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Created page with "'''Longissimus capitis''' is a long, relatively narrow posterior cervical muscle whose trigger points (TrPs) refer pain concentrating in the region of the ear or just behind and below it, with possible extension a short distance down the neck and occasionally into a periorbital region behind the eye. It lies deep to the lateral part of the splenius capitis, and its nearly vertical fibre direction helps distinguish it from the more diagonal fibres of the splenius capitis..."

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'''Longissimus capitis''' is a long, relatively narrow posterior cervical muscle whose trigger points (TrPs) refer pain concentrating in the region of the ear or just behind and below it, with possible extension a short distance down the neck and occasionally into a periorbital region behind the eye. It lies deep to the lateral part of the splenius capitis, and its nearly vertical fibre direction helps distinguish it from the more diagonal fibres of the splenius capitis during palpation.

Because it spans from the mastoid process to the transverse processes of the upper thoracic vertebrae, TrP tension in this muscle characteristically produces an '''apparent elevation of the first rib''' concurrent with a T₁ articular dysfunction — an indirect mechanical effect mediated through its pull on the costotransverse junction.

== Contents ==
* [[#Anatomy|1 Anatomy]]
* [[#Referred Pain Patterns|2 Referred Pain Patterns]]
* [[#Activation and Perpetuating Factors|3 Activation and Perpetuating Factors]]
* [[#Clinical Examination|4 Clinical Examination]]
* [[#Differential Diagnosis|5 Differential Diagnosis]]
* [[#Treatment|6 Treatment]]
** [[#Trigger Point Release|6.1 Trigger Point Release]]
** [[#Trigger Point Injection|6.2 Trigger Point Injection]]
** [[#Corrective Actions|6.3 Corrective Actions]]
* [[#Satellite Trigger Points|7 Satellite Trigger Points]]
* [[#Related Pages|8 Related Pages]]
* [[#References|9 References]]

== Anatomy ==

The longissimus capitis attaches '''below''' to the articular processes of the last 3 or 4 cervical vertebrae and to the transverse processes of the upper 4 or 5 thoracic vertebrae. It attaches '''above''' to the skull along the posterior margin of the mastoid process, deep to the splenius capitis and sternocleidomastoid muscles.

The longissimus capitis muscle is often partially or completely divided into two muscle bellies by a tendinous inscription, which would produce two endplate zones.

'''Primary actions:''' Extension of the head; lateral flexion of the head to the same side; rotation of the head toward the same side.

'''Innervation:''' Branches of the posterior primary divisions of the cervical spinal nerves.

'''Layer:''' The longissimus capitis forms part of the erector spinae of the cervical spine, together with the longissimus cervicis, iliocostalis cervicis, and the variable spinalis capitis and cervicis. In terms of functional anatomy, it belongs to the group of four muscles that attach to and control movement of the head (with upper trapezius, splenius capitis, and semispinalis capitis).

'''Articular effect of TrP tension:''' The muscle spans the region from the mastoid process to the transverse process of T₁, which allows it to '''indirectly affect the first rib''' through its pull on the costotransverse junction. Resultant rotation of the vertebra produces the '''apparent''' rib elevation commonly seen with longissimus capitis TrP involvement. One will frequently see an apparent elevation of the first rib concurrent with a T₁ articular dysfunction when TrP tension is present in this muscle.

== Referred Pain Patterns ==

The pain pattern of the longissimus capitis concentrates in the '''region of the ear or just behind and below it'''. The pain may extend a short distance down the neck and may also include a periorbital region behind the eye.

This pattern is distinct from:
* Semispinalis capitis — which refers in a band encircling the head to the temporal region and over the eye
* Splenius capitis — which refers to the vertex of the skull
* Splenius cervicis (upper TrP) — which refers diffusely through the inside of the head to the back of the eye

== Activation and Perpetuating Factors ==

* Sustained forward head posture with neck in flexion — checkrein overload, same as semispinalis capitis
* Motor vehicle accident (whiplash): automobile impact from any direction is likely to activate semispinalis capitis TrPs; longissimus capitis is frequently co-involved
* Prolonged reading or writing at a flat desk surface
* Emotional depression leading to sustained flexed posture
* Lying prone propped up on elbows for prolonged periods
* Eyeglasses with inadequate focal length requiring sustained neck flexion to read

== Clinical Examination ==

The longissimus capitis lies deep to the lateral part of the splenius capitis, near the level of the C₃ vertebra. It can be palpated by locating the splenius capitis (lateral to the trapezius and posterior to the sternocleidomastoid) and pressing anteriorly and medially through the lateral part of the splenius capitis.

'''If the splenius capitis has TrPs and taut bands, they must first be released''' — otherwise the deeper tenderness of the longissimus capitis may not be distinguishable.

If the longissimus capitis has severe TrPs, it should be prominent and firm; its nearly '''vertical fibres''' help distinguish it from the more diagonal fibres of the splenius.

Palpation range:
* Superior to the level of C₂: the longissimus capitis is too deep and covered by too many other muscles to be reliably identified, even indirectly
* Inferior to the level of C₄: similarly too deep to identify reliably

The primary accessible zone is between C₂ and C₄ spinous process levels.

'''Articular screen:''' Given the muscle's attachment to the costotransverse junction via T₁, assess for apparent first rib elevation and T₁ articular dysfunction whenever longissimus capitis TrPs are suspected. These articular dysfunctions are often corrected concurrently with TrP inactivation.

== Differential Diagnosis ==

{| class="wikitable"
|-
! Condition !! Distinguishing features
|-
| Semispinalis capitis TrPs || Semispinalis capitis refers in a band to the temporal region and over the eye; longissimus capitis refers to the ear region and just behind it; fibre directions differ (vertical in both, but longissimus capitis is more lateral)
|-
| Splenius capitis TrPs || Splenius capitis refers to the vertex; splenius capitis must be released before longissimus capitis can be reliably palpated; both occupy similar lateral posterior cervical territory
|-
| Deep masseter TrPs || Deep masseter refers to the region of the TMJ and deep into the ear; distinguish by palpation location (masseter is anterior to the tragus; longissimus capitis is posterior to the mastoid) and by associated jaw symptoms
|-
| T₁ rib dysfunction | Apparent first rib elevation concurrent with T₁ articular dysfunction is a direct mechanical consequence of longissimus capitis TrP tension; TrP inactivation should resolve the apparent rib elevation; persistent rib elevation after TrP treatment requires independent articular assessment
|}

== Treatment ==

=== Trigger Point Release ===

The longissimus capitis is released as part of the longitudinal posterior cervical muscle group, using the same spray and stretch technique as for the semispinalis capitis (Fig. 16.6A and B). See [[Muscle:Semispinalis_Capitis#Trigger_Point_Release|Semispinalis Capitis — Trigger Point Release]] for the full technique.

In addition, a specific treatment for the longissimus capitis employs the combination of a myofascial release technique with a contract-relax technique:
# Patient supine; clinician cradles the patient's head
# The clinician applies pressure along the distal attachments of the muscle with the other hand
# The clinician sidebends the patient's head '''away''' from the involved longissimus capitis and '''fine-tunes''' the muscle release by adding small amounts of head/neck rotation, taking up slack
# When the barrier is encountered and the area of the costotransverse junction seems to elevate against the monitoring thumb, that same hand applies '''gentle downward pressure''' for release, while the clinician's other hand stabilises the patient's head

This release technique can also release the scalene muscles (which directly elevate the first rib) if the neck is guided toward slight extension rather than flexion.

=== Trigger Point Injection ===

A TrP region in this long, relatively narrow muscle can be injected in the lateral part of the neck, deep to the splenius capitis and lateral to the semispinalis capitis, at approximately the level of C₃ — the most common location for TrPs in this muscle.

The needle should be directed laterally so as to pose no danger to the vertebral artery, and the muscle must not be injected superior to C₂.

Injection is followed immediately by spray and stretch and then by full active range of motion.

=== Corrective Actions ===

Same as for [[Muscle:Semispinalis_Capitis#Corrective_Actions|Semispinalis Capitis — Corrective Actions]]. The primary corrective measures are:
* Raising reading and work materials to eye level to eliminate sustained neck flexion
* Adequate focal length eyeglasses
* Ergonomic workstation setup — monitor elevated, lumbar support
* Combined self-stretch shower exercise (Fig. 16.11)
* Cervical pillow for sleeping

== Satellite Trigger Points ==

* [[Muscle:Semispinalis_Capitis|Semispinalis capitis]] — same functional layer; released together
* [[Muscle:Splenius_Capitis|Splenius capitis]] — superficial to longissimus capitis; must be released first before longissimus capitis can be palpated
* [[Muscle:Scalene|Scalene muscles]] — the longissimus capitis release technique also releases the scalenes when the neck is guided into slight extension; scalenes directly elevate the first rib
* [[Muscle:Suboccipital|Suboccipital muscles]] — treat suboccipital group first in the sequence of posterior cervical release

== Related Pages ==

* [[Pain:Ear_and_TMJ|Pain:Ear and TMJ]] — Longissimus capitis ear-region referral pattern
* [[Pain:Head_and_Neck|Pain:Head and Neck]] — Diagnostic algorithm
* [[Muscle:Semispinalis_Capitis|Muscle:Semispinalis Capitis]] — Companion longitudinal muscle; released together
* [[Muscle:Splenius_Capitis|Muscle:Splenius Capitis]] — Superficial layer; must be released first

== References ==

* Travell JG, Simons DG. ''Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume 1: The Upper Half of Body''. 2nd ed. Baltimore: Williams & Wilkins; 1999. Chapter 16.

[[Category:Muscle]]
[[Category:Vol1 Ch16]]
[[Category:Head and Neck]]

Muscle:Longissimus Capitis - Revision history