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Atlas · Neck

Splenius Cervicis

Splenius cervicis connects the upper thoracic spine to the upper cervical transverse processes. It works with other posterior muscles during neck extension and rotation. Assess the neck and upper-back contribution to turning and sustained work.

Splenius Cervicis
Body region
Neck · Upper Back
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

  • Face the main work object when possible and support the arms.
  • Alternate comfortable neck turns with normal walking.
  • Reduce the duration of repeated looking-up tasks during a flare.

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.

Splenius cervicis attaches to C1–C3, not to the skull. Its upper attachment is deep and should not be approached by searching for a hard knot on the side of the neck.

Examination, palpation and treatment evidence

Illustrated overview

Splenius Cervicis

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 Cervicis · Anatomy 1

Anatomical view of the illustrated muscle.

Open full-size image

Trigger points

1. TrP1

Location. Back of neck, lower cervical

Trigger point map
Splenius Cervicis — Splenius Cervicis · 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 Cervicis — Splenius Cervicis · 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 upper back

Pain Pattern

  • Posterior neck
  • Upper thoracic region

What This Pain Feels Like

A neck and upper-back ache may become more noticeable when looking beside or behind the body. Compare the movement with trunk support and assess any accompanying headache separately.

What Patients Report

  • Neck and upper-back ache
  • Difficulty turning comfortably

What Makes It Worse

  • Sustained head rotation
  • Long seated tasks
Browse related exercises (1)

Symptoms patients report

Neck-to-upper-back ache Record where movement starts the pain and whether trunk support changes it.

Limited rotation Turning may be uncomfortable during driving or conversation.

Pain with extension effort Several cervical extensors contribute; isolated weakness cannot be inferred from pain.

Contributors to assess

Repeated extension work Looking upward for work or sport may exceed current tolerance.

Sustained rotated sitting A task with little movement variation can accumulate discomfort.

Recent injury or activity change History determines whether a regional strain or another problem needs assessment.

For clinicians and supervised training

Clinical reference

Upper-back and neck symptoms overlap across muscles and joints. Neither their distribution nor a tender spot establishes a cause of headache.

Anatomy and palpation

Anatomical relationships

Splenius cervicis rises from the T3–T6 spinous processes to the C1–C3 transverse processes. It assists extension and ipsilateral rotation/side-bending of the neck.[1]

  • Upper-thoracic spinous-process region provides broad origin orientation.
  • Upper-cervical transverse-process attachments remain deep.

Nearby structures. Trapezius and rhomboids overlap the lower region; splenius capitis, levator scapulae and deeper extensors surround the cervical course.

Palpation

Patient position. Prone with forehead and arms supported; use seated support if prone is uncomfortable.

Find the landmarks

  • Orient from the upper-thoracic midline to the posterolateral neck.
  • Distinguish scapular-border tenderness from the cervical extensor region.

Examination sequence

  1. Ask for a small extension effort to identify the broad posterior muscle layer.
  2. Relax the head and use light regional contact from lower to upper neck.
  3. Compare tenderness with active rotation and extension findings; document uncertainty about the specific layer.

Document the findings

  • Familiar pain and local sensitivity can support a regional muscle contribution.
  • Surface palpation does not confirm the deep C1–C3 attachments.

Limits and precautions

  • Avoid forceful lateral-neck pressure or attempts to palpate between cervical transverse processes.
[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 neck extension 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 neck extension 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.

With the head centered and the trunk supported, practise a small look-up movement and return to level. Add gentle turns only in the comfortable range.

Dose and review
Starting example: 3–5 slow repetitions once daily; use a smaller arc if irritable.
Progression
Increase the comfortable arc, then practise checking a high shelf or looking beside the body. 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 reading, driving or overhead work.

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

  • Repeat extension effort and rotation with the same support and light resistance.
  • Track task duration and next-day response rather than repeatedly searching for a tender point.
  • Record sleep interruptions and how long neck stiffness limits comfortable turning after waking.

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