A pain in the neck, well, is a real ‘pain in the neck’. So much of our neck pain originates from lifestyle patterns: sleep, work posture, how we sit at home, head position during gait and exercise. The common mistake to relieve neck pain is to simply stretch out the tension. Instead of addressing the cause of the problem, it can be tempting to just treat the symptoms. Treating ‘symptoms’ with unmindful stretching can readily be contraindicating and ineffective, such is the case with issues surrounding the suboccipital muscles and forward head syndrome.
Common poor sitting posture often translates into having the head project forward of the body. As the cervical (neck) spine is pulled out its’ harmonious curvature, this forward head position is often coupled with a localized hyperextension of the highest vertebrae (ie sitting at a computer, head drawn forward, and face tilted up to look at screen). The combination of forward head posture with upper neck hyperextension places a great amount of chronic strain on a group of muscles called the suboccipitals. This branch of muscles interconnect from the back of the skull down and across to cervical vertebrae 1 and 2. They mechanically function to generate extension, lateral flexion, and rotation of the skull and upper vertebrae. What is very interesting to note is these muscles are massively dense with proprioceptive receptors leading researchers to believe that these muscles also operate much like sensory organs telling the body where the head is in space.
Forward head posture forces the suboccipital muscles to chronically fire and support the weight of the skull along with other neck musculature. The chronic hyperextension of the top 2 vertebrae also has a tendency to throw off the proper axis of mechanical movement between these joints. This has implications running deep into the spinous tissues. Our brain is surrounded by dura mater that continues as a covering down the spinal cord. This dura mater has connections to cervical vertebrae 1 and 2. When these vertebrae undergo axis dysfunction, this can pull on the dura mater which cascades into spasms of the suboccipital muscles.
Besides the obvious discomfort of suboccipital muscle spasms and pain, these muscles also have cranial nerves travelling from the vertebrae through these muscles to innervate the skull. With muscle spasms, cranial nerve compression can occur leading to tension headaches.
As mentioned, many people experiencing neck tension may be tempted to stretch these muscles by pulling the head forward into flexion. Some exercise science experts believe that this can be contraindicating since deep neck flexion could lead to disc herniation in the cervical region. Therefore, a more effective (and safer approach) is to address the source of the problem and restore balance accordingly. In this case, we should work to re-establish proper head and neck alignment to take the strain off of the suboccipital region. Problem, though, is we often return to this habitual musculoskeletal pattern and repeat settling into this poor posture. Therefore, we need to create a new, inherent pattern through conditioning and muscle memory.
To bring a new pattern of muscle balance and memory is through conditioning the splenii group of neck muscles that are more functional for supporting neck weight and posture. One exercise to apply is to very lightly cup the back of the skull with the palms while sitting or standing tall. Then, with the head retaining neutral alignment, press the skull back into the hands as the hands resist. The resistance of the hands creates an isometric conditioning of the splenii muscles without sending any movement into the neck. It is ideal to contract and press each repetition for 3-5 seconds. Exhale during each repetition contraction and repeat several times.
A more progressive exercise (if the isometric exercise is very easy and comfortable to do) is to perform neck ‘retraction’ exercises. Sitting tall, simply exhale and slide the skull back (like it is on tracks) ending with the chin slightly tucked. You will feel the neck musculature working as you manipulate spinal curvature. Again, important to breath through these exercises as you repeat several times.
Note: If you have neck issues that are severe, you should consult a qualified health professional before attempting any neck restoration exercises.
During recovery phases for the neck, take note during activities how your habitual head position settles. Is your head posture supporting restorative intentions or exacerbating the issues?
*Walking – keep your head position tall instead of letting the eyes pull the skull forward and down.
*Sitting at a computer – adjust the size of screen fonts to allow you to sit with the head back / raise the monitor height
*Cardio exercises – avoid reading while on cardio machines as this tends to collapse cervical position and be mindful throughout the exercise duration to keep the skull hovering with balanced lightness over the body
*Yoga – chronic suboccipital pain is a calling that some yoga postures should be (at least temporarily) avoided. With a strong potential of having cervical axis dysfunction, placing the neck in a horizontal line and then twisting (ie revolving triangle pose) can readily exacerbate and stress the suboccipital region further. This is especially true when I constantly see yoga participants misaligning the neck and skull in these horizontal lines, thus causing compressive forces while rotating the neck. Consider finding poses that are more accessible for the neck in terms of less gravitational loads and more controlled lines of rotation on the neck.
Once you start to address the causes of poor head posture and add some light restorative conditioning, you will hopefully find the suboccipital releasing tension on there own. The symptoms will ideally dissipate. Along with neck issues, you may need to address additional musculoskeletal imbalances in the upper and lower body. The whole body is interconnected through a kinetic chain – dysfunction in one region easily affects other areas. Again, if the symptoms are severe, consider seeking support from experts who can apply deep tissue work along with prescribed exercises.
Kreg Weiss 
Very good article on this often overlooked problem – thankyou for sharing…