Suboccipitals

Origin, Insertion, Action, Innervation

Rectus capitis posterior major (RCPma):
Origin: Spinous process of C2 (axis)
Insertion: Lateral portion of the inferior nuchal line of the occiput
Action: Extension of the head, ipsilateral rotation of the head at C1–C2

Rectus capitis posterior minor (RCPmi):
Origin: Posterior tubercle of C1 (atlas)
Insertion: Medial portion of the inferior nuchal line of the occiput
Action: Extension of the head (minimal rotation capacity)

Obliquus capitis superior (OCS):
Origin: Transverse process of C1 (atlas)
Insertion: Occipital bone between the superior and inferior nuchal lines
Action: Extension of the head, ipsilateral lateral flexion of the head

Obliquus capitis inferior (OCI):
Origin: Spinous process of C2 (axis)
Insertion: Transverse process of C1 (atlas)
Action: Ipsilateral rotation of the head at C1–C2

Innervation (all four): Suboccipital nerve (dorsal ramus of C1)

Palpation Guide

Client position: Prone with forehead on a face cradle or folded towel, or supine with head supported.
Landmark sequence:

Locate the external occipital protuberance (EOP) at the midline of the occiput. The suboccipitals lie in the space between the EOP and the C2 spinous process, deep to the upper trapezius and semispinalis capitis.
From the EOP, slide inferiorly and slightly lateral — you will pass through the overlying upper trapezius and semispinalis capitis before reaching the suboccipitals. These muscles are deep — approximately 2–3 cm below the skin surface.
The suboccipital triangle is bordered by RCPma (medially and inferiorly), OCS (laterally and superiorly), and OCI (inferiorly). The vertebral artery passes through this triangle.
Apply gentle, sustained pressure with fingertips just inferior to the inferior nuchal line, approximately 2–3 cm lateral to the midline bilaterally. You are now in the region of the suboccipital group.

Tissue feel: Deep and dense. When hypertonic (very common), the suboccipitals feel like hard, unyielding tissue at the base of the skull — a "concrete shelf" that students must work through the overlying layers to reach. The muscles are small — each is approximately the size of a fingertip.
Confirmation test: Ask the client to nod the head slightly (capital extension — "yes" motion) while you palpate. The suboccipitals produce this small rocking motion of the head on the atlas. You will feel subtle contraction deep under your fingertips.
Common errors:
Palpating too superficially — treating the overlying upper trapezius or semispinalis capitis and thinking you are on the suboccipitals. The suboccipitals are the deepest layer at the craniovertebral junction.
Applying excessive pressure — the vertebral artery passes through the suboccipital triangle. Use sustained moderate pressure, not aggressive depth.
Palpating too far lateral — moving beyond the transverse process of C1 puts you on unrelated structures.

Trigger Point Referral

Common TrP locations: TrPs develop throughout the suboccipital group, particularly in RCPma and OCI. Because the muscles are small and deep, individual TrP locations are difficult to distinguish clinically — the group is treated as a functional unit.
Referral pattern: Refers as a deep, diffuse aching that wraps from the occiput anteriorly to behind the ipsilateral eye. The pain is often described as a "band" around the head or a deep pressure behind the eye that is distinct from the more superficial upper trapezius referral.
Clinical significance: The suboccipital referral is the primary muscular source of conditions/cervicogenic-headache. Unlike upper trapezius referral (which concentrates at the temple), suboccipital referral is deeper, more diffuse, and wraps further forward to the periorbital region. If the client describes their headache as "deep behind the eye" or "inside the skull," the suboccipitals are the most likely muscular source.

Trigger point referral diagram — coming soon

Image coming soon. For visual reference, see [Suboccipitals at TriggerPoints.net](http://www.triggerpoints.net/muscle/suboccipital).

Clinical Notes

Innervation significance:

All four suboccipitals are innervated by the suboccipital nerve (dorsal ramus of C1). This is a motor nerve — it does not carry pain sensation. Pain from the suboccipitals is mediated by the greater occipital nerve (C2), which passes through or near the group. Compression of the greater occipital nerve by hypertonic suboccipitals is a direct mechanism for conditions/occipital-neuralgia.

Common conditions:

Primary muscular contributor to conditions/cervicogenic-headache — the dense proprioceptor population means that dysfunction produces not only pain but also dizziness, visual disturbance, and spatial disorientation.
One of Janda's "tight" muscles in conditions/upper-crossed-syndrome. The suboccipitals shorten in response to forward-head posture to maintain horizontal gaze — the head tilts back on the atlas to keep the eyes level as the cervical spine flexes forward.
Compression of the greater occipital nerve by hypertonic suboccipitals contributes to conditions/occipital-neuralgia — sharp, shooting pain from the occiput over the vertex of the skull.
Suboccipital dysfunction following conditions/whiplash is extremely common and contributes to the persistent headache, dizziness, and visual disturbance component of post-whiplash syndrome.

What you'll typically find:

Hypertonic suboccipitals are present in virtually every client with forward-head posture. The "concrete shelf" at the base of the skull is one of the most consistent clinical findings in practice. Clients often have no awareness of how tight this region is until you begin palpation.
The high proprioceptor density means that suboccipital dysfunction produces more than just pain — it produces postural disorientation. Clients may report feeling "off-balance" or "foggy" without associating it with the back of their skull.
The greater occipital nerve is often tender to palpation at the point where it emerges through the suboccipital musculature, approximately 2–3 cm lateral to the EOP.

Treatment effects:

Suboccipital release is one of the most effective techniques in the MT toolkit. Sustained compression (fingertip pressure directed anteriorly and superiorly at the base of the skull) held for 2–5 minutes produces a gradual softening of the tissue. Clients often report the headache diminishing in real time during treatment.
The release is slow — unlike upper trapezius, which may release in 30–60 seconds, the suboccipitals require patience. Apply steady, moderate pressure and wait. The tissue will gradually soften and your fingers will sink deeper.
Post-treatment, clients frequently report feeling "lighter," clearer-headed, and less dizzy. These proprioceptive and vestibular effects make suboccipital release one of the most dramatic treatments a student will learn.

Cautions:

The vertebral artery passes through the suboccipital triangle (between RCPma, OCS, and OCI) and through the transverse foramen of C1 before entering the foramen magnum. Do not apply aggressive, direct pressure into the suboccipital triangle. Use broad, sustained fingertip pressure rather than a focused tool (no T-bar or elbow in this region).
The greater occipital nerve passes through the suboccipital group — if the client reports sharp, shooting, electrical-type pain during palpation, you may be directly compressing the nerve. Adjust your angle slightly medial or lateral.
Avoid vigorous upper cervical rotation or extension during or after suboccipital treatment — the vertebral artery is at risk during combined extension and rotation at C1–C2.

Postural significance:

In forward-head posture, the suboccipitals shorten to extend the upper cervical spine, keeping the eyes horizontal. This compensatory shortening is adaptive — it maintains gaze — but produces chronic compression at the craniovertebral junction. The reciprocally inhibited muscles are the deep cervical flexors (longus colli, longus capitis), which weaken and fail to support the cervical lordosis.

Clinical pearl:

Suboccipital release combined with deep cervical flexor activation (chin tucks) is the single most effective intervention for cervicogenic headache. If you release the suboccipitals without activating the deep flexors, the forward-head posture returns and the suboccipitals re-tighten. If you prescribe chin tucks without releasing the suboccipitals first, the client cannot perform the exercise because the suboccipitals are too shortened to allow the motion. Sequence matters: release first, activate second.

Assessment

Manual muscle testing:

Capital extension: Client supine. Place one hand under the occiput and ask the client to push the back of the head into your hand (extending the head on the atlas). This engages the suboccipitals. The test assesses the group as a unit — individual suboccipitals cannot be isolated.

Stretch test:

Capital flexion (chin tuck): Client supine. Gently flex the client's head — tucking the chin toward the throat — while stabilizing the cervical spine. This stretches the suboccipitals without flexing the cervical spine. Restriction in capital flexion (the chin cannot approach the throat) indicates shortened suboccipitals.

Related special orthopedic tests:

Cervical flexion-rotation test — tests C1–C2 rotation; restriction may indicate suboccipital shortening or atlantoaxial dysfunction
Vertebral artery test — required before any manual technique involving upper cervical extension or rotation

Muscle Groups

Suboccipital group (anatomical):

Rectus capitis posterior major (RCPma)
Rectus capitis posterior minor (RCPmi)
Obliquus capitis superior (OCS)
Obliquus capitis inferior (OCI)

Capital extensors (functional):

Suboccipitals (this article)
Semispinalis capitis
Splenius capitis

Upper crossed syndrome — "tight" group (clinical):

Suboccipital nerve (C1 dorsal ramus) group (innervation):

All four suboccipital muscles share the same nerve

Related Muscles

Synergists for capital extension:

Semispinalis capitis — large superficial extensor overlying the suboccipitals
Splenius capitis — extends and ipsilaterally rotates the cervical spine

Antagonists:

Deep cervical flexors (longus colli, longus capitis) — the reciprocally inhibited muscles in upper crossed syndrome

Clinically related:

anatomy/muscles/upper-trapezius — the two form the "stress triangle" of bilateral upper trapezius and suboccipitals; both are chronically hypertonic in desk workers
anatomy/muscles/sternocleidomastoid — SCM's bilateral contraction extends the upper cervical spine, reinforcing suboccipital shortening

Key Takeaways

Most proprioceptor-dense muscles in the body — dysfunction produces headache, dizziness, and postural disorientation, not just pain.
The greater occipital nerve passes through the group — compression causes occipital neuralgia (sharp, shooting pain from occiput to vertex).
Release first, activate second: suboccipital release followed by deep cervical flexor activation (chin tucks) is the most effective sequence for cervicogenic headache.