Therapist Notes – Anterior Suboccipital Muscles

Actual treatment of the rectus capitis anterior can be done more easily by mobilizing the atlas from the transverse process and following up with ice and stretch. If the trigger point is more chronic and requires direct work on the muscle, more advanced intra-oral or anterior throat techniques are needed.

Muscle Energy Techniques and Strain-counter-strain are easy and less invasive techniques. Mobilization of the axis is usually needed to ensure that the atlas stays free after the client becomes mobile.

Need to review some anatomy?

This post has the basics of suboccipital muscles and a link to the Wikipedia entry if you need more info.


The most effective treatment, for me, starts with intra-oral atlas mobilizations. This post also reviews mobilization from the transverse process so that the atlas can be mobilized from both points.

The intra-oral approach allows more direct contact o the anterior sub-occipitals and surrounding tissues, if this is a real possibility for you and your client.

If you are trained in releasing the palatini muscles and emptying the eustation tube, do that while you are working in the back of the mouth. It will support lasting results.

A common approach is an extended-release that lifts the occiput from underneath until the anterior attachments relax and the occiput is distracted from the atlas.

This contact of the transverse processes is probably the simplest and most direct way of mobilizing the atlas.

This can allow more specific mobilization than the atlantooccipital distraction.


This protocol is the next step in releasing the atlantooccipital joint. This increases mobility and further relaxes the many layers of upper cervical musculature.

In these cases, getting relief is not as difficult as making the long term changes in the surrounding structures. The neck becomes stable in a posture that supports the released muscle.


If the ear and sub-occipital irritation are relieved at this point, focus on supporting structures in the cervical, cranial and shoulder areas.

The cervical lamina protocol, TMJ balancing, pelvic balancing, work on the cranial base and a solid Self-Care effort are all helpful.



This following treatment can be complicated and requires navigating sensitive structures around the throat. It also requires great sensitivity and a good client/therapist level of trust. If you have not released the problem through the previous protocols, it may be best to refer these cases to an upper cervical specialist.

Follow up with these routines to treat the front of the neck..

There are two protocols. The first one treats the superficial tissues and allows for better access to the deep tissues. Then, the anterior suboccipital muscles are treated in the protocol for the deep anterior cervical region.

Self-care can really help.

Often, this treatment needs support from self-care. This post has ideas for activities to avoid, temporary relief strategies and stretches that stabilize the neck.


This site is undergoing changes. Starting in early 2020, we began changing the format of the posts to include more extensive self-care, illustrations, therapist notes, anatomy, and protocols. We’d love your feedback. We are adding posts and converting the old posts as quickly as time permits.


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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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