Suboccipital Manual Static Release (Soft Tissue Mobilization)

Differentiation

1. The suboccipital muscles lie deep to the upper trapezius and splenii.
2. It may not be possible to palpate the suboccipital muscle individually, but palpation of the group of muscles can be accomplished by applying deep pressure within the borders created by the "outer edge" of these muscles.
3. The obliquus capitis inferior can be used as the "inferior border" of the suboccipital region - originating from the spinous process of C2 (the first palpable spinous process beneath the occiput), and inserting into the transverse process of C1 (the tip of this transverse process lies inferior and deep to the mastoid process).
4. The obliquus capitis superior can be used as the "lateral border" of the suboccipital region, inserting on the transverse process of C1 (found above), and running superior to the inferior nuchal line of the skull.
5. The inferior nuchal line can be used as the "superior border" of the suboccipital region The inferior nuchal line may be palpated by investigating the occipital bone and locating the ledge created by the steep change in angle between the back of the head, and the part of the bone that heads toward the cervical spine.
6. Within these borders, the suboccipitals can be palpated by pressing through the first few layers of tissue (the upper trapezius and splenii), until a layer of firm but mobile soft tissue resists your fingers from palpating deeper.

Potentially Sensitive Tissues

• The vertebral arteries are deep to these tissues. Although it may be possible to compress these vessels, it is unlikely. Keep your vertebrobasilar insufficiency (VBI) signs in mind while using these techniques.

Trigger Points

• This area is fairly small, making it difficult if not impossible to differentiate a "most common trigger point site" within the region. As mentioned in "research corner", suboccipital trigger points are very common.

Release Technique:

1. Although this technique can be performed with the patient prone or supine, it is likely most comfortable with the patient lying in supine and the practitioner sitting at the head of the table.
2. The practitioner slides both hands under the patient's head, flexing the distal interphalangeal (IP) joints of digits two through five.
3. The practitioner allows the weight of the patient's head to press the soft tissue of the upper cervical spine into the practitioner's fingertips.
4. The practitioner then adjusts the fingertips so they fall within the borders described in differentiation.
5. The practitioner may extend and ipsilaterally rotate the head to add slack to the superficial posterior cervical muscles, making it easier for the fingers to sink deep into the suboccipital musculature.
6. The practitioner can also flex and contra-laterally rotate the head to increase tension in the suboccipital muscles
   • Note, the obliquus capitis superior is the one suboccipital muscle lengthened by ipsilateral rotation).
7. The practitioner may gently move the fingertips within the suboccipital region to look for dense or tender areas.
   • Note, strumming for taut bands and locating nodules is likely not possible for these small muscles.
8. Consistent pressure is held until the dense area softens under the practitioner's fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).