Therapist Notes – Semispinalis cervicis

This headache at the base of the head is almost always relieved by mobilizing the atlas. Several techniques, including cranial, intra-oral, and anterior cervical NMT mobilize the atlas. The common mistake is to spend too much time behind the atlas. After loosening the posterior musculature, the atlas needs to move back into a mobile positon. Afterward, the trigger points in the semispinalis cervicis will release and stabilize. Mobilizing the fixated atlas prevents the pattern from re-establishing because of upper cervical imbalances.


Start by Understanding the Anatomy.
About the coloring of the illustrations…

This muscle is deep in the back of the neck and extends into the upper ribs. You can read more about it in this post about semispinalis cervicis.


Treatment Sequencing

This pain pattern is often used as an indicator that the atlas is anterior. The pain pattern usually dissipates when the atlas is properly mobilized.

This protocol loosens the suboccipital region, which, as a rule of thumb, is the first step in treating around the cervical spine.

Now that the suboccipital region is loosened, the next step is to evaluate and mobilize the atlas. I like the intraoral mobilization but some therapists and clients are not comfortable with that and prefer using the transverse processes. This post has pages from the manual for evaluation and mobilization of the atlantooccipital joint.


This pattern may linger when trigger points around the 5th cervical are still active. This cervical lamina routine is a solid approach to releasing those fixations. As well, it releases the trigger points in the semispinalis cervicis.

Stretching and other techniques can be used to stabilize the musculature around the upper cervicals and prevent the atlas from being wedged forward again. Lengthening the scalenes and other musculature in the lower anterior cervicals allows the base of the neck to support the correction of Forward-Head posture.



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.


Weekly Featured Post

Is the pain from
degenerative discs or
trigger points in the muscle?

This post discusses the differences in pain from disc problems and pain from trigger points. Who should you see to help with your pain?

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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*This site is undergoing major changes. We are reformatting and expanding the posts to make it easier to read, more accessible, and
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