Brief Anatomy Overview
The anatomy of the semispinalis capitis is significant for managing pain. It is a large muscle that extends the head, perpetuates forward head posture and squeezes the greater occipital nerve.
- transverse processes of T1-T6 and the articular processes of C4-C7
- between the superior and inferior nuchal ridges of the occipital ridge
- extension and some rotation of the head
- greater occipital nerve, posterior ramus of C2
- spinal nerve C3
The functional anatomy of semispinalis capitis is significant when it comes to upper cervical pain. It attaches to the occiput and then usually skips the first three cervical vertebrae. After that, it has variable attachments to the vertebrae from C4 through T7.
Variations in Attachments
Dissection studies vary in their report of attachments on the thoracic vertebrae. They show that they differ in which vertebrae are attached, and some slips attach to the transverse or spinous processes.
Greater Occipital Nerve Involvement
The greater occipital nerve (GON) is structurally vulnerable to the tension in semispinalis capitis. This nerve branches off of the C2 dorsal ramus below the posterior arch of the atlas. Often, it has fibers from the C1 nerve root and occasionally from C3. The palpable tension of the C2 nerve root at its emergence is a reliable indicator of atlas displacement. It winds around the lower border of obliquus capitis inferior. Then, it passes superficial to the suboccipital muscles. The nerve extends superiorly until it pierces semispinalis capitis and emerges deep to the trapezius. It passes through the attachment tendon on the superior nuchal line near the external occipital protuberance. It then passes under the galea aponeurosis.
The GON has variations in its path. Studies vary slightly but show that the GON pierces the semispinalis capitis about 90% of the time. However, it pierces the trapezius about 45% of the time. In rare instances, about 7% of the time, it pierces the obliquus capitis inferior.
Tension in semispinalis capitis entraps the greater occipital nerve, creating posterior head pain and paraesthesia.
Semispinalis Muscle Group
The semispinalis muscle group includes:
Capitis attaches to the base of the cranium, but the other two muscles are the interspinous muscles. These muscles are deep to the extrinsic back muscles and superficial interspinous muscles. They provide another layer of paraspinal erectors to support the cervical muscles on the thoracic column.
All of these muscles have statistically significant variations in their structure.
Note how the atlas is skipped so that these muscles easily render it in an anterior displacement.
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Tony Preston has a practice in Atlanta, Georgia, where he sees clients. He has written and taught about anatomy, trigger points, and cranial therapies since the mid-90s.
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