Treating Suboccipitals and Dural DragThe obliquus capitis inferior (OCI) muscles may be the most underappreciated of all the suboccipitals. Arising from the spinous process of C2 (axis) and inserting on the transverse process of C1 (atlas), their primary function is head-on-neck rotation. Notice in Image 1. how the overstretched left OCI creates reciprocal shortening on the right.
Biomechanical ExplanationsIn this scenario, the stomach-sleeping client rises from bed and attempts to left rotate his head back to neutral. Optimally, the atlas vertebra rotates with the head, but with a neurologically shortened right OCI, the atlas drags the axis with it. Left untreated, an “atlas wedge” causes chronic OCI spasm that ﬁxates C1 on C2 (Image 3.). If the head is forced to left rotate, the joint jamming moves down the chain to C2–3. With the dura ﬁrmly attached to only three spinal segments (foramaen magnum, C2–3, and sacrum), the brain abhors bony disturbances at this key neurological center.
Clients must understand that the brain is their best friend, and pain is there to protect their body from further perceived insult. It’s tempting but counterproductive to tell clients their pain results from muscle spasm, trigger points, or bones out of place. Clients simply need to be reassured they are in a safe place, and that everything is all right, right now.
- N. Bogduk, “Anatomy and Physiology of Headache,” Biomedicine & Pharmacotherapy 49, no. 10 (1995): 435–45
- F. Scali, E. S. Marsili, and M. E. Pontell, “Anatomical Connection Between the Rectus Capitis Posterior Major and the Dura Mater,” Spine 36, no. 25 (December 2011): E1612–4.
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