Is This Small Neck Muscle Driving You Mad?
Neck muscles have been a source of suffering for patients for a long time. In recent years, one neck muscle in particular is getting a lot of attention in the world of head injury.
Meet the rectus capitis posterior minor (RCPMi)
Image Credit: Duke Univeristy Learning lab https://web.duke.edu/anatomy/Lab01/Lab2_new2014.html
Yep. It’s that tiny little muscle deep in the middle of your neck. It connects from the top bone in your neck called the atlas, and it connects into the head via connective tissue called the myodural bridge. But more on that later.
All in all, the the RCPMi is not much bigger than the end of your pinky finger, but it’s capable of wreaking havoc on people with neck problems including concussion.
Headaches, Trauma and the Rectus Capitis Posterior Minor
The RCPMi has been considered a muscle of importance in chiropractic literature for a long time. It’s only been a recent phenomenon where more mainstream medical science has started to look at its role in headaches and trauma. Two such studies examined the RCPMi in 2016.
The first study was published in the American Journal of Neuroradiology. They saw that patients with atrophy in the RCPMi had more severe concussion symptoms and a worse prognosis. You can check out the abstract here:
The second study was published in the presigious headache journal, Cephalgia. The authors found that patients with chronic headache tended to have more hypertrophy in the RCPMi than controls. You can check out that abstract here:
In case you weren’t paying attention, you should probably find those 2 outcomes to be a little strange.
On one hand, having smaller RCPMi had worse outcomes with concussion symptoms. On the other hand, having larger RCPMi was more likely to be associated with chronic headaches.
Granted we are dealing with 2 different conditions, but one of the biggest problems with chronic concussive symptoms is chronic headache. It would seem like there should be some overlap. What gives?
How Can That Small Muscle Cause So Many Problems?
There’s a few unique things about these muscles.
- The RCPMi does not connect into bone like most muscles do. It connects into a piece of tissue called the myodural bridge. That means it has a direct link into the outer covering of the brain which is known to be very sensitive to pain.
- The RCPMi is too small to provide much in the way of meaningful movement of the head and neck. Inside the belly of this small muscle are abnormally large amounts of prorioceptors called muscle spindles. Proprioceptors help provide feedback to the brain about joint position and movement.
- Changes in the RCPMi can deform the myodural bridge which changes movement in cerebral spinal fluid. Abnormal movement of this fluid is associated with headache.
So as you can see, even though the RCPMi is small it carries a large baggage of neurology with it.
What’s Happening in Headaches and Concussions?
This is where things get a little interesting, because we don’t really know how this muscle is causing problems. More evidence is showing that there is a correlation between this muscle and headaches, but we don’t really know anything about causation yet.
With that being said, this is mostly just speculation on my part, so here it goes.
In my office we are always striving to create symmetry in the structural positioning of the head and neck.
When the head and neck shift, it creates asymmetrical force production in the suboccipital muscles. Image Credit: Daniel O. Clark uppercervicalillustrations.com
When there is an injury like a trauma or whiplash, you create injury in some of these small muscles of the neck. When these muscles are injured, the brain loses some critical feedback mechanisms that helped to maintain proper positioning of the head and neck.
The injury also creates asymmetrical tension on the myodural bridge. This abnormal tension on the dura stimulates the sensitive pain receptors in this tissue leading to head and neck pain. There have even been cases where cutting this muscle can relieve a patient of chronic headache.
That same tension on the dura may also be creating abnormal flow of cerebral spinal fluid which may lead to chronic effects of brain physiology.
Our success rate in taking care of patients with chronic and post-traumatic headache are upwards of 85%. While we don’t measure the activity of the RCPMi, it may help us understand why we get the results that we do.