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Therapy Notes – Suboccipital Muscles

Treatment of the suboccipital region is probably the single most important area to treat.

Upper cervical treatment is the focus of many bodywork practices. It has been a strong focus of practice for chiropractors for more than 70 years. In the early 40s, John Grostic pioneered atlas analysis and treatment. Since then, a multitude of practitioners has implemented variations on his approach. It changes the pelvic balance, digestion, polyvagal regulation, Forward-Head Posture, and much more.  These approaches vary from precise, research-driven approaches to intuitive based emotional release work.

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

This post has illustrations of each muscle including the anterior and lateral muscles.

Entire bodywork practices are built on treating the upper cervical region because it impacts the entire body.


Sub-occipitals strap the head on to the first 2 vertebrae. They have a direct bearing on and are strongly affected by the atlantooccipital joint and the atlanto-odontoid joint.

Upper cervical function and alignment strongly influence muscle tension, pain patterns, visceral function, and postural alignment throughout the body. This area should be addressed early in the session so that other areas respond well and have longer-lasting results.

Before directly using any muscle work, gentle mobilization of the joint can be very effective in making the work less painful, quicker, and longer-lasting.

The atlantooccipital and atlantoaxial joints need to mobilize for a lasting release of suboccipital trigger points. That can happen in the NMT routine but can be more direct and effective through direct techniques. The atlas commonly moves anteriorly and to the right. This is more difficult to correct with suboccipital techniques that focus on pressing into the back of the head.

Bodywork Protocols

This post, from Integrative Craniosacral – Transition to Integrative Techniques offers an intra-oral and transverse process approach to mobilizing the atlas.

This post has a routine for treating the area with joint mobilizations and then an NMT protocol.

This area has difficulty stabilizing when Forward-Head Posture or other chronic cervical or cranial imbalances are present. This collection on FHP is helpful to pinpoint other patterns that might be perpetuating suboccipital

I find that treating this area, followed by other cervical approaches and then returning to this for additional work is sometimes needed for stabilization.


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This site is undergoing changes. Starting in early 2020, we began improving the format. We are also adding more extensive self-care, illustrations, therapist notes, anatomy, and protocols. We appreciate your input and feedback. You will see us adding posts and updating older posts as time permits.


Weekly Featured Post

This post shows you how to press out the trigger points and stretch the infraspinatus muscle. It’s a small muscle on the back of the shoulder but creates a number of problems, including:

  • shoulder pain when sleeping
  • loss of grip strength
  • upper neck pain
  • pain along the inside edge of the shoulder blade

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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