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Trigger Point Therapy - Torsional Release Technique (Seated)



Posterior Cervical Muscles - Important Trigger Points for Treating Common Head and Neck Pain

[Latin longissimus, longest; capitis, of the head; semispinalis, half spinal; cervicis, of the neck]

Comprising: longissimus capitis, semispinalis capitis, and semispinalis cervicis.


Longissimus capitis: transverse processes of upper five thoracic vertebrae (T1–T5). Articular processes of lower three cervical vertebrae (C5–C7).

Semispinalis cervicis: transverse processes of upper ve or six thoracic vertebrae (T1–T6). Semispinalis capitis: transverse processes of lower four cervical and upper six or seven thoracic vertebrae (C4–T7).


Longissimus Capitis Trigger Points

Longissimus Capitis - Common Trigger Point Sites


Longissimus capitis Trigger Points Pain Map

Longissimus Capitis - Trigger Point Referred Pain Pattern




Longissimus capitis: posterior part of mastoid process of temporal bone. Semispinalis cervicis: spinous processes 2nd to 5th cervical vertebrae (C2–C5).
Semispinalis capitis: between superior and inferior nuchal lines of occipital bone.


Longissimus capitis: extends and rotates head. Helps maintain correct curvature of thoracic and cervical spine in the erect and sitting positions.

Semispinalis cervicis: extends thoracic and cervical parts of vertebral column. Assists rotation of thoracic and cervical vertebrae. Semispinalis capitis: most powerful extensor of the head. Assists in rotation of head.


Longissimus capitis: dorsal rami of middle and lower cervical nerves. Semispinalis cervicis: dorsal rami of thoracic and cervical nerves. Semispinalis capitis: dorsal rami of cervical nerves.

Basic Functional Movement

Longissimus capitis: keeps upper back straight (with correct curvatures).
Semispinalis cervicis and capitis. Examples: looking up; turning head to look behind.


Semispinalis Capitis/Cervicis Trigger Points

Semispinalis Capitis/Cervicis - Common Trigger Point Sites


Semispinalis Capitis (upper) Trigger Points 


Semispinalis Capitis (upper) Trigger Point Referred Pain Pattern


Semispinalis capitis (middle) and cervicis Trigger Points


Semispinalis Capitis (middle) and Cervicis Trigger Point Referred Pain Pattern


Multifidus Trigger Points


Multifidus (mid cervical). Even though not mentioned here, this muscle runs up the spine as part of the erector spinae, and so is relevant as part of the posterior cervical muscles.



Trigger Point Referred Pain Patterns

Several areas along the fibers, all radiating superiorly into head and skull and toward frontal region.


Treatment Techniques

Spray and Stretch Yes
Dry Needling Yes
Deep Stroking Massage Yes
Compression Yes
Muscle Energy Techniques Yes
Positional Release Yes
Wet Needling Yes



Headache, neck pain and stiffness, decreased cervical flexion, suboccipital pain, restricted neck rotation (often related to prolonged occupational positions), whiplash, pain using certain pillows, “burning” in scalp.


Poor posture, playing musical instruments, lying on front with head propped up, poor glasses, upper crossed pattern, kyphosis, scoliosis, wear and tear, cold drafts/ air conditioning, vertebral alignment issues, certain sports (e.g. archery), tight shirt/tie, depression.

Differential Diagnosis

Cervical mechanical dysfunction. Spondyloarthropathy of facets. Vertebral artery syndrome. Discopathy (cervical) 1st rib dysfunction. Polymyalgia rheumatica. Rheumatoid arthritis. Osteoarthritis. Ankylosing spondylitis (seronegative spondyloarthropathy). Paget’s disease. Psoriatic arthropathy.


Trapezius, erector spinae, temporalis, digastricus, infraspinatus, levator scapulae, SCM, splenius capitis/cervicis, suboccipital muscles, occipitalis, pectoralis major.

General Advice to Patients

Occupational ergonomics. Posture. Eyewear. Use of ergonomic pillows. Heat and stretch. 



Find a Trigger Point Professional in your area

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This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell. 




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