Understanding the muscles of the neck, where they are, what they do, where pain refers from each is key to figuring out what’s causing your pain. As a Neuromuscular Therapist in the Boston area, these are the five muscle groups that I find are most often in trouble when you feel pain in the back of the neck.

Trapezius: The trapezius is a three part muscle that moves the shoulder blade. The upper trap is most important because it attaches to the neck and lifts the shoulder up towards the ears and inward toward the spine. attaching to the middle of the back of the head and all the way down the neck bones (cervical spine). The Trigger Points are strong to the sides and back of the neck. They also cause headaches in a question mark pattern around the ear and across the to the temples and eyes.

Levator scapula: The levator scapula is the major shoulder lifter and and does so by it’s attachments to the sides (transverse processes) of the top four vertabrae. It also turns the head so this is usually the cause of pain trying to look over your shoulder. Trigger Points are strong into the angle of the shoulder at the base of your neck. Both the traps and the levator are “stress” muscles and hurt when you’re on the phone too long.

Splenius: There are two parts of this muscle. At the top, the “capitis” attaches to the side of the back of the head and the “cervicis” to the sides of the top vertabrae along side the levator attachments. They run diagonally toward the spine and at the bottom they both attach to it from the middle of the neck to the middle of the upper back. The action of the muscles is to rotate the head and tilt it backward at an angle. If both the levator and splenius are affected it can prevent you from turning your head at all. Trigger points are to the top of the head and inside it, and often into the shoulder and angle of the neck. Blurry vision can also be a result of Trigger Points here.

Suboccipitals: This is my favorite and the place I go first with neck pain problems. These four little pairs of muscles are deep under your skull and connect it to the top two vertabrae. They do the yes and no motions of your head plus side-bending. They get activated by poor posture, by a head-forward position, and activities like biking where the body is forward and the head looking up. Not only do they cause neck pain, they are a major source of headaches.

Posterior cervical muscles: On top of the suboccipitals are four groups of muscles that go down the back of your neck. The superficial ones extend your head backwards (semispinalis capitis and cervicis, longissimus capitis, and the deeper ones extend and rotate (multifidi and rotatores). When these are affected, any kind of pressure, even from a pillow at night can be painful. Tension produces limited range of motion associated with pain.

The next post will review the Trigger Point patterns of these muscles.