually that of C2, since the SP of C1 is so short that it cannot be felt on 99 percent of the population. The SP of C2, however, is quite large and easily felt.

The sub-occipital muscles from the rear, the standard view given in most common anatomy atlases.

When we look at the sub-occipitals obliquely, we

can see better how they run and what they do.

A side view of the suboccipitals shows us that the RCPMaj runs straight down, or even down and back a little, while the RCPM and the Obliquus Superior run down and forward, and thus tend to pull the occiput forward on the atlas, since they cannot pull the atlas back.

For most hands and most heads, the ring, middle and index finger applied to the inferior surface of the occiput will contact the RCPM, RCPMaj and OCS respectively.

While we cannot as a rule feel the SP of C1, we can, with a little practice, definitely feel the TPs. To feel the relative position of the C1 TPs, have your client lie supine, and sit at the head of the table with your hands around the skull such that the second phalange of both your index fingers lie against the mastoid processes, leaving the distal bone free. Your wrists should be close to or on the table, so that your index finger follows roughly the direction of the SCM. Now gently flex the distal part of your index fingers -- the first bone -- into the flesh just inferior to the mastoid, keeping the second bone of your finger in contact with the mastoid process equally on both sides. If your wrists are too high and your fingers point down toward the table, you will miss the atlas. If your wrists are too low or your index finger is in front of the mastoid, you will go into the space between the jaw and the mastoid, which is definitely a no-no. Sometimes you can feel the TPs directly, just inferior and anterior to the mastoid, sometimes, because so many muscles are competing for attachment space on the TP, you can only feel them by implication. If, however, you keep the middle phalange in contact with the mastoid process, with a little practice you will be able to feel accurately whether one TP is more prominent than the other (indicating a lateral translation to the prominent side), or forward of the other (indicating a rotation of the O- joint), or closer to the skull than the other (indicating a lateral flexion between the two). Now that we have found the C2 spinous processes and the C1 transverse processes, we can now locate these four muscles with greater accuracy. Let's begin with the OCI -- the obliquus capitis inferior. The OCI is badly named, since it does not attach to the head (caput) at all, but runs from the large SP of the axis to the large TPs of the atlas, somewhat like the reins on a horse. This muscle thus parallels the splenius capitis and provides the deepest and smallest muscle of ipsilateral rotation, creating that "no" motion, the rotation of the atlas and occiput together on the axis. You can find this muscle by locating the TPs of the atlas and the SP of the axis as we did above, and then positioning your fingertips right between the two, fixing the skull with your thumbs, and calling for head rotation against your resistance. Work with freeing these muscles and balancing the two sides can be helpful in postural head rotations, and in helping the eyes track in reading and other fine eye work. The other three sub-occipital muscles run down from deep underneath the occipital shelf. Going from medial to lateral, the RCPM -- rectus capitis posterior minor -- runs from the occiput to the spinous process of the atlas, crossing only the O-A joint. But we have already said the atlas does not have much of a spinous process, so what few anatomy books seem to show clearly is that this muscle runs down and very much forward to do this (Figs 6-7).

The next muscle lateral, the rectus capitis posterior major (RCPMaj) runs down to the SP of the axis, but since that bone has such a huge spinous process, this muscle runs pretty much straight up and down (Fig 7). This points to a difference in function between these two muscles: the RCPMs, among their other functions, tend to pull the occiput forward on the atlas (occipital protraction, sometimes called axial flexion, or what we in my school call an anterior shift), while the RCPMaj is going to create pure hyperextension in both the A-A and the O-A joints. The most lateral of these three that attach to the occiput, the obliquus capitis superior (OCS), runs down and forward again, this time to the large TPs of the atlas (Fig 7). This muscle, which runs parallel to the RCPM, will have the same effect -- pulling the occiput forward on the atlas, as well as helping to create a postural rotation if it is tighter on one side than the other. Though treatment of these muscles can be a complex process of unwinding, for the reasons given above, we can facilitate palpation and treatment. Once again, your supine client's head rests in your hands, but this time the occiput is in your palms, so your fingers are fully free. Curl your fingers behind the client's neck up under the occiput, "swimming" into the deeper layers past the trapezius and semispinalis to these little guys, and put your ring fingers together at the midline so that six fingertips are arrayed along the bottom of the occiput (Fig 8). Your fingers should be doing a 180-degree turn, pointing right at you, not up toward the ceiling, as in some O-A releases. With adjustments for differently-sized hands and heads, your ring finger will be in contact with the RCPM, your middle fingers on the RCPMaj, and your index fingers on the OCS. Strumming back and forth with the middle finger will often (but not always) reveal the more prominent band of the RCPMaj, and the two other fingers can be placed to either side of it. To reverse the common postural problem of the occiput being held forward on the atlas (occipital protraction or anterior shift), you need to create length and release in the muscles under your index and ring fingers. Gently "glue" your fingers to the underside of the occiput and bring your fingers down into the padding of your table and then up toward you, bringing the occiput with you each step of the way. Let me emphasize that this is all gentle work -- these muscles and joints respond badly to manhandling. This technique is a matter of magnetizing your fingers to the occiput and persuading it to come with you. To combat postural hyperextension of the neck, you need to release the slightly more prominent RCPMaj under your middle fingers with cross-fiber friction or direct stretching (while getting your client to engage the longus muscles in the front of the neck by flattening the neck against the table and sliding the back of the head up toward you). While these two patterns -- anterior shift and hyperextension -- often accompany each other, they are occasionally separate, so that this distinction in techniques becomes useful. A little perseverance with sensitive fingers will soon allow you to make these distinctions quickly and select appropriate treatment for your clients. Specific treatment of these muscles will be rewarded with a surprising general improvement in posture and coordination, as well as a reduction in back and neck pain, so it is well worth the time invested. Author's note: While I hope to explain the concepts in these upcoming columns sufficiently to allow each article to stand on its own, readers who may want to explore the myofascial meridian system more deeply can delve into the Anatomy Trains book, videos, or short courses, all accessible throughwww.AnatomyTrains.net. Thomas Myers, Certified Advanced Rolfer, LMT, NCTMB, studied directly with Drs. Ida Rolf and Moshe Feldenkrais, and has practiced integrative bodywork for more than 25 years in a variety of cultural and clinical settings. Myers directs Kinisis, Inc. which develops and runs training courses internationally for manual and movement therapists. He served as founding member of the NCBTMB, and as chair of the Rolf Institute's anatomy faculty. His articles have appeared in a number of magazines and his newest book, Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists,is now available. Myers retains a strong interest in perinatal and developmental issues around movement. His practice in Boston combines structural integration, physiological rhythmic sensitivity and movement. He lives, writes and sails on the coast of Maine. References 1. Chaitow, L, Clinical Application of Neuromuscular Technique, Vol. 1,The Upper Body, 2000, Churchill Livingstone, Edinburgh.