Rectus Capitis Posterior Major

Description[edit | edit source]

The fibers of the Rectus Capitis Posterior Major (RCPM) muscle skips C1 as it runs from C2 to the occiput, lateral to the rectus capitis posterior minor. It is also known as the Greater Posterior Rectus Capitis[1]. The RCPM, along with obliquus capitis superior, and the obliquus capitis inferior form the borders of the suboccipital triangle. [2]

OCI_post_view
OCI_right_lateral_view

Origin[edit | edit source]

It arises from the tip of the spinous process of the axis (C2).[3]

Insertion[edit | edit source]

Lateral aspect of the inferior nuchal line of the occiput,[3] as well as to the bone inferior to this line.[1]

Nerve Supply[edit | edit source]

Suboccipital nerve or dorsal ramus of cervical spinal nerve (C1).[3]

Blood Supply[edit | edit source]

Vertebral artery and the deep descending branch of the occipital artery.[3]

Action[edit | edit source]

  • Bilateral contraction of rectus capitis posterior muscles contributes to extension of the head at the occipitoatlantal and atlantoaxial joints
  • Unilateral contraction of the RCPM muscles causes ipsilateral rotation and side bending of the head[4][5]

Function[edit | edit source]

Likely a postural muscle that monitors the position of the head [3] which could be attributed to the high spindle density found in RCPM providing significant feedback on the motion and position of the head to the central nervous system [6] These proprioceptive signals from the cervical muscles play a vital role in head-eye coordination and postural control.[7]

Assessment[edit | edit source]

Palpation[edit | edit source]

This is the easiest suboccipital muscle to palpate. RCPM can be palpated between the spinous process of the axis (C2) and the occiput. This muscle can be palpated when all the subocciptal muscles are in a relaxed state.[8]

  • With the client supine and therapist seated at the head end of the plinth, therapist locates the spinous process of C2
  • Then move superolaterally to feel the RCPM fibres.

Clinical Significance[edit | edit source]

Cervicogenic Headaches:

According to the studies, the suboccipital muscle may be the possible cause of cervicogenic headaches[9]. Studies have shown increased tone and stiffness of the suboccipital muscles in patients with cervicogenic headache. [10] It initially present as unilateral neck pain and spread to the head.

OCI_RCPM_TrP_Refferal

Cervicogenic dizziness:

Incorrect posture alignment may cause non-vestibular dizziness.[11] The forward head posture may change the alignment and put an excessive load on the upper cervical spine, resulting in structural and functional changes in the suboccipital muscles. In cases where there is instability in the ligament and facet joint, it can cause abnormal inputs to the central nervous system, which can lead to inconsistencies with the vestibular and visual inputs.This might show as a variety of symptoms, including pain, headache, dizziness, and lightheadedness, all of which are caused by improper information integration.

References[edit | edit source]

  1. 1.0 1.1 Travell JG, Simons DG, Simons LS (1998). Travell and Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume 1: Upper Half of Body (2nd ed). Baltimore, MD: Williams & Wilkins.
  2. Scali F, Marsili ES, Pontell ME. Anatomical connection between the rectus capitis posterior major and the dura mater. Spine. 2011 Dec 1;36(25):E1612-4.
  3. 3.0 3.1 3.2 3.3 3.4 http://www.anatomyexpert.com/structure_detail/5210/
  4. Hallgren RC, Pierce SJ, Sharma DB, Rowan JJ. Forward head posture and activation of rectus capitis posterior muscles. Journal of Osteopathic Medicine. 2017 Jan 1;117(1):24-31.
  5. Agur AMR, Dalley AF (2012). Grant's Atlas of Anatomy (13th ed). Philadelphia, PA: Lippincott Williams & Wilkins.
  6. Hallgren RC, Rowan JJ, Bai P, Pierce SJ, Shafer-Crane GA, Prokop LL. Activation of rectus capitis posterior major muscles during voluntary retraction of the head in asymptomatic subjects. Journal of Manipulative and Physiological Therapeutics. 2014 Jul 1;37(6):433-40.
  7. Kulkarni V, Chandy MJ, Babu KS. Quantitative study of muscle spindles in suboccipital muscles of human foetuses. Neurology India. 2001 Oct 1;49(4):355. Available from https://www.webpages.uidaho.edu/mindinmovementlab/2018_AT_Congress_References/Kulkarni-2001%20-%20Muscle%20spindle%20density%20in%20neck.pdf
  8. Chapter 12 Palpation of the Neck Muscles. The Muscle and Bone Palpation Manual Joseph E. Muscolino 3rd Edition
  9. George T, Tadi P. Anatomy, head and neck, suboccipital muscles.
  10. Park SK, Yang DJ, Kim JH, Heo JW, Uhm YH, Yoon JH. Analysis of mechanical properties of cervical muscles in patients with cervicogenic headache. Journal of physical therapy science. 2017;29(2):332-5.
  11. Sung YH. Suboccipital muscles, forward head posture, and cervicogenic dizziness. Medicina. 2022 Dec 5;58(12):1791.