Suboccipital Muscles Research Articles

The Additional Effect of Neurodynamic Slump and Suboccipital Muscle Inhibition to Passive Stretching of the Short Hamstring: A Single-Blind, Randomized Controlled Trial

Background/Objectives: Hamstring shortening is a significant musculoskeletal condition affecting the posture and mobility of the spine and lower extremities. This study examined the impact of incorporating neurodynamic slump stretch and suboccipital muscle inhibition into passive static stretching on hamstring flexibility in individuals with short hamstrings. Methods: 117 female participants were classified into three groups: the control group, which received passive static stretch of the hamstring muscle; the neurodynamic slump group, which received neurodynamic slump stretch with passive static stretch; and the suboccipital muscle inhibition group, which received suboccipital muscle inhibition with passive static stretch, for three sessions a week, 10 min each, for four weeks. The outcome measures were the popliteal angle test (PAT), straight leg raising (SLR) test, and forward bending test (FBT) at baseline, immediately following the first session and after four weeks. Results: Statistically significant differences were found within groups (p < 0.001) for all outcome measures. Between the groups, there was a more significant improvement in the PAT and the SLR tests, favoring the neurodynamic slump and suboccipital muscle inhibition groups in comparison with the passive static stretch group (p < 0.001) with no significant difference between the two groups after the first session and at four weeks of treatment. However, the FBT showed no significant differences immediately following the first session or at four weeks of treatment (p > 0.05). Conclusions: This study found that incorporating neurodynamic slump stretch and suboccipital muscle inhibition into passive static stretch techniques effectively treats short hamstrings in healthy individuals.

Variations of the rectus capitis posterior muscles: a case report.

Duplication, accessory slips, and division of the rectus capitis posterior muscles are rare anatomical variations. Here we report a case of unilateral doubling of rectus capitis posterior major, and doubling of rectus capitis posterior minor with an accessory slip originating from the spinous process of the second cervical vertebra. The gross anatomical characteristics, clinical significance, and relationship of suboccipital musculature to the cervical myodural bridge is discussed in this report. Knowledge of rectus capitis posterior muscle variations may be of interest to clinicians practicing surgical approaches to the posterior cervical region due to the close proximity of the variations to typical muscular and neurovascular structures of the suboccipital region and potential association with the cervical myodural bridge.

Could the Suboccipital Release Technique Result in a Generalized Relaxation and Self-Perceived Improvement? A Repeated Measure Study Design.

Background: Musculoskeletal disorders such as cervicogenic headaches present with suboccipital muscle hypertonicity and trigger points. One manual therapy intervention commonly used to target the suboccipital muscles is the suboccipital release technique, previously related to positive systemic effects. Therefore, this study aimed to determine the immediate and short-term effects of the Suboccipital Release Technique (SRT) on brainwave activity in a subgroup of healthy individuals. Methods: Data were collected from 37 subjects (20 females and 17 males, with a mean age of 24.5). While supine, the subjects underwent a head hold followed by suboccipital release. A total of four 15 s electroencephalogram (EEG) measurements were taken and a Global Rating of Change Scale was used to assess self-perception. Results: There was a statistically significant difference (p < 0.005) in various band waves under the following electrodes: AF3, F7, F3, FC5, T7, P7, O1, O2, P8, T8, and FC6. An 8-point range in the Global Rating of Change Scores with a mean score of 1.649 (SD = 1.719 and SE = 0.283) supported the hypothesis of a self-perceived benefit from the intervention. Conclusions: The results of this study indicate that the suboccipital release technique significantly affects brain wave activity throughout different brain regions. This change is likely not the result of any placebo effect and correlates highly with the subject's self-perception of a change following the intervention. These findings support the clinical use of the suboccipital release technique when a centralized effect is desired.

Effect of Hamstring Active Release Technique in Cervicogenic Headache

Objectives: To investigate the effect of Hamstring active release technique on pain intensity level, headache intensity, pressure pain threshold, cervical flexion rotation range of motion and Hamstring flexibility in patients with cervicogenic headache. Methods: Fifty-six patients with cervicogenic headache participated in the study, aged 25-45 years. Patients were randomized into two groups of 28 individuals each. Group A was given conventional physiotherapy only in the form of ultrasonic therapy, stretching as well as strengthening exercises. Group B was given conventional physiotherapy and active release technique for Hamstring. Each group was treated three times a week for one month. Pain intensity level, headache intensity, pressure pain threshold of Sub-occipital and Hamstring muscles trigger points, cervical flexion rotation range of motion and Hamstring flexibility were measured by visual analogue scale, the Arabic version of 6-item headache impact test, digital pressure algometry, CROM device and straight leg raising test respectively, pre and post-treatment. Results: Within group comparison showed significant difference in pain intensity level, headache intensity, pressure pain threshold of Sub-occipital and Hamstring muscles, cervical flexion rotation range of motion and Hamstring flexibility. Between groups comparison showed no significant difference in all variables, pre-study. Where a significant difference in all variables, post study, in favor of group B except right and left cervical flexion rotation range of motion. Conclusion: Hamstring active release technique improves pain intensity level, headache intensity, pressure pain threshold and Hamstring flexibility, in patients with cervicogenic headache.

Minimally Invasive Surgery for Posterior Atlantoaxial Lateral Mass Joint Fusion (MIS-PALF): A Muscle-Sparing Procedure for Atlantoaxial Instability or Dislocation.

Conventional surgical procedures for atlantoaxial instability or dislocation (AAI/D) have been associated with a high prevalence of postoperative occipitocervical pain and dysfunction, as well as substantial perioperative blood loss. We hypothesized that minimally invasive surgery for posterior atlantoaxial lateral mass joint fusion (MIS-PALF), a procedure that can largely avoid disruption of suboccipital musculature, would be superior to the standard Goel-Harms technique in terms of postoperative pain and perioperative blood loss. This was a prospective cohort study of patients undergoing MIS-PALF for AAI/D at Peking University Third Hospital's Department of Orthopaedics from January 2021 to December 2021 and a historical control group of patients with the same diagnoses who were treated with the Goel-Harms technique. The duration of surgery, perioperative blood loss, postoperative length of hospital stay, postoperative body temperature, pain, supplementary use of narcotics, spinal cord function/improvement (assessed using the Japanese Orthopaedic Association [JOA] scores), reduction of AAI/D (determined based on radiographic parameters), rate of successful fusion, and complication rate were all compared between the 2 groups. No significant differences were noted between the groups (43 MIS-PALF cases, 86 control cases) regarding baseline data, operative time, spinal cord function or improvement, reduction of AAI/D, rate of successful fusion, and complication rate. MIS-PALF was associated with significantly less perioperative blood loss, a shorter postoperative hospital stay (decreased by 30.8%), lower intensity and frequency of postoperative pain (decreased by 10.6% and 61.9%, respectively), less need for supplementary narcotics, and less frequent postoperative fever (decreased by 48.7%). This was the first prospective cohort study of which we are aware on minimally invasive procedures for atlantoaxial fusion. Clinical efficacy (AAI/D reduction, rate of successful atlantoaxial fusion, JOA score improvement), efficiency (operative time), and safety (complications) of MIS-PALF appeared to be noninferior to those of the Goel-Harms technique. MIS-PALF was superior in terms of postoperative occipitocervical pain and length of hospital stay, both of which directly affect overall patient satisfaction and postoperative recovery of quality of life. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Reliability of Rehabilitative Musculoskeletal Sonography for Measuring the Visible Cross-Sectional Area of Suboccipital Muscles.

Aims The primary aim of this study is to assess the reliability of rehabilitative sonography as a non-invasive imaging technique for measuring the visible cross-sectional area (CSA) of the deep suboccipital muscles. Objectives Objectives involve determining both the intra-rater and inter-rater reliability of sonographic measurements to ensure consistent and reproducible results across different sessions and examiners. The ultimate goal is to validate rehabilitative sonography as a reliable tool for clinical and research applications in the assessment and management of musculoskeletal (MSK) conditions involving the deep suboccipital muscles. Design and setting Seventeen participants, including nine women and eight men without neck or vertebral pain, were evaluated using MSK sonography. The visible CSA of suboccipital muscles was assessed using real-time B-mode sonography in a sitting position with a linear probe (5 cm, 7.5 MHz) aligned perpendicularly to the muscle fibers of the rectus capitis posterior minor (RCPM) in one sonogram and the obliquus capitis inferior (OCI) and rectus capitis posterior major (RCPMJ) in another. Two experienced examiners performed sonography measurements, and the procedure was repeated one hour and again one day later. Results Intra-class correlation coefficient (ICC) values for Examiner 1 were 0.84 and 0.79 for RCPM, 0.84 and 0.71 for RCPMJ, and 0.86 and 0.77 for OCI at the one-hour and one-day repetitions, respectively. ICC values for Examiner 2 were 0.86 and 0.77 for RCPM, 0.77 and 0.86 for RCPMJ, and 0.61 and 0.64 for OCI at the one-hour and one-day repetitions, respectively. Inter-rater ICC values were 0.77 for RCPM, 0.82 for RCPMJ, and 0.68 for OCI. Standard error of measurement (SEM) values for Examiner 1 were 11.63 and 13.92 mm² for RCPM, 10.30 and 7.91 mm² for RCPMJ, and 22.84 and 34.61 mm² for OCI. SEM values for Examiner 2 were 11.82 and 13.40 mm² for RCPM, 11.91 and 7.04 mm² for RCPMJ, and 39.20 and 37.73 mm² for OCI. SEM values between examiners were 13.74 mm² for RCPM, 10.36 mm² for RCPMJ, and 36.03 mm² for OCI. Conclusions These findings suggest that sonography is a reliable method for measuring the CSA of the RCPM, RCPMJ, and OCI muscles, provided that the examiners are well-trained and consistent in their techniques and that the average of three measurements is used.

Prevalence of Myofascial Trigger Points in Isolated Idiopathic Cervical Dystonia: A Possible Contributor to Pain, Movement and Disability.

Myofascial trigger points (TrPs) are hypersensitive points located in a tight band of muscle that, when palpated, produce not only local pain but also referred (distant) pain. The role of TrPs in patients with cervical dystonia (CD) has not been investigated. To identify the presence of TrPs in patients with isolated idiopathic CD and their association with pain. Thirty-one patients (74.2% women; age: 61.2 years, SD: 10.1 years) participated. TrPs were explored in the sternocleidomastoid, upper trapezius, splenius capitis, levator scapulae, anterior scalene, suboccipital, and infraspinatus muscles. Clinical features of CD were documented as well as the presence of pain. The severity of dystonia and its consequences were assessed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). The mean number of TrPs for each patient was 12 (SD:3), with no differences between patients with pain (n = 20) and those without pain (n = 11). Active TrPs were only found in patients with pain (mean: 7.5, SD:4). Latent TrPs were found in both groups but were more prevalent (P < 0.001) in patients without pain (mean: 11, SD:3.5) than in those with pain (mean: 5, SD:3.5). The number of active TrPs or latent TrPs was positively associated with the TWSTRS disability subscale and the TWSTRS total score. The number of active, but not latent, TrPs was associated with worse scores on the TWSTRS pain subscale. Active TrPs were present in patients with CD reporting pain, while latent TrPs were present in all CD patients, irrespective of their pain status. The numbers of active/latent TrPs were associated with disability. TrPs could act as pain generators in CD and also contribute to the involuntary muscle contractions characteristic of dystonia.

Effects of the Suboccipital Muscle Inhibition Technique on Pain, Functional Disability and Quality of Life in Patients with Sacroiliac Joint Pain: a Randomized Controlled Trial

Effects of the Suboccipital Muscle Inhibition Technique on Pain, Functional Disability and Quality of Life in Patients with Sacroiliac Joint Pain: a Randomized Controlled Trial

Effectiveness and Safety of Pharmacopuncture on Inpatients with Tension Headache Caused by Traffic Accidents: A Pragmatic Randomized Controlled Trial.

Background: This study investigated the effectiveness and safety of pharmacopuncture for pain relief and functional improvement in patients with traffic accident (TA)-induced acute tension headaches. Methods: The study employed a parallel, single-centered, pragmatic, randomized controlled trial design. Eighty patients complaining of acute tension headaches were randomized into the integrative Korean medicine treatment (IKM treatment) group and the pharmacopuncture group on suboccipital muscles (suboccipital muscles pharmacopuncture + IKM treatment), with 40 participants assigned to each group. The patients in the pharmacopuncture group underwent pharmacopuncture as an add-on therapy, consisting of three sessions. Both groups were reassessed 2 months post-intervention. To assess the outcomes, the Numeric Rating Scale (NRS) for Headache, NRS for Neck Pain, Headache Disability Index, Headache Impact Test-6, EuroQol 5-Dimension, and Patient Global Impression of Change were used. Results: The improvement in the outcomes of the pharmacopuncture group was significantly greater than that of the comparison group on day 4 of hospitalization in terms of pain (difference in NRS of headache -2.59, 95% CI -3.06 to -2.12; NRS of Neck pain -1.05, 95% CI -1.50 to -0.59) and function (difference in HDI -24.78, 95% CI, -31.79 to -17.76; HIT-6 -6.13, 95% CI, -9.47 to -2.78). Additionally, in 2 months of follow-up, the recovery rate of headache was significantly higher in the pharmacopuncture group than in the comparison group. Conclusions: The pharmacopuncture group demonstrated superior outcomes in symptom improvement than the comparison group did, providing insights into novel and useful applications of pharmacopuncture in the clinical practice of Korean medicine.

Additional Effects Of Suboccipital Muscle Inhibition Along With Conventional Approach On Pain, Physical Function and Range of Motion in Patients with Chronic Mechanical Low Back Pain: An Experimental Study

Additional Effects Of Suboccipital Muscle Inhibition Along With Conventional Approach On Pain, Physical Function and Range of Motion in Patients with Chronic Mechanical Low Back Pain: An Experimental Study

Safety and Preliminary Efficacy of Cervical Paraspinal Interfascial Plane Block for Postoperative Pain after Pediatric Chiari Decompression.

Surgery for lesions of the posterior fossa is associated with significant postoperative pain in pediatric patients related to extensive manipulation of the suboccipital musculature and bone. In this study, we assess the preliminary safety, effect on neuromonitoring, and analgesic efficacy of applying a cervical paraspinal interfascial plane block in pediatric patients undergoing posterior fossa surgery. In this prospective case series, we enrolled five patients aged 2-18 years undergoing surgery for symptomatic Chiari type I malformation. An ultrasound-guided cervical cervicis plane (CCeP) block was performed prior to the incision. A local anesthetic agent (bupivacaine) and a steroid adjuvant (dexamethasone) were injected into the fascial planes between the cervical semispinalis capitis and cervical semispinalis cervicis muscles at the level of the planned suboccipital decompression and C1 laminectomy. Motor-evoked and somatosensory-evoked potentials were monitored before and after the block. Patients were assessed for complications from the local injection in the intraoperative period and for pain in the postoperative period. No adverse events were noted intraoperatively, and there were no changes in neuromonitoring signals. Pain scores were low in the immediate postoperative period, and rescue medications were minimal. No complaints of incisional pain or need for narcotics were noted at the time of the 3-month postsurgical follow-up. In this study, we demonstrate the preliminary safety and analgesic efficacy of a novel application of a CCeP block to pediatric patients undergoing suboccipital surgery. Larger studies are needed to further validate the use of this block in children.

The Immediate Effect of Dry Needling Electric Muscle Stimulation on the Position of Atlas.

Background: cervicogenic headaches are common and are believed to be the cause of dysfunction in the upper cervical spine. The mobility and the position of the atlas have been identified as a cause of upper cervical dysfunction. The mobility of the atlas is entirely under the control of the suboccipital muscles. The oblique capitis inferior muscle has a rotatory effect on the atlas when contracted. This study evaluated the immediate effects of a dry needling electrical stimulation-induced contraction of the left oblique capitis inferior muscle on the position and mobility of the atlas in the atlantoaxial joint. Methods: thirty-one subjects participated in this within-subject repeated measure study design. Each subject underwent a pre-measures neck flexion rotation test, palpation of the atlas position, and measurement of the length of the right oblique capitis inferior muscle with musculoskeletal ultrasound imaging. The pre-measures were repeated after two five-second tetanic contractions of the oblique capitis inferior muscle. Results: post-intervention analysis revealed significant changes in the length of the right oblique capitis inferior muscle. This length change correlated with the palpated positional default position immediately after the intervention. Conclusions: two five-second tetanic contractions of the left oblique capitis inferior muscle immediately affected the position of the atlas in the atlantoaxial joint. In our subjects, 90% displayed a positional default in the left rotation, and this was correlated with a change in the neck flexion rotation test. This study supports the notion that suboccipital muscle tonicity can result in mobility dysfunction and, thus, conditions such as cervicogenic headaches.

Sensory nerve formations in the myodural bridge complex of adult humans

The myodural bridge complex (MDBC) consists of connective tissue bands connecting the spinal dura mater to the suboccipital muscles passing throughout the posterior atlanto-occipital and atlanto-axial spaces. It is a universal evolutionarily conserved anatomical structure present in most vertebrate species including humans. Its physiology is unknown, but it is thought that it may be related to cerebrospinal fluid circulation. On the other hand, there is no information about the possible innervation of MDBC in humans. In the present study, immunohistochemistry (S100 protein and neurofilament proteins) was used to study the innervation of MDBC in five specimens of adult human cadavers. In all cases, nerve profiles were observed forming isolated nerve fibers or small nerve bundles, sometimes associated with blood vessels. In one case (1/5), at the level of the junction of the MDBC with the posterior rectus capitis minor muscle, complex capsulated formations containing a variable number of sensory nerve formations were found. We consider that such formations may be related to the proprioceptor system of the suboccipital muscles, but further studies are needed to determine their frequency, density and possible function.

Effects of Sub-Occipital Muscle Inhibition with and Without Hold Relax Agonist Contraction of Hamstrings on Pain, Disability and Craniovertebral Angle in Neck Pain Patients with Hamstring Tightness

Background: Neck pain is a prevalent musculoskeletal disorder with significant impacts on individuals' daily functioning and quality of life. The Superficial Backline (SBL) concept suggests that muscles and fascial structures are interconnected, implying that addressing muscle tightness in one area can influence distant regions. This study explored the effects of sub-occipital muscle inhibition (SMI) with and without hold-relax agonist contraction (HR-AC) of the hamstrings on pain, disability, and craniovertebral angle in patients with neck pain and hamstring tightness. Objective: To determine the efficacy of SMI with and without HR-AC on pain relief, neck disability, and craniovertebral angle in patients suffering from neck pain and hamstring tightness. Methods: This randomized controlled trial included 34 participants aged 20-40 years with neck pain (NPRS ≥ 5) and hamstring tightness (≥ 30° extension lag). Participants were randomly assigned to two groups: Group A (SMI without HR-AC) and Group B (SMI with HR-AC). Interventions were administered three times per week for two weeks. Pain, craniovertebral angle, and neck disability were assessed using the Numeric Pain Rating Scale (NPRS), Bubble Inclinometer, Image J software, and Neck Disability Index (NDI). Data were collected at baseline and post-treatment. Statistical analysis was performed using SPSS version 25, with paired and independent t-tests used to compare outcomes within and between groups. Results: Significant reductions in NPRS scores were observed in both groups: Group A (mean pre-treatment: 6.25 ± 0.85, post-treatment: 3.18 ± 0.98) and Group B (mean pre-treatment: 6.40 ± 0.986, post-treatment: 2.133 ± 0.743). Craniovertebral angle improved significantly in both groups: Group A (mean pre-treatment: 41.25° ± 3.51, post-treatment: 45.48° ± 2.94) and Group B (mean pre-treatment: 40.99° ± 2.70, post-treatment: 49.02° ± 2.868). NDI scores also showed marked improvement: Group A (mean pre-treatment: 32.96 ± 3.04, post-treatment: 15.38 ± 3.39) and Group B (mean pre-treatment: 33.03 ± 2.89, post-treatment: 11.25 ± 3.27). Group B demonstrated more significant improvements in all measured outcomes compared to Group A (p &lt; 0.05). Conclusion: Both interventions, SMI without HR-AC and SMI with HR-AC, significantly reduced pain, improved craniovertebral angle, and decreased neck disability. However, the combination of SMI with HR-AC was more effective, highlighting the importance of addressing both ends of the myofascial chain in managing neck pain and hamstring tightness.

Effects of suboccipital inhibition versus soft tissue manipulation on pain intensity and disability in tension-type headache among undergraduate physiotherapy students

BackgroundTension-type headache (TTH) is prevalent among collegiate students due to academic stress. Manual therapies like suboccipital inhibition and soft tissue manipulation have shown efficacy in TTH management. However, comparative studies between these interventions in collegiate populations are scarce. Understanding their relative effectiveness can enhance treatment strategies and improve outcomes, shedding light on optimal manual therapy approaches for TTH among collegiate students. This study aimed to investigate the effects of suboccipital inhibition and soft tissue manipulation on pain intensity and disability in tension-type headache (TTH) among undergraduate physiotherapy students.MethodsForty undergraduate physiotherapy students diagnosed with TTH were randomly assigned to the suboccipital inhibition group (group A, n = 20) and the soft tissue manipulation group (group B, n = 20). The suboccipital inhibition group received manual therapy targeting the suboccipital muscles, while the soft tissue manipulation group received manipulation techniques focusing on the cervical and shoulder girdle muscles. Pain intensity and disability were assessed using Visual Analogue Scale (VAS) and Headache Disability Index (HDI) Questionnaire at baseline and after 6 weeks of intervention. The data were collected and analysed using independent t test.ResultsBoth interventions demonstrated significant reductions in pain intensity and disability after 6 weeks, with the t value − 4.3150 and − 3.3106 at p < 0.05 for VAS and HDI respectively.ConclusionSuboccipital inhibition and soft tissue manipulation are effective interventions for reducing pain intensity and disability among undergraduate physiotherapy students with TTH. However, the suboccipital inhibition group showed improvement in pain intensity and disability and it has been statistically significant when compared to the soft tissue manipulation group.

The Effects of Cervical Mobilization with Clinical Pilates Exercises on Pain, Muscle Stiffness and Head and Neck Blood Flow in Cervicogenic Headache: Randomized Controlled Trial.

Background and Objectives: Physiotherapy approaches are used to eliminate the problems caused by cervicogenic headache (CHA), known as secondary headache associated with the structures of the upper cervical region. This study aimed to investigate the effects of cervical mobilization (CM) with clinical Pilates exercises (CPE) on pain, muscle stiffness and head-neck blood flow in CGH. Materials and Methods: A total of 25 patients participated in this randomized controlled study and were randomized into either the CM group or the CM+CPE group. All treatment methods were applied 3 days a week for 6 weeks. The outcome measure was headache intensity and frequency, the number of analgesics, muscle stiffness and vertebral artery (VA) and internal carotid artery (ICA) blood flow. Headache intensity was measured by a visual analogue scale, muscle stiffness by a myotonometer and blood flow by Doppler US. Evaluations were repeated after 6 weeks of treatment. Within-group comparisons were made by the Wilcoxon signed rank test, and between-group comparisons were made by the Mann-Whitney U test. Results: After treatments in the two groups, headache intensity and frequency and the number of analgesics decreased, the muscle stiffness of the suboccipital, upper trapezius and sternocleidomastoid (SCM) muscles decreased, and the blood flow of the ICA and VA increased (p < 0.05). There was a significant difference between the groups in terms of headache intensity (p = 0.025) and muscle stiffness in SKM (p = 0.044) in favor of the CM+CPE group. Conclusions: Non-pharmacological treatment approaches have an important role in CHA related to the upper cervical region. This study suggests that it would be beneficial to add CM in combination with CPE to the non-pharmacological treatment of patients with CHA.

The effect of suboccipital muscle dysfunction on the biomechanics of the upper cervical spine: a study based on finite element analysis

ObjectiveMuscle dysfunction caused by repetitive work or strain in the neck region can interfere muscle responses. Muscle dysfunction can be an important factor in causing cervical spondylosis. However, there has been no research on how the biomechanical properties of the upper cervical spine change when the suboccipital muscle group experiences dysfunction. The objective of this study was to investigate the biomechanical evidence for cervical spondylosis by utilizing the finite element (FE) approach, thus and to provide guidance for clinicians performing acupoint therapy.MethodsBy varying the elastic modulus of the suboccipital muscle, the four FE models of C0-C3 motion segments were reconstructed under the conditions of normal muscle function and muscle dysfunction. For the two normal condition FE models, the elastic modulus for suboccipital muscles on both sides of the C0-C3 motion segments was equal and within the normal range In one muscle dysfunction FE model, the elastic modulus on both sides was equal and greater than 37 kPa, which represented muscle hypertonia; in the other, the elastic modulus of the left and right suboccipital muscles was different, indicating muscle imbalance. The biomechanical behavior of the lateral atlantoaxial joint (LAAJ), atlanto-odontoid joint (ADJ), and intervertebral disc (IVD) was analyzed by simulations, which were carried out under the six loadings of flexion, extension, left and right lateral bending, left and right axial rotation.ResultsUnder flexion, the maximum stress in LAAJ with muscle imbalance was higher than that with normal muscle and hypertonia, while the maximum stress in IVD in the hypertonic model was higher than that in the normal and imbalance models. The maximum stress in ADJ was the largest under extension among all loadings for all models. Muscle imbalance and hypertonia did not cause overstress and stress distribution abnormalities in ADJ.ConclusionMuscle dysfunction increases the stress in LAAJ and in IVD, but it does not affect ADJ.

Improving Function and Quality of Life in Patients with Chronic Neck Pain, Tension-Type Headache, and Forward Head Posture: The Role of Eyeball Exercise and Cervical Stabilization Programs.

BACKGROUND The purpose of this study was to investigate the effects of eyeball exercise and cervical stabilization programs to patients with chronic neck pain, tension-type headache (TTH), and forward head posture (FHP). MATERIAL AND METHODS The design of this study was a randomized controlled trial. A total of 40 participants were randomly divided into 2 groups: the experimental group (n=20) and the control group (n=20). Both groups received cervical manual therapy and biofeedback-guided stabilization exercises (30 min/session, 3 sessions/week, 6 weeks). In addition to the regular treatments, the participants in the experimental group also performed eyeball exercises for 20 minutes per session, 3 sessions per week, for a total of 6 weeks. Changes in neck pain (numeric rating scale, NRS), neck disability index (NDI), quality of life (Short Form-12 Health Survey Questionnaire, SF-12), headache impact test-6 (HIT-6), craniovertebral angle (CVA), cranial rotation angle (CRA), and muscle tone were measured. RESULTS Both groups showed significant improvements in NRS, NDI, SF-12, HIT-6 scores, CVA, CRA, and muscle tone (p<0.05). The experimental group had significant differences in NDI, SF-12, HIT-6 scores, and suboccipital muscle tone compared to the control (p<0.05). CONCLUSIONS Combining the eyeball exercise program with commonly used manual therapy and stabilization exercises for patients with chronic neck pain can help reduce nerve compression and promote muscle relaxation in the eye and neck areas. The method is thus proposed as an effective intervention to enhance function and quality of life in patients with chronic neck pain patients, TTH, and FHP.

The Effect of Self-Myofascial Release Method on the Suboccipital Muscle Group in the Treatment of Cervicogenic Headache

The primary objective of this study is to investigate the short-term and long-term effects of the Self-Myofascial Release Method (SMFR) on the suboccipital muscle group in the improvement of cervicogenic headache. Additionally, the study aims to compare the therapeutic mechanism of Self-fascial Release and acupuncture in the treatment of cervicogenic headache

Musculoskeletal Ultrasound to Identify Changes in Obliquus Capitis Inferior Muscle &amp; Position of Atlas After a Manual Stretch

Introduction: Cervicogenic headache (CGH) is a prevalent condition caused by a disorder of the cervical spine that is commonly accompanied by neck pain and headaches. There is limited research regarding interventions benefiting CGH long-term. Interventions geared toward the suboccipital musculature may be used to improve CGH symptoms due to their anatomical connection to the cervical spine. Purpose: To determine if an isolated manual stretch of the obliquus capitis inferior will create a change in muscle diameter and length and position of atlas relative to axis. Methods: This quasi-experimental study used a single group of 36 subjects. Pre- and post-test measurements of the muscle diameter and length of the obliquus capitis inferior and the distance between atlas and axis were obtained using musculoskeletal ultrasound before and after our manual stretching intervention. Results: The results showed a significant increase in both measures, indicating increased length of the right Obliquus Capitis Inferior and the distance between the transverse process of C1 and spinous process of C2 after the manual stretch was applied. The average width of the right Obliquus Capitis Inferior was found to be 1.01 cm prior to applying the manual stretch and 1.99 cm after applying the manual stretch, demonstrating an increase in the width of the R OCI pre- and post-stretch. Conclusion: The results of this study indicate that the application of a manual static stretch held for 2x30 seconds will produce and immediate and significant increases in muscle length and width of the right Obliquus Capitis Inferior. Further research should be conducted to establish validated stretching parameters targeting the suboccipital muscles and further examine the effects of these muscles on CGH symptoms