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  • Writer's pictureAlexandre Calamaro

sub-occipitals pain & Osteopathy



Neck pain is the second most common area of pain worldwide after lower back pain. It can be triggered by a huge variety of causes such as trauma, infections, degenerative changes, biomechanical changes, medical conditions and others.


As an osteopath, it is imperative to rule out any red flags scenarios and to make sure that the patient is safe to treat.

The main focus of this article will be on the sub-occipital muscles, as they are a reoccurring cause of neck pain.



The Sub-Occipitals

The sub-occipital muscles are a group of 4 muscles located underneath the occipital bone (the back of the skull), at the top of the neck, posteriorly.

These 4 muscles are: the rectus capitis posterior major, the rectus capitis posterior minor, the obliquus capitis superior and the obliquus capitis inferior.

The sub-occipitals allow us to extend and rotate our neck.


Sub-occipitals can cause pain due to various reasons such as:

  • Trauma to the area or around it (road traffic accidents, collisions)

  • Infections which can cause neck stiffness and pain (meningitis)

  • A biomechanical issue causing joint restriction, irritation or inflammation (osteoarthritis, osteoarthrosis, facet joint irritation).



How can Osteopathy help with sub-occipitals pain?

When treating the sub-occipitals, the osteopath uses a variety of techniques such as soft tissue techniques and mobilisations.

Soft tissue techniques can have a direct impact on changing the tonicity of the muscle group.

Most of the time, due to environmental and social factors, the sub-occipitals are hypertonic (tensed up) which can cause neck pain and cervicogenic headaches (most common form of headaches due to sub-occipital pain). The patient may even experience referral pain, a pain perceived at a location other than the site of the painful stimulus/ origin. In the case of the sub-occipitals, pain referral can be felt behind the eye, around the temple area and scalp.




x -> sub-occipitals

red points -> pain referral felt when being treated for sub-occipital pain


As the sub-occipitals are found in the upper neck, the joints in the area can be affected, either by being restricted, irritated or inflamed depending of the assessment and diagnosis given.

If all red flags have been ruled out, the practitioner can use mobilising techniques, aiming to restore the range of movements and decreasing the pain threshold of said joints.




If you suffer from neck pain

Neck pain is one of the most common areas of complaint worldwide. If you do suffer from neck and/or headaches, please contact your Osteopath.

First, as Osteopaths we have to rule out any possible red flag, and if the neck pain and headaches you’re suffering from are indeed related to sub-occipital pain and cervicogenic headaches.

If it is the case, we’ll put a treatment plan in action.

If it is not, not too worry, we will still help you to find the appropriate assistance.


Remember: listen to your body, trust your body. Do not ignore it or be afraid to ask for help.


Do take care of yourself,

And see you then,

Alexandre Calamaro

Registered Osteopath London


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