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Splenius Capitis Pain

Dr. Marianne Abouyared, Md - Otolaryngology (ENT) Dr. Marianne Abouyared, Md - Otolaryngology (ENT)
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Rx Musculoskeletal System (A - Z)

Splenius capitis pain is discomfort or aching originating from the splenius capitis muscle, a key neck muscle involved in head extension and rotation. This pain can range from a dull ache to sharp, stabbing sensations and may be accompanied by headaches or restricted neck movement. Understanding the anatomy, causes, symptoms, and treatment options for splenius capitis pain empowers individuals to manage and prevent this common form of neck discomfort.

Anatomy of the Splenius Capitis

Structure and Location

The splenius capitis is a broad, straplike muscle on the back of the neck. It lies deep to the trapezius and superficial to the semispinalis capitis and longissimus capitis muscles. It forms part of the superficial layer of intrinsic back muscles on the posterolateral neck, contributing to the floor of the posterior triangle of the neck PhysiopediaWikipedia.

Origin

The muscle originates from the lower half of the nuchal ligament and the spinous processes of the seventh cervical (C7) through third (T3) or fourth (T4) thoracic vertebrae TeachMeAnatomyWikipedia.

Insertion

Fibers travel superolaterally to insert onto the mastoid process of the temporal bone and the lateral one‑third of the superior nuchal line on the occipital bone PhysiopediaWikipedia.

Blood Supply

Arterial supply is provided by muscular branches of the occipital artery, a branch of the external carotid, and from the deep cervical artery in some individuals www.elsevier.com.

Nerve Supply

Innervation comes from the lateral branches of the posterior rami of the C3 and C4 spinal nerves PhysiopediaWikipedia.

Functions

  1. Bilateral Contraction: Extends the head at the atlanto‑occipital joint.

  2. Unilateral Contraction: Rotates the head to the same side.

  3. Lateral Flexion: Assists in bending the head toward the shoulder on the same side.

  4. Head Support: Helps maintain an erect head posture against gravity.

  5. Jaw Movement: Tightens during mandibular protrusion and wide opening of the jaw.

  6. Synergistic Action: Works with sternocleidomastoid for controlled head movements PhysiopediaKenhub.

Types of Splenius Capitis Pain

  1. Myofascial Pain Syndrome: Trigger points in the splenius capitis refer pain to the vertex and mimic tension‑type headaches Morningside Acupuncture NYCBioMed Central.

  2. Acute Muscle Strain: Sudden overload or trauma leads to microtears and sharp pain Rehab My PatientStudy.com.

  3. Chronic Muscle Tension: Long‑term poor posture causes low‑grade inflammation and aching PhysiopediaPhysiopedia.

  4. Cervicogenic Headache: Referred pain from cervical structures, including splenius capitis, causing unilateral headache PhysiopediaBreathe Physio.

  5. Occipital Neuralgia: Entrapment of the greater occipital nerve within or near the splenius capitis causing paroxysmal stabbing pain PubMed CentralPhysiopedia.

Causes of Splenius Capitis Pain

  1. Poor Posture: Forward head posture stresses the muscle fibers PhysiopediaPhysiopedia.

  2. Whiplash from MVCs: Rapid head movement causes overstrain and microtrauma PhysiopediaMedCentral.

  3. Falls or Blunt Trauma: Direct impact to the neck region PhysiopediaMedCentral.

  4. Prolonged Head Rotation: Working with monitors off‑axis Morningside Acupuncture NYCRehab My Patient.

  5. Awkward Sleeping Position: Lack of neck support or sleeping on armrest Morningside Acupuncture NYCRehab My Patient.

  6. Cold Exposure: Air‑conditioning drafts leading to muscle spasm Morningside Acupuncture NYCRehab My Patient.

  7. Repetitive Overuse in Sports: Swimming crawl stroke or cycling neck extension Harvard Health.

  8. Heavy Lifting: Straining neck to look upward or tilt Harvard Health.

  9. Degenerative Disc Disease: Alters biomechanics and increases muscle load Cleveland Clinic.

  10. Facet Joint Dysfunction: Pain referral to splenius capitis Breathe PhysioPhysiopedia.

  11. Cervical Spondylosis: Bone spurs irritate adjacent muscles Cleveland Clinic.

  12. Trigger Points: Local hyperirritable muscle nodules BioMed Central.

  13. Nerve Entrapment: Greater occipital nerve compressed by semispinalis or splenius PubMed CentralPhysiopedia.

  14. Myositis: Inflammatory myopathy can involve deep neck muscles PubMed Central.

  15. Fibromyalgia: Widespread pain includes neck muscles PubMed Central.

  16. Osteoarthritis: Degeneration of cervical joints leading to secondary muscle pain Cleveland Clinic.

  17. Tumors or Infections: Rarely, local pathology causes muscle irritation PubMed Central.

  18. Vitamin D Deficiency: May predispose to myalgia PubMed Central.

  19. Psychological Stress: Increases muscle tension and trigger point formation Physiopedia.

  20. Workstation Ergonomics: Laptop or mobile device use without breaks Physiopedia.

Symptoms of Splenius Capitis Pain

  1. Occipital Headache: Pain at the base of the skull radiating upward PhysiopediaMorningside Acupuncture NYC.

  2. Neck Stiffness: Reduced range of motion on turning Morningside Acupuncture NYCPubMed Central.

  3. Muscle Tenderness: Palpable pain over mastoid and superior nuchal line Morningside Acupuncture NYCPubMed Central.

  4. Trigger Point Referral: Vertex or forehead pain from muscle nodules Morningside Acupuncture NYC.

  5. Sharp, Stabbing Pain: Occipital neuralgia episodes PubMed CentralScienceDirect.

  6. Dull Aching: Chronic muscle tension discomfort Physiopedia.

  7. Muscle Spasm: Involuntary tightness and knots Morningside Acupuncture NYC.

  8. Head Tilt: Compensatory posture to avoid pain PubMed Central.

  9. Radiating Shoulder Pain: Downward referral into trapezius or shoulder Physiopedia.

  10. Jaw Pain or TMJ Stress: Muscle tightness affecting jaw opening Physiopedia.

  11. Visual Disturbances: Blurring from referred tension BioMed Central.

  12. Dizziness: Neck‑related positional vertigo Breathe Physio.

  13. Nausea or Photophobia: With severe headache Physiopedia.

  14. Fatigue: From constant muscle tension PubMed Central.

  15. Tinnitus or Ear Pain: Referred from upper cervical irritation Physiopedia.

  16. Paraesthesia: Tingling from nerve involvement Physiopedia.

  17. Muscle Weakness: In severe or chronic cases PubMed Central.

  18. Difficulty Concentrating: Pain‑related cognitive distraction PubMed Central.

  19. Sleep Disturbance: Pain preventing restful sleep PubMed Central.

  20. Mood Changes: Chronic pain affecting emotional well‑being PubMed Central.

Diagnostic Tests

  1. Physical Examination: Palpation for tenderness and trigger points Morningside Acupuncture NYC.

  2. Range of Motion Assessment: Measuring flexion, extension, rotation limitations Morningside Acupuncture NYC.

  3. Neurological Exam: Testing sensory and motor function of C2–C4 distribution Wikipedia.

  4. Pressure Pain Threshold (PPT) Algometry: Quantifies muscle sensitivity BioMed Central.

  5. Electromyography (EMG): Detects muscle activation patterns and nerve entrapment BioMed Central.

  6. Nerve Conduction Studies: Evaluates greater occipital nerve function PubMed Central.

  7. Ultrasound Imaging: Visualizes muscle structure and nerve compression BioMed Central.

  8. MRI of Cervical Spine: Rules out disc, ligament, or joint pathology PubMed Central.

  9. CT Scan: Bone detail for joint or fracture evaluation Cleveland Clinic.

  10. X‑Ray: Assesses cervical alignment and degenerative changes Cleveland Clinic.

  11. Diagnostic Nerve Block: Local anesthetic injection to confirm source PubMed Central.

  12. Trigger Point Injection Test: Relief after local anesthetic indicates myofascial origin PubMed Central.

  13. Facet Joint Block: Diagnostic anaesthetic injection into C2–C3 facet joint PubMed Central.

  14. Third Occipital Nerve Block: Identifies pain from third occipital nerve PubMed Central.

  15. Atlantoaxial Joint Injection: Diagnostic and sometimes therapeutic PubMed Central.

  16. Ultrasound‑Guided Greater Occipital Nerve Block: Confirms nerve entrapment source BioMed Central.

  17. Myelography: Contrast study for spinal canal and nerve root detail PubMed Central.

  18. Surface Electromyography (sEMG): Assesses muscle fatigue patterns PubMed Central.

  19. Functional Movement Screen: Identifies biomechanical contributions to pain PubMed Central.

  20. Laboratory Tests: Rule out inflammatory myopathies (e.g., CK levels) PubMed Central.

Non‑Pharmacological Treatments

  1. Postural Correction Exercises: Strengthen deep cervical flexors Physiopedia.

  2. Myofascial Release Massage: Relieves trigger points Physiopedia.

  3. Trigger Point Dry Needling: Minimally invasive stimulation PubMed Central.

  4. Acupuncture: Releases muscle tension and improves blood flow Morningside Acupuncture NYC.

  5. TENS Therapy: Gate‑control pain modulation Wikipedia.

  6. Heat Therapy: Promotes circulation and relaxes muscles Wikipedia.

  7. Cold Packs: Reduces acute inflammation and pain Wikipedia.

  8. Ultrasound Therapy: Deep tissue heating for pain relief Well Health Pro.

  9. Laser Therapy: Low‑level laser reduces pain and inflammation Well Health Pro.

  10. Cervical Mobilization/Manipulation: Joint gliding to improve motion Physiopedia.

  11. Spinal Stabilization Exercises: Enhance neck and core control PubMed Central.

  12. Ergonomic Workstation Adjustment: Proper monitor and chair height Physiopedia.

  13. Stretching: Gentle elongation of splenius capitis and antagonists Morningside Acupuncture NYC.

  14. Yoga and Pilates: Improves posture, flexibility, and core strength Cleveland Clinic.

  15. Biofeedback: Teaches muscle relaxation techniques PubMed Central.

  16. Cognitive Behavioral Therapy (CBT): Manages pain‑related stress PubMed Central.

  17. Postural Taping or Strapping: Reminds correct head position Well Health Pro.

  18. Neck Bracing (Soft Collar): Short‑term support during acute pain PubMed Central.

  19. Aquatic Therapy: Gentle resistance and relaxation in water Cleveland Clinic.

  20. Joint Mobilization: Small‑amplitude oscillatory glides Physiopedia.

  21. Muscle Energy Technique (MET): Active muscle contraction to improve length ScienceDirect.

  22. Neural Mobilization: Gentle gliding of cervical nerves Breathe Physio.

  23. Mindfulness Meditation: Reduces muscle tension through relaxation PubMed Central.

  24. Soft Tissue Release: Manual techniques to reduce adhesion Well Health Pro.

  25. Posture‑Correcting Devices: Wearables that vibrate when posture falters Physiopedia.

  26. Pilates Ring Exercises: Target cervical stabilization Cleveland Clinic.

  27. Gua Sha: Traditional scraping technique for muscle tension PubMed Central.

  28. Cupping Therapy: Suction to increase local blood flow PubMed Central.

  29. Occupational Therapy Ergonomics: Task‑specific adaptations Physiopedia.

  30. Postural Education and Self‑Care Training: Teaches daily habits to protect the neck Cleveland Clinic.

Pharmacological Treatments (Drugs)

  1. Ibuprofen (NSAID): Over‑the‑counter pain relief by reducing inflammation Spine-health.

  2. Naproxen (NSAID): Longer half‑life for sustained relief Spine-health.

  3. Diclofenac Gel (Topical NSAID): Local application to reduce systemic effects Spine-health.

  4. Meloxicam (NSAID): Selective COX‑2 inhibitor with fewer GI side effects Spine-health.

  5. Celecoxib (Selective COX‑2 NSAID): Reduced GI risk profile Spine-health.

  6. Acetaminophen (Paracetamol): Analgesic for mild neck pain Medical News Today.

  7. Cyclobenzaprine (Muscle Relaxant): Central action for acute muscle spasm Medscape.

  8. Tizanidine (Muscle Relaxant): Alpha‑2 agonist, used with NSAIDs PubMed Central.

  9. Baclofen (Muscle Relaxant): GABA‑B agonist for chronic spasm PubMed Central.

  10. Methocarbamol (Muscle Relaxant): Centrally acting for spasm relief PubMed Central.

  11. Gabapentin (Antiepileptic): Neuropathic pain modulation Cleveland Clinic.

  12. Pregabalin (Antiepileptic): Similar to gabapentin, for neuropathic neck pain PubMed Central.

  13. Amitriptyline (TCA): Low‑dose for chronic headache and myofascial pain PubMed Central.

  14. Duloxetine (SNRI): For coexisting depression/anxiety and pain PubMed Central.

  15. Venlafaxine (SNRI): Alternative antidepressant for pain modulation PubMed Central.

  16. Diazepam (Benzodiazepine): Short‑term relief of severe spasm Physiopedia.

  17. Opioids (e.g., Tramadol): For refractory acute pain under strict supervision Wikipedia.

  18. Corticosteroid Injection (e.g., Dexamethasone): Intra‑muscular or peri‑nerve block PubMed Central.

  19. Botulinum Toxin: For chronic myofascial trigger point deactivation (off‑label) ScienceDirect.

  20. NSAID/Acetaminophen Combination (e.g., Vicoprofen): Synergistic pain relief Drugs.com.

Surgical Options

  1. Occipital Nerve Decompression: Releases greater occipital nerve entrapment in semispinalis capitis PubMed Central.

  2. Greater Occipital Nerve Neurolysis: Microsurgical release of nerve adhesions PubMed Central.

  3. Third Occipital Nerve Radiofrequency Ablation: Denervation of C3 nerve branch PubMed Central.

  4. Atlantoaxial (C1–C2) Fusion: Stabilizes unstable upper cervical segment PubMed Central.

  5. C2–C3 Facet Joint Fusion: Eliminates painful joint motion PubMed Central.

  6. Anterior Cervical Discectomy and Fusion (ACDF): Removes disc and fuses vertebrae Verywell Health.

  7. Cervical Disc Arthroplasty: Artificial disc replacement to preserve motion PubMed Central.

  8. Posterior Cervical Laminoforaminotomy: Decompresses nerve root via posterior approach Verywell Health.

  9. Cervical Laminectomy: Removal of lamina to decompress spinal canal Verywell Health.

  10. Percutaneous Radiofrequency Neurotomy: Minimally invasive nerve lesioning for long‑term relief Legacy Spine & Neurological Specialists.

Prevention Strategies

  1. Ergonomic Workspace: Adjust monitor at eye level and use supportive chair Physiopedia.

  2. Frequent Breaks: Take 5‑minute neck stretches every hour Cleveland Clinic.

  3. Posture Education: Maintain neutral spine and head alignment Cleveland Clinic.

  4. Supportive Pillow/Mattress: Sleep with cervical support to avoid neck flexion Cleveland Clinic.

  5. Strengthening Exercises: Build deep neck flexors and upper back muscles ScienceDirect.

  6. Stress Management: Yoga, meditation to reduce muscle tension PubMed Central.

  7. Proper Lifting Techniques: Use legs, avoid looking up or twisting neck Harvard Health.

  8. Neck Warm‑Up in Sports: Gentle mobilizations before activity Harvard Health.

  9. Avoid Cold Drafts: Wear scarves or use neck warmers in cold environments Morningside Acupuncture NYC.

  10. Regular Physical Activity: Improves posture, circulation, and muscle resilience Cleveland Clinic.

When to See a Doctor

  • After Significant Trauma: Whiplash, falls, or blows to the head/neck Physiopedia.

  • Persistent Pain > 1 Week: Unrelieved by self‑care Cleveland Clinic.

  • Neurological Signs: Numbness, weakness, or coordination loss Cleveland Clinic.

  • Severe Headache: Unusual intensity or associated with nausea/vomiting Cleveland Clinic.

  • Fever or Infection Signs: Raises concern for infectious myositis PubMed Central.

  • Unexplained Weight Loss: Potential red flag for systemic disease PubMed Central.

  • Pain Wakes You at Night: Suggests serious underlying condition PubMed Central.

  • Swallowing or Breathing Difficulty: Possible cervical spine compromise PubMed Central.

  • Loss of Bladder/Bowel Control: Indicates possible spinal cord issue PubMed Central.

  • Ineffective Conservative Care: After 4–6 weeks of therapy without improvement Cleveland Clinic.

 Frequently Asked Questions

  1. What is splenius capitis pain?
    Pain arising from strain or irritation of the splenius capitis muscle at the back of the neck Wikipedia.

  2. How is it diagnosed?
    Through physical exam, range of motion tests, and sometimes imaging or nerve blocks PubMed Central.

  3. What causes trigger points?
    Microtrauma from poor posture, overuse, or stress leads to hypersensitive muscle nodules Morningside Acupuncture NYC.

  4. Can stress make it worse?
    Yes, psychological stress increases muscle tension and exacerbates pain PubMed Central.

  5. Is imaging always needed?
    No—most cases respond to conservative care; imaging is reserved for red‑flag symptoms Cleveland Clinic.

  6. What home remedies help quickly?
    Heat or cold packs, gentle stretches, and over‑the‑counter NSAIDs often provide relief Wikipedia.

  7. Can exercise prevent recurrence?
    Regular strengthening and posture exercises reduce future flare‑ups ScienceDirect.

  8. Are injections effective?
    Yes—trigger point, occipital nerve, or facet joint injections can both diagnose and treat pain PubMed Central.

  9. When are muscle relaxants used?
    For acute spasm or severe pain unresponsive to NSAIDs PubMed Central.

  10. Is surgery common?
    Rare—only for refractory cases or specific nerve entrapment situations PubMed Central.

  11. What role does posture play?
    Major—correct posture alleviates chronic muscle tension Cleveland Clinic.

  12. Can sleep position affect it?
    Yes—unsupported neck during sleep can trigger muscle pain Morningside Acupuncture NYC.

  13. Are alternative therapies helpful?
    Techniques like acupuncture, cupping, and yoga can complement standard care Morningside Acupuncture NYC.

  14. How long does recovery take?
    Acute cases often improve in days to weeks; chronic cases may require months of therapy Cleveland Clinic.

  15. When should I worry?
    Seek help for persistent or worsening pain, neurological deficits, or post‑traumatic symptoms Cleveland Clinic.

Conclusion
Splenius capitis pain encompasses a spectrum from acute strain to chronic myofascial and nerve‑related syndromes. A comprehensive approach—understanding the muscle’s anatomy, identifying your specific pain type, and applying evidence‑based diagnostics and treatments—ensures optimal relief and prevention. By integrating ergonomic, therapeutic, pharmacological, and, when necessary, surgical strategies, individuals can effectively manage and minimize splenius capitis–related discomfort.

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 Update: April 16, 2025.

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References

 

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