An isolated contraction of the Obliquus Capitis Inferior and Rectus Capitis Posterior Major demonstrated with Musculoskeletal Ultrasound Imaging

Main Article Content

Rob Sillevis, PT, DPT, Ph.D., OCS, FAAOMPT David Stockhausen, SPT Nicole Gerdts, DPT Anne Weller Hansen, BS, MBA

Abstract

Study design:  A quasi-experimental study design


 


Background: The motion of the suboccipital region is controlled by several groups of the smaller and larger muscle group, and these might play a role in the development of cervicogenic headache. Abnormal muscle tone can lead to abnormal movement patterns resulting in altered proprioceptive information from the mechanoreceptors in this region. Thus, abnormal muscle tone will contribute to cervical dysfunction and might result in pain, joint irritation, and poor functioning of the neck. At the same time , unilateral contraction of the suboccipital muscles could lead to rotation of the atlas. This could result in a significant translation of the spinal cord toward the side of rotation within the dural sack. This homolateral shift of the spinal cord could then lead to dural tension and possibly contribute to cervicogenic headaches.


Methods: A convenience sample of 25 healthy subjects were recruited for this study. Musculoskeletal ultrasound imaging was used to measure the diameter of the Obliquus Capitis Inferior and the Rectus Capitis Posterior Major immediately following an isometric contraction into head extension and rotation.


Outcomes: An isometric-induced contraction resulted in a significant change in the diameter of the obliquus capitis inferior and contralateral rectus capitis posterior major and, thus, could affect the position of atlas in the atlantoaxial joint.


Discussion: The effect of an isometric-induced contraction of the obliquus capitis inferior and contralateral rectus capitis posterior major in a subgroup of asymptomatic individuals was measured using musculoskeletal ultrasound imaging. The results of this study indicate that the diameter of both muscles significantly changed with the isometric contraction. This study's findings support that suboccipital muscles can contract in isolation and, thus effect the position of atlas.

Keywords: Obliquus Capitis Inferior, Rectus Capitis Posterior Major, Atlas positional default, Cervicogenic Headache, Musculoskeletal Ultrasound Imaging

Article Details

How to Cite
SILLEVIS, Rob et al. An isolated contraction of the Obliquus Capitis Inferior and Rectus Capitis Posterior Major demonstrated with Musculoskeletal Ultrasound Imaging. Medical Research Archives, [S.l.], v. 11, n. 6, june 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/4001>. Date accessed: 08 dec. 2024. doi: https://doi.org/10.18103/mra.v11i6.4001.
Section
Research Articles

References

1. Arnold M. Headache classification committee of the international headache society (IHS) the international classification of headache disorders. Cephalalgia. 2018; 38(1):1-211.

2. Vaccaro AR, Hulbert RJ, Patel AA, et al. The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex. Spine (Phila Pa 1976). Oct 1 2007;32(21): 2365-74. doi:10.1097/BRS.0b013e3181557b9200007632-200710010-00015 [pii]

3. Sillevis R, Hogg R. Anatomy and clinical relevance of sub occipital soft tissue connections with the dura mater in the upper cervical spine. PeerJ. 2020;8:e9716. doi:10.7717/peerj.9716

4. Zhuang J, Huang J, Zhao Z, et al. [The treatment of Semont maneuver for 40 patients with posterior semicircular canal benign paroxysmal positional vertigo]. Lin Chuang Er Bi Yan Hou Ke Za Zhi. Apr 2005;19(7):300-1, 304.

5. Fernandez-de-Las-Penas C, Ge HY, Alonso-Blanco C, Gonzalez-Iglesias J, Arendt-Nielsen L. Referred pain areas of active myofascial trigger points in head, neck, and shoulder muscles, in chronic tension type headache. J Bodyw Mov Ther. Oct 2010;14(4):391-6. doi:S1360-8592(09)00083-7 [pii] doi:10.1016/j.jbmt.2009.06.008

6. Rasmussen OS. Sonography of tendons. Scand J Med Sci Sports. Dec 2000;10(6):360-4.

7. Finnoff JT, Smith J, Nutz DJ, Grogg BE. A musculoskeletal ultrasound course for physical medicine and rehabilitation residents. Am J Phys Med Rehabil. Jan 2010;89(1):56-69. doi:10.1097/PHM.0b013e3181c1ee69

8. Poltawski L, Ali S, Jayaram V, Watson T. Reliability of sonographic assessment of tendinopathy in tennis elbow. Skeletal Radiol. Jan 2012;41(1):83-9. doi:10.1007/s00256-011-1132-4

9. Aprill C, Axinn M, Bogduk N. Occipital headaches stemming from the lateral atlanto-axial (C1-2) joint. Cephalalgia. 2002;22(1):15-22.

10. Sjaastad O, Bakketeig LS. Prevalence of cervicogenic headache: Vaga study of headache epidemiology. Acta Neurol Scand. Mar 2008;117(3):173-80. doi:10.1111/j.1600-0404.2007.00962.x

11. Sillevis. Correlation and Reliability of the Atlas Position on X-Ray in Subjects with and without Cervicogenic Headache: A Retrospective Study. 2021:

12. Hsieh CY, Vicenzino B, Yang CH, Hu MH, Yang C. Mulligan's mobilization with movement for the thumb: a single case report using magnetic resonance imaging to evaluate the positional fault hypothesis. Man Ther. Feb 2002;7(1):44-9. doi:10.1054/math.2001.0434

13. Chamnan R, Chantarasirirat K, Paholpak P, Wiley K, Buser Z, Wang JC. Occipitocervical measurements: correlation and consistency between multi-positional magnetic resonance imaging and dynamic radiographs. Eur Spine J. Nov 2020;29(11):2795-2803. doi:10.1007/s00586-020-06415-6

14. Corso M, Cancelliere C, Mior S, Kumar V, Smith A, Cote P. The clinical utility of routine spinal radiographs by chiropractors: a rapid review of the literature. Chiropr Man Therap. Jul 9 2020;28(1):33. doi:10.1186/s12998-020-00323-8

15. Sillevis R, Swanick K. Musculoskeletal ultrasound imaging and clinical reasoning in the management of a patient with cervicogenic headache: a case report. Physiother Theory Pract. Nov 5 2019:1-11. doi:10.1080/09593985.2019.1686793

16. Szikszay TM, Luedtke K, Harry von P. Increased mechanosensivity of the greater occipital nerve in subjects with side-dominant head and neck pain - a diagnostic case-control study. J Man Manip Ther. Aug 2018;26(4):237 -248. doi:10.1080/10669817.2018.1480912

17. Moore MK. Upper crossed syndrome and its relationship to cervicogenic headache. Case Reports. J Manipulative Physiol Ther. Jul-Aug 2004;27(6):414-20. doi:10.1016/j.jmpt.2004.05.007

18. Biondi DM. Cervicogenic headache: diagnostic evaluation and treatment strategies. Curr Pain Headache Rep. Aug 2001;5(4):361-8. doi:10.1007/s11916-001-0026-x

19. Biondi DM. Noninvasive treatments for headache. Expert Rev Neurother. May 2005 ;5(3):355-62. doi:10.1586/14737175.5.3.355

20. Caamano-Barrios LH, Galan-Del-Rio F, Fernandez-de-Las-Penas C, Cleland JA, Plaza-Manzano G, Ortega-Santiago R. Evaluation of neurodynamic responses in women with frequent episodic tension type headache. Musculoskelet Sci Pract. Dec 2019;44:102063. doi:10.1016/j.msksp.2019.102063

21. von Piekartz HJ, Schouten S, Aufdemkampe G. Neurodynamic responses in children with migraine or cervicogenic headache versus a control group. A comparative study. Comparative Study Research Support, Non-U.S. Gov't. Man Ther. May 2007;12(2): 153-60. doi:10.1016/j.math.2006.06.004

22. Scali F, Pontell ME, Nash LG, Enix DE. Investigation of meningomyovertebral structures within the upper cervical epidural space: a sheet plastination study with clinical implications. Spine J. Nov 1 2015;15(11): 2417-24. doi:10.1016/j.spinee.2015.07.438

23. Shi B, Zheng X, Min S, Zhou Z, Ding Z, Jin A. The morphology and clinical significance of the dorsal meningovertebra ligaments in the cervical epidural space. Spine J. Nov 1 2014; 14(11):2733-9. doi:10.1016/j.spinee.2014.04.014

24. Hall TM, Robinson KW, Fujinawa O, Akasaka K, Pyne EA. Intertester reliability and diagnostic validity of the cervical flexion-rotation test. Clinical Trial. J Manipulative Physiol Ther. May 2008;31(4):293-300. doi:10.1016/j.jmpt.2008.03.012

25. Ogince M, Hall T, Robinson K, Blackmore AM. The diagnostic validity of the cervical flexion-rotation test in C1/2-related cervicogenic headache. Evaluation Studies. Man Ther. Aug 2007;12(3):256-62. doi:10.1016/j.math.2006.06.016

26. Chen Y-Y, Chai H-M, Wang C-L, Shau Y-W, Wang S-F. Asymmetric thickness of oblique capitis inferior and cervical kinesthesia in patients with unilateral Cervicogenic headache. Journal of Manipulative and Physiological Therapeutics. 2018;41(8):680-690.

27. Lin Y-J, Chai H-M, Wang S-F. Reliability of thickness measurements of the dorsal muscles of the upper cervical spine: an ultrasonographic study. journal of orthopaedic & sports physical therapy. 2009;39(12):850-857.

28. Ghaderi F, Jafarabadi MA, Javanshir K. The clinical and EMG assessment of the effects of stabilization exercise on nonspecific chronic neck pain: A randomized controlled trial. J Back Musculoskelet Rehabil. 2017; 30(2):211-219. doi:10.3233/BMR-160735

29. Scali F, Marsili ES, Pontell ME. Anatomical connection between the rectus capitis posterior major and the dura mater. Spine (Phila Pa 1976). Dec 1 2011;36(25):E1612-4. doi:10.1097/BRS.0b013e31821129df

30. Kissin EY, Nishio J, Yang M, et al. Self-directed learning of basic musculoskeletal ultrasound among rheumatologists in the United States. Arthritis Care Res (Hoboken). Feb 2010;62(2):155-60. doi:10.1002/acr.20063

31. Filippucci E, Unlu Z, Farina A, Grassi W. Sonographic training in rheumatology: a self teaching approach. Ann Rheum Dis. Jun 2003;62(6):565-7.