Suboccipital muscles needling

Anatomy

1. Rectus capitis posterior major

   Spinous process of axis to lateral part of inferior nuchal line.

2. Rectus capitis posterior minor

   Posterior arch of atlas to medial part of the inferior nuchal line.

3. Oblique capitis inferior

   Spinous process of the axis to transverse process of the atlas.

4. Oblique capitis superior

   Upper part of the transverse process of the atlas and inserted between superior and inferior nuchal line of the occipital bone.

Triggers and RP

Suboccipital trigger point can mimick migraine headache. It produce occipital headache, parietal pain and eye pain. Rectus capitis muscle fascia attaches with the duramatter of spinal cord. So fascial tightness of rectus capitis can disturb the csf flow.

Dry needling procedure

Rectus capitis posterior major and minor

• Patient position: prone
• Needle size: 30mm
• Needling direction: Inferior to superior and lateral to medial
• Be aware of the depth of needle to avoid unwanted penetration into vertebral artery or spinal cord.

Obliqus capitis inferior

• Patient position: prone
• Needle size: 30mm
• Needling direction: Inferior to superior and lateral to medial.
• Therapist should be aware of depth of the needle.

Obliqus capitis superior

Do not needle this muscle. Follow the non-invasive trigger point release techniques e.g. Ischemic compression.