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Atlas · Neck

Splenius Capitis

Splenius capitis links the lower neck and upper thoracic spine to the skull behind the ear. It contributes to head extension and same-side rotation. A painful head turn and posterior-neck ache are useful examination targets when headache also occurs.

Splenius Capitis
Body region
Neck
Trigger points
3
documented in this muscle
Common symptoms
3
patterns cataloged
Contributors
3
Factors to assess

Muscle overview

Symptoms and first steps

Practical first steps

  • Move a frequently viewed screen or object closer to the center.
  • Use slow comfortable turns and vary positions.
  • Choose sleep support that reduces morning pain.

When to seek assessment

  • Seek urgent care for a sudden unusual severe headache, new double vision or visual loss, imbalance, weakness or speech/swallowing change.
  • Arrange examination after substantial trauma or for a new or progressively changing headache.

Its skull attachment distinguishes capitis from splenius cervicis. Tenderness behind the ear can also involve SCM and other posterior-neck muscles.

Examination, palpation and treatment evidence

Illustrated overview

Splenius Capitis

Blue highlights the muscle. Crosses mark representative trigger-point sites; shaded areas show possible referred pain. These examples do not correspond one-to-one with the numbered points below. Patterns vary and cannot diagnose the cause of pain.

Illustrated overview

Splenius Capitis · Anatomy 1

Anatomical view of the illustrated muscle.

Open full-size image

Trigger points

1. TrP1

Location. Back of neck, upper cervical

Trigger point map
Splenius Capitis — Splenius Capitis · Trigger-point examples 1Open full-size image

Regional muscle reference; this is not an individual map of the selected numbered trigger point.

Referred pain map
Splenius Capitis — Splenius Capitis · Referred-pain pattern 1Open full-size image

Regional muscle reference; this is not an individual map of the selected numbered trigger point.

Pain referral. Posterior neck and accompanying head pain

Pain Pattern

  • Posterior neck
  • Occipital or crown discomfort may coexist

What This Pain Feels Like

Posterior-neck aching can accompany pain at the back or crown of the head. Compare head turning, extension and the headache history before assigning the complaint to splenius capitis.

What Patients Report

  • Headache with posterior-neck soreness
  • Stiffness on waking

What Makes It Worse

  • Sustained head rotation
  • Looking up
  • Long viewing tasks
Browse related exercises (1)

Symptoms patients report

Painful head turning Often easier to reproduce and follow than a vague report of tightness.

Ache behind the ear The local anatomy overlaps with SCM, upper-cervical joints and occipital nerves.

Headache with neck soreness Record headache features separately from the tenderness finding.

Contributors to assess

Long periods looking to one side A side monitor or repeated work task may exceed current rotation tolerance.

Sudden change in neck loading New work or exercise demands may contribute to soreness.

Neck trauma Requires an injury assessment before attributing pain to a tender band.

For clinicians and supervised training

Clinical reference

Headache and neck pain may coexist; a crown or eye-region pain map does not establish splenius as the cause.

Anatomy and palpation

Anatomical relationships

Fibers ascend from the nuchal ligament and C7–T4 spinous processes toward the mastoid and lateral occiput. Bilateral activity extends the head; unilateral activity contributes to same-side rotation and side-bending.[1]

  • Mastoid behind the ear and lateral occipital ridge.
  • Posterior neck between the upper trapezius and posterior SCM border.

Nearby structures. SCM overlaps the mastoid region; trapezius overlies more medial fibers and semispinalis lies deeper. Deep probing cannot reliably distinguish these layers.

Palpation

Patient position. Prone with forehead supported, or seated with head resting on supported hands.

Find the landmarks

  • Identify the mastoid and posterior SCM border externally.
  • Follow the expected oblique muscle course toward the lower midline neck.

Examination sequence

  1. Use a very light head-extension or same-side rotation effort to orient to contractile tissue.
  2. Let the head relax and compare gentle contact across the posterolateral muscle region.
  3. Record location and familiar pain, then retest active rotation.

Document the findings

  • A reproducible tender region can accompany load-sensitive neck pain.
  • A palpable layer cannot by itself separate splenius from neighboring extensors.

Limits and precautions

  • Avoid the anterior neck and sustained focal pressure behind the mastoid.
[1][2]

Examination and tests

2

Active neck rotation with a repeatable task[2]

Measure the movement needed for checking a mirror or looking beside the body.

Position
Seated, trunk supported, looking forward.
Technique
Turn the head slowly left and right without turning the trunk. Record angle, familiar pain location and onset. Repeat the relevant task at a comfortable speed using the same starting position.
Positive finding
Consistent pain or reduced rotation on one side; record the actual finding rather than a positive trigger-point label.
Interpretation
Local pain guides movement dosing. Radiating arm symptoms require a neurological assessment.
Limitations
Rotation recruits several muscles and joints; the result cannot identify splenius as the sole source.

Low-load same-side rotation resistance[1][2]

Compare movement pain with tolerance to muscle effort.

Position
Seated with head centered, shoulders relaxed and trunk supported.
Technique
The examiner applies light, gradually increasing resistance to same-side rotation while the patient holds the head still. Compare sides, record pain location and whether force can be maintained; avoid end-range positioning.
Positive finding
Familiar posterior-neck discomfort or a repeatable side-to-side loss of tolerance.
Interpretation
Pain with effort supports a load-sensitive cervical presentation; marked weakness or distal symptoms changes the assessment.
Limitations
This is a pragmatic functional comparison, not a validated isolation test for either splenius muscle.

Distinguishing other causes

Migraine or tension-type headache[4][2]

Findings that matter. Recurrent headache with light/sound sensitivity, nausea, activity sensitivity or bilateral pressure may coexist with neck tenderness.

Next step. Use headache history and a diary; arrange medical headache assessment when recurrent or disabling.

Upper-cervical joint-related pain[3]

Findings that matter. Neck movement repeatedly provokes familiar head pain, with restricted upper-cervical motion.

Next step. Assess the headache and cervical region together; palpation alone cannot distinguish joint from muscle pain.

Vestibular, visual or vascular disorder[4]

Findings that matter. New spinning, double vision, visual loss, imbalance, speech change or unusual abrupt head/neck pain does not establish a muscle diagnosis.

Next step. Urgent assessment for acute neurological or visual symptoms; appropriate vestibular/eye evaluation for other persistent symptoms.

Treatment selection and progression

Exercise and rehabilitation

Comfortable movement for the restricted task[2]

Consider when. Assessed movement-related neck pain.

Sit with the trunk supported and turn the head within a comfortable arc, keeping the shoulders relaxed. Return to center between turns.

Dose and review
Starting example: 3–5 slow repetitions once daily; use a smaller arc if irritable.
Progression
Increase the comfortable arc, then practise looking over the shoulder. Judge the next dose by the later-day and next-morning response.
Stop or reassess
Stop for a new severe headache, visual disturbance, dizziness, arm symptoms or worsening that persists after practice.
Evidence and limits
Active cervical rehabilitation has regional guideline support; this example is a clinical adaptation, not a muscle-specific efficacy claim.

Self-care and activity

Adjust sustained head-position tasks[2]

Consider when. Symptoms accumulating during side-facing monitor work or driving.

Bring the object being viewed into an easier position, support the forearms, and alternate the task with brief comfortable movement. Choose pillow height by morning comfort rather than a prescribed neck curve.

Dose and review
Trial one practical change during the usual task for several days.
Progression
Gradually extend comfortable task time; retain the changes that improve function.
Stop or reassess
Persistent worsening, new headache features or symptoms following significant trauma need reassessment.
Evidence and limits
This task adjustment applies regional neck-care advice. Judge its usefulness by reading or head-turning comfort and morning symptoms.

Clinician-delivered care

Short trial of clinician-led manual care[2]

Consider when. Local tenderness or stiffness limiting an active rehabilitation plan.

After a neck and headache assessment, use tolerable soft-tissue contact or mobilization and immediately repeat the restricted movement.

Dose and review
Agree on a short trial and review response before booking further treatment.
Progression
Continue when relief helps reading, head turning or exercise between visits.
Stop or reassess
Stop for new visual, balance or neurological symptoms and investigate them; avoid escalating pressure when benefit is absent.
Evidence and limits
Neck guidelines support manual care with exercise for selected regional presentations. Track pain and activity gains; these recommendations do not identify an isolated splenius or suboccipital treatment effect.

Reassessment and follow-up

  • Compare rotation angle and the same looking-behind task.
  • Track headache separately; an improved neck movement does not confirm the source of all head pain.
  • Repeat a light neck-extension effort at the same head position and resistance, distinguishing local muscle pain from accompanying headache.

Evidence and sources

  1. University of Utah: Deep Back and Suboccipital Region

    2014 · University anatomy teaching reference

    Attachment and layer reference, particularly the distinct cranial versus cervical insertions of the splenius muscles.

  2. Blanpied et al. Neck Pain: Revision 2017

    2017 · Clinical practice guideline

    Regional assessment and multimodal active care; the home examples here are individualized starting options, not trial prescriptions.

  3. Hall et al. Comparative analysis and diagnostic accuracy of the cervical flexion-rotation test

    2010 · Diagnostic comparison study

    Upper-cervical movement assessment across headache presentations; does not isolate a suboccipital muscle or validate a trigger-point map.

  4. Seemungal et al. The Bárány Society position on Cervical Dizziness

    2022 · Society position statement

    A neck-to-vertigo mechanism is not established; vestibular and neurological alternatives require assessment.

Associated Trigger Points