Rectus Capitis Posterior Muscle Research Articles

Determine the immediate effect on cervicogenic headache by primal reflex release technique (PRRT)TM on rectus capitis posterior muscle

Background/Purpose: The present study aimed to determine the immediate effect on cervicogenic headache by primal reflex release technique (PRRT)TM on rectus capitis posterior muscle. Objective: To determine the effects of primal reflex release techniques on the Rectus capitis posterior muscle in cervicogenic headache. Methodology: 46 patients were examined according to the inclusion and exclusion criteria and randomly divided into experimental group and conventional group. Outcome measure including VAS, Cervical Rotation, NPDS, NDI and HDI were assessed prior to the intervention. Experimental group received primal reflex release technique which includes rectus capitis posterior muscle. Conventional treatment group received hot packs, stretching and cervical isometric. Post intervention assessment was done to assess immediate changes in subjects of both group for assessing immediate effects of treatment protocol. Result: The study compares data from five outcome measures to assess the effectiveness of Primal Reflex Release Technique (PRRT) on cervicogenic headache. Results show that both PRRT and conventional therapy have similar effects on cervicogenic headache. Conclusions: This study found positive changes in all outcome measures (VAS, cervical rotation, NPDS, HDI, and NDI) from pre- to post-intervention in both groups receiving either PRRT or conventional therapy for cervicogenic headache with rectus capitis posterior muscle involvement.

Implied Evidence of the Functional Role of the Rectus Capitis Posterior Muscles.

Osteopathic physicians often target the rectus capitis posterior minor (RCPm) and rectus capitis posterior major (RCPM) muscles when using muscle energy or soft tissue cervical techniques to treat patients with head and neck pain. The RCPm and RCPM muscles are located deep within the posterior occipitoatlantal and atlantoaxial interspaces, respectively. To characterize the functional role of RCPm and RCPM muscles by comparing electromyographic (EMG) activation patterns of these muscles with EMG activation patterns of specific flexor and extensor muscles of the head and neck, the sternocleidomastoid (SCM), and the splenius capitis (SC) muscles, respectively. Asymptomatic participants were recruited from the Michigan State University College of Osteopathic Medicine student body. Disposable 25-gauge, bipolar fine-wire intramuscular electrodes were used to collect EMG data from the right and left RCPm and RCPM muscles. Surface electrodes were used to collect EMG data from the right and left SCM and SC muscles. Data were collected as participants performed 4 cycles of flexion and extension with an external 4-lb force applied to the back of the head and the forehead. In RCPM muscles, EMG activity was significantly greater (P<.003) during flexion and extension of the head and neck when an external force was applied to the back of the head. EMG activity in SCM muscles was significantly greater (P<.0001) during flexion and extension of the head and neck when an external force was applied to the forehead. The authors observed that EMG activity in SC muscles was significantly greater (P<.015) during flexion and extension of the head and neck when an external force was applied to the back of the head. No significant difference was found in EMG activity in RCPm muscles (P<.834) during flexion and extension of the head and neck, regardless of whether the external force was applied to the back of the head or the forehead. The EMG activation patterns of the RCPm muscles suggest that their functional role may be to stabilize the occipitoatlantal joint by helping maintain congruency of the joint surfaces. In contrast, the EMG activation patterns of the RCPM muscles suggest that their functional role may be to contribute to extension of the head, primarily at the occipitoatlantal and the atlantoaxial joints.

Cervical Spine Muscle-Tendon Unit Length Differences Between Neutral and Forward Head Postures: Biomechanical Study Using Human Cadaveric Specimens.

Forward head posture (FHP) may be associated with neck pain and poor health-related quality of life. Literature describes only qualitative muscle length changes associated with FHP. The purpose of this study was to quantify how muscle-tendon unit lengths are altered when human cadaveric specimens are placed in alignments representing different severities of FHP. This biomechanical study used 13 fresh-frozen cadaveric cervical spine specimens (Occiput-T1, 54±15y). Specimens' postural changes simulating increasing FHP severity while maintaining horizontal gaze were assessed. Specimen-specific anatomic models derived from computed tomography-based anatomic data were combined with postural data and specimen-specific anatomy of muscle attachment points to estimate the muscle length changes associated with FHP. Forward head posture was associated with flexion of the mid-lower cervical spine and extension of the upper cervical (sub-occipital) spine. Muscles that insert on the cervical spine and function as flexors (termed "cervical flexors") as well as muscles that insert on the cranium and function as extensors ("occipital extensors") shortened in FHP when compared to neutral posture. In contrast, muscles that insert on the cervical spine and function as extensors ("cervical extensors") as well as muscles that insert on the cranium and function as flexors ("occipital flexors") lengthened. The greatest shortening was seen in the major and minor rectus capitis posterior muscles. These muscles cross the Occiput-C2 segments, which exhibited extension to maintain horizontal gaze. The greatest lengthening was seen in posterior muscles crossing the C4-C6 segments, which exhibited the most flexion. This cadaver study did not incorporate the biomechanical influence of active musculature. This study offers a novel way to quantify postural alignment and muscle length changes associated with FHP. Model predictions are consistent with qualitative descriptions in the literature.

Forward Head Posture and Activation of Rectus Capitis Posterior Muscles.

Rectus capitis posterior (RCP) muscles have physical attachments to the pain-sensitive spinal dura. Atrophy of these muscles is associated with chronic headache in some patients. The authors suspect that the significance of atrophy in the RCP muscles has been undervalued because the functional role of these muscles is not well defined. To determine whether a statistically significant change in normalized levels of electromyographic activity in RCP muscles occurs when the head is voluntarily moved from a self-selected neutral head position to a protruded head position. Fine wire, intramuscular electrodes were used to collect electromyographic data as asymptomatic participants moved their head from a neutral head position into a forward head position and back into the neutral head position. This sequence was repeated 4 times. Normalized levels of electromyographic activity were quantified using a 2-head position × 2 sides of the body repeated measures design that incorporated mixed-effects β regression models. Twenty participants were studied. Electromyographic activity collected from RCP muscles was found to increase as the head was voluntarily moved from a self-selected neutral head position (11% of maximum voluntary isometric contraction [MVIC] in RCP minor, 14% of MVIC in RCP major) into a protruded head position (35% of MVIC in RCP minor, 39% of MVIC in RCP major) (P<.001). Rectus capitis posterior muscles may contribute to segmental stabilization of the occipitoatlantal and atlantoaxial joints by helping to maintain joint congruency during movement of the head.

Magnetic Resonance Imaging Study of The Morphometry of Cervical Extensor Muscles in Chronic Tension-Type Headache

This study analyses the differences in the relative cross-sectional area (rCSA) of several cervical extensor muscles, assessed by magnetic resonance imaging (MRI), between patients with chronic tension-type headache (CTTH) and healthy controls. MRI of the cervical spine was performed on 15 CTTH females and 15 matched controls. The rCSA values for the rectus capitis posterior minor (RCPmin), rectus capitis posterior major (RCPmaj), semispinalis capitis and splenius capitis muscles were measured from axial T1-weighted images using axial MR slices aligned parallel to the C2/3 intervertebral disc. A headache diary was kept for 4 weeks in order to substantiate the diagnosis and record the pain history. CTTH patients showed reduced rCSA for both RCPmin and RCPmaj muscles (P < 0.01), but not for semispinalis and splenius capitis muscles, compared with controls. Headache intensity, duration or frequency and rCSA in both RCPmin and RCPmaj muscles were negatively correlated (P < 0.05): the greater the headache intensity, duration or frequency, the smaller the rCSA in the RCPmin and RCPmaj muscles. CTTH patients demonstrate muscle atrophy of the rectus capitis posterior muscles. Whether this selective muscle atrophy is a primary or secondary phenomenon remains unclear. In any case, muscle atrophy could possibly account for a reduction of proprioceptive output from these muscles, and thus contribute to the perpetuation of pain.

Insight into understanding the anatomical and clinical aspects of supernumerary rectus capitis posterior muscles

Rectus capitis posterior muscles are located in the suboccipital triangle and function in extension and lateral rotation of the head and neck. There are two of these muscles on each side: the rectus capitis posterior major and the rectus capitis posterior minor. This study describes the presence of a third suboccipital muscle in a 55-year-old cadaver. In addition to highlighting the possible relationship between these muscles and cervicogenic headaches or balance in an individual, we also relate this observation to similar musculature in the cat that have been shown to effect crucial functions.

Distribution of motoneurons supplying dorsal and ventral suboccipital muscles in the feline neck.

A combination of retrograde tracers was used to compare the relative distributions of motoneurons supplying the ventral and lateral suboccipital muscles, rectus capitis anterior (RCA), and rectus capitis lateralis (RCL), with those supplying dorsal muscles, including rectus capitis posterior muscles (RCP), complexus (CM), and the medial head of obliquus capitis superior (OCS). Three of the tracers, horseradish peroxidase, fluororuby, and fluorescein-conjugated dextran, were applied to cut nerve ends. Fast blue was applied by intramuscular injection, and fluorogold was delivered both by injection and by cut nerve exposure. Motoneurons supplying RCA and RCL were clustered on the medial wall of the ventral horn in a restricted region defined previously as the commissural nucleus. Labelled cells supplying RCL were confined to the C1 segment, but those supplying RCA were distributed from C1 to rostral C4. Motoneurons supplying RCA tended to lie more dorsomedially than those supplying RCL, but there was substantial overlap between the two populations. Motoneurons supplying dorsal muscles had a separate, more ventral distribution. RCP motoneurons were located primarily in the ventromedial nucleus, but a small proportion of cells was found in the white matter of the ventral funiculus or the gray matter surrounding the central canal. Motoneurons supplying CM and OCS were located dorsomedially to the RCP cell population. These results suggest that neck motoneurons are arranged according to a "musculotopic" pattern in which dorsal muscles have the most ventral locations, and progressively more lateral and then ventral muscles are layered dorsomedially along the medial wall of the ventral horn.

Excitatory effects on neck and jaw muscle activity of inflammatory irritant applied to cervical paraspinal tissues

A study was carried out in 19 anaesthetized rats to determine if the electromyographic (EMG) activity of jaw and neck muscles could be influenced by injection of the inflammatory irritant mustard oil into deep paraspinal tissues surrounding the C1-3 vertebrae. The EMG activity was recorded ipsilaterally in the digastric, masseter and trapezius muscles and bilaterally in deep neck muscles (rectus capitis posterior). In comparison with control (vehicle) injections, mustard oil (20 μl, 20%) injected into the deep paraspinal tissues induced significant increases in EMG activity in the neck muscles in all the animals and in the jaw muscles in the majority of the animals; the effects of mustard oil were more prominent in the former. The EMG response evoked by mustard oil injection was frequently reflected in two phases of enhanced activity. The early phase of the increase in EMG activity was usually initiated immediately following mustard oil injection (mean latency: 20.4 ± 17.7 sec) and lasted 1.6 ± 1.1 min. The second phase occurred 11.3 ± 7.6 min later and lasted 11.0 ± 8.1 min. Evans Blue extravasation was apparent in the deep paraspinal tissues surrounding the C1-3 vertebrae after mustard oil injection, and histological examination showed that mustard oil injection induced an inflammatory reaction in the rectus capitis posterior muscle. These results document that injection of the inflammatory irritant mustard oil into deep paraspinal tissues results in a sustained and reversible activation of both jaw and neck muscles. Such effects may be related to the reported clinical occurrence of increased muscle activity associated with trauma to deep tissues.