Splenius Capitis Contracture

A splenius capitis contracture is the persistent tightening or shortening of the splenius capitis muscle—the strap‑like muscle that runs from the upper spine to the back of your skull. When the muscle stays in spasm it loses flexibility, pulls the head to one side, and causes neck pain, stiffness, and poor posture.


Basic anatomy of the splenius capitis muscle

Structure & location

The splenius capitis is a broad, flat muscle that lies deep to the trapezius on the back of the neck and upper back. It spans from the mid‑spine (C‑7 to T‑3) up to the base of the skull. Kenhub

Origin (where it starts)

  • Lower half of the nuchal ligament

  • Spinous processes of vertebrae C‑7 to T‑3/T‑4 Kenhub

Insertion (where it ends)

  • Mastoid process of the temporal bone (just behind your ear)

  • Lateral third of the superior nuchal line of the occipital bone The Muscular System

Blood supply

Nerve supply

key functions

  1. Extends the head (looks up).

  2. Rotates the head toward the same side.

  3. Bends (laterally flexes) the neck to the same side.

  4. Helps maintain upright head posture.

  5. Assists in gentle head retraction (tucking the chin).

  6. Works with neighboring muscles to stabilize the cervical spine during chewing and heavy lifting. KenhubThe Wellness Digest

A contracture happens when the muscle fibers and surrounding fascia stay stuck in a shortened state for weeks or months. Scar‑like changes develop, the muscle becomes less elastic, local nerves get irritated, and normal neck movements—especially turning the head—become painful. The problem may appear on its own, after injury, or as part of broader conditions like cervical dystonia (spasmodic torticollis). Samarpan Physiotherapy ClinicJNNP


Types of contracture

  1. Acute protective spasm – short‑term tightening after a strain.

  2. Chronic myofascial contracture – long‑standing trigger‑point knots that shorten the muscle belly.

  3. Post‑traumatic fibrotic contracture – scar tissue after whiplash or surgery.

  4. Neurogenic contracture – driven by nerve disorders such as cervical dystonia.

  5. Congenital muscular torticollis – rare birth‑related shortening of one neck muscle group that may include the splenius capitis.


Common causes

  1. Poor “forward‑head” desk posture

  2. Sleeping on too many pillows

  3. Carrying a heavy bag on one shoulder

  4. Whiplash from car accidents

  5. Sports collisions or falls

  6. Repeated overhead work (painting, plumbing)

  7. Long hours of smartphone use (“text neck”)

  8. Cold drafts on the neck

  9. Sudden chill after heavy sweating

  10. Cervical disc degeneration or arthritis

  11. Anxiety‑related muscle guarding

  12. Vitamin D or magnesium deficiency

  13. Chronic dehydration

  14. Jaw‑clenching or bruxism

  15. Uneven eyeglass prescription causing head tilt

  16. Post‑viral myositis

  17. Cervical dystonia or other movement disorders

  18. Post‑operative scarring in the neck

  19. Extended cervical immobilization (halo brace)

  20. Radiation therapy to the neck

(Causes compiled from physiotherapy and neurology case reviews.) Samarpan Physiotherapy ClinicNiel Asher Education


Recognizable symptoms

  1. Localized aching on one side of the neck

  2. Sharp pain when turning the head

  3. Head locked in slight rotation (“wry neck”)

  4. Headaches that start at the skull base

  5. Tender knot behind the ear

  6. Pain shooting to the temples or eye ­socket

  7. Shoulder‑blade discomfort

  8. Reduced neck rotation range

  9. Feeling of “pulling” or tight band in the neck

  10. Muscle cramps at night

  11. Tingling in the scalp (C2 nerve irritation)

  12. Sense of imbalance when turning quickly

  13. Jaw fatigue while chewing hard food

  14. Audible neck crepitus (grating)

  15. Visual fatigue from constant head tilt

  16. Disturbed sleep due to pain when rolling

  17. Low‑grade nausea triggered by head motion

  18. Difficulty reversing a car (checking blind spot)

  19. Dull upper‑back stiffness on the involved side

  20. Mood irritability linked to chronic pain triggerpointsecrets.comSamarpan Physiotherapy Clinic


Diagnostic tests

  1. Detailed history & physical exam – cornerstone assessment.

  2. Palpation for myofascial trigger points.

  3. Cervical range‑of‑motion (goniometer) test.

  4. Posture analysis (plumb‑line or digital).

  5. Spurling’s manoeuvre to rule out nerve root compression.

  6. Neurological exam (sensation, reflexes, myotomes).

  7. Plain cervical X‑ray – checks alignment, arthritis.

  8. Dynamic X‑ray (flexion‑extension views) – looks for instability.

  9. Magnetic resonance imaging (MRI) – gold‑standard for soft‑tissue injury, disc disease, muscle edema. NINDS

  10. Ultrasound of the muscle – visualizes real‑time fiber shortening. PMC

  11. Electromyography (EMG) – detects abnormal muscle firing or dystonia. Medscape

  12. Nerve conduction study – rules out radiculopathy.

  13. Surface thermography – maps local inflammation.

  14. Diagnostic trigger‑point injection – pain relief confirms muscular source.

  15. Computed tomography (CT) – clarifies bony spurs if X‑ray equivocal.

  16. Bone scan – excludes occult fracture after trauma.

  17. Blood tests (CBC, ESR, CK) – screens for infection or myositis.

  18. Vitamin‑D, magnesium levels – detects metabolic contributors.

  19. Posture‑related ergonomic audit (workplace check).

  20. Video motion analysis – quantifies abnormal head movement patterns in dystonia.


Non‑pharmacological treatments (drug‑free)

  1. Active stretching – slow chin‑tucks and gentle neck rotation.

  2. Passive muscle energy technique (MET) supervised by a therapist.

  3. Trigger‑point massage and myofascial release. triggerpointsecrets.comNiel Asher Education

  4. Dry needling into tight bands. Niel Asher Education

  5. Heat therapy (warm packs or showers).

  6. Intermittent ice packs for acute spasm.

  7. Ultrasound therapy – deep heating.

  8. Transcutaneous electrical nerve stimulation (TENS).

  9. Low‑level laser therapy (LLLT).

  10. Cervical traction (over‑door or pneumatic collar).

  11. Posture re‑education exercises.

  12. Ergonomic workstation correction (screen height, chair support).

  13. Foam‑roller or peanut‑ball self‑mobilization.

  14. Yoga neck sequences (cat‑cow, thread‑the‑needle).

  15. Pilates deep‑neck‑flexor training.

  16. Tai Chi for gentle range and balance.

  17. Alexander technique to reduce unnecessary tension.

  18. Kinesiology taping for proprioceptive cueing.

  19. Hydrotherapy (warm‑water exercises).

  20. Cupping therapy for myofascial decompression.

  21. Mindfulness‑based stress reduction (MBSR).

  22. Progressive muscle relaxation.

  23. Biofeedback for muscle tone awareness.

  24. Breathing retraining (diaphragmatic).

  25. Core‑strengthening to unload the neck.

  26. Isometric neck‑strength drills.

  27. Scapular stabilization exercises.

  28. Weighted blanket or warm scarf for comfort.

  29. Adequate hydration and anti‑oxidant diet.

  30. Regular micro‑breaks from screens (20‑20‑20 rule).


Medicines doctors may prescribe

  1. Acetaminophen (paracetamol) – first‑line pain reducer.

  2. Ibuprofen (NSAID).

  3. Naproxen (NSAID).

  4. Diclofenac (oral or gel).

  5. Celecoxib – COX‑2 selective NSAID.

  6. Aspirin – anti‑inflammatory at high dose.

  7. Cyclobenzaprine – muscle relaxant.

  8. Methocarbamol – muscle relaxant.

  9. Tizanidine – central muscle relaxant.

  10. Baclofen – GABA‑B agonist for spasticity.

  11. Diazepam (short course at night for severe spasm).

  12. Gabapentin – neuropathic pain modulator.

  13. Pregabalin – similar to gabapentin.

  14. Amitriptyline – low‑dose tricyclic for chronic myofascial pain.

  15. Duloxetine – SNRI for pain and mood.

  16. Capsaicin cream 0.025 % – topical analgesic.

  17. Lidocaine 4 % patch – localized relief.

  18. Oral corticosteroid taper (prednisone) for acute inflammatory flare.

  19. Botulinum toxin type A (e.g., Botox®, Dysport®, Xeomin®, Daxxify®) – injected every 12 weeks for dystonic contracture. Blue Cross NC

  20. Topical CBD or menthol gels (emerging but limited evidence).

Always follow professional dosing guidance; self‑medication can be risky.


Surgical options for severe or resistant cases

  1. Selective peripheral denervation – cutting overactive posterior neck nerve branches. JNNP

  2. Splenius capitis tendon‐lengthening or release – frees the shortened fibers.

  3. Endoscopic cervical rhizotomy – radiofrequency ablation of pain nerves.

  4. Open dorsal rhizotomy with ventral root excision for complex dystonia.

  5. Deep‑brain stimulation (DBS) of the globus pallidus internus when dystonia is widespread. JNNP

  6. Microvascular decompression if a vascular loop compresses accessory nerves.

  7. Posterior cervical spine fusion if instability drives chronic spasm.

  8. Anterior cervical discectomy & fusion (ACDF) when a herniated disc is the trigger.

  9. Intrathecal baclofen pump implantation for spasticity uncontrolled by oral drugs.

  10. Scar‑tissue excision and muscle flap repair after penetrating trauma.

Surgery is reserved for < 5 % of cases that fail exhaustive conservative care.


Practical ways to prevent contracture

  1. Keep your monitor at eye level to avoid chin‑poking.

  2. Take 30‑second neck‑stretch breaks every 30 minutes.

  3. Sleep on one medium‑height pillow that supports the natural curve.

  4. Strengthen deep‑neck flexors and shoulder blade muscles twice a week.

  5. Lift loads close to your body—no “one‑handed suitcase” carry.

  6. Wear seat belts and adjust headrests to head height.

  7. Warm‑up and cool‑down before and after sports.

  8. Stay hydrated—muscles cramp more when dehydrated.

  9. Manage stress with breathing or meditation to reduce tension holding.

  10. Get regular vitamin‑D‑rich sun exposure or supplements as advised.


When should you see a doctor?

  • Sudden neck pain after an accident or fall

  • Ongoing pain or stiffness that lasts more than two weeks despite self‑care

  • Headaches or dizziness linked to neck movement

  • Numbness, tingling, or weakness in the arm or hand

  • Visible head tilt or inability to keep the head straight

  • Night‑time pain that wakes you

  • Unexplained weight loss, fever, or night sweats (rule out infection or tumor)

Early medical review prevents chronic disability and helps you access imaging or injections quickly.


frequently asked questions (FAQs)

  1. Is splenius capitis contracture the same as torticollis?
    – It can be one cause of torticollis, but torticollis also involves other muscles.

  2. Can I treat it at home?
    – Mild cases often respond to heat, gentle stretching, and posture fixes within 7–14 days.

  3. How long does recovery take?
    – Acute cases may clear in weeks; chronic fibrotic contractures can take months.

  4. Will it come back?
    – Yes, if posture errors or stress triggers persist. Prevention exercises are key.

  5. Does sleeping without a pillow help?
    – Sometimes, but most people do better with a single supportive pillow.

  6. Are chiropractic adjustments safe?
    – When done by a qualified practitioner on screened patients, they may relieve stiffness, but avoid rapid neck thrusts if you have arthritis or vascular risks.

  7. Is botulinum toxin painful?
    – Injections are quick; discomfort is brief and similar to a bee sting.

  8. Will I need surgery?
    – Only if conservative and injectable treatments fail and your quality of life is severely limited.

  9. Can anxiety really tighten my neck?
    – Yes. Stress increases baseline muscle tone and can trigger or maintain contractures.

  10. Does magnesium help?
    – Low magnesium can worsen cramps; supplements may help if your levels are low.

  11. What kind of doctor should I see?
    – Start with a primary‑care physician or physiatrist; severe cases may need a neurologist or orthopedic spine surgeon.

  12. Are imaging tests always necessary?
    – Not for every strain, but MRI or ultrasound is recommended when pain persists beyond six weeks or red‑flag signs appear.

  13. Can children develop this problem?
    – It is rare but possible, especially after trauma or viral myositis.

  14. Is exercise bike or running okay?
    – Yes, cardiovascular exercise is good, but keep your head in neutral and stretch afterward.

  15. Will insurance cover Botox or surgery?
    – Most plans cover injections or surgery for documented cervical dystonia or contracture that fails therapy; check pre‑authorization rules.

A splenius capitis contracture is a common yet often overlooked reason for nagging neck pain and limited head turning. Good posture, timely stretching, and targeted physiotherapy solve most cases. Evidence‑based drug options, including botulinum toxin injections, provide added relief for stubborn spasms. Surgery is a last‑line choice but offers hope when all else fails. By understanding its anatomy, causes, and treatments, you can take practical steps to prevent, spot, and beat this painful neck problem.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: April 17, 2025.

References

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