Modeling length-tension properties of RCPm muscles during voluntary retraction of the head.

Head retraction exercises are one of several commonly used clinical tools that are used to assess and treat patients with head and neck pain and to aid in restoration of a normal neutral head posture. Retraction of the head results in flexion of the occipitoatlantal (OA) joint and stretching of rectus capitis posterior minor (RCPm) muscles. The role that retraction of the head might have in treating head and neck pain patients is currently unknown. RCPm muscles arise from the posterior tubercle of the posterior arch of C1 and insert into the occipital bone inferior to the inferior nuchal line and lateral to the midline. RCPm muscles are the only muscles that attach to the posterior arch of C1. The functional role of RCPm muscles has not been clearly defined. The goal of this project was to develop a three-dimensional, computer-based biomechanical model of the posterior aspect of the OA joint. This model should help clarify why voluntary head retraction exercises seem to contribute to the resolution of head and neck pain and restoration of a normal head posture in some patients. The model documents that length-tension properties of RCPm muscles are significantly affected by variations in the physical properties of the musculotendonous unit. The model suggests that variations in the cross sectional area of RCPm muscles due to pathologies that weaken the muscle, such as muscle atrophy, may reduce the ability of these muscles to generate levels of force that are necessary for the performance of normal, daily activities. The model suggests that the main benefit of the initial phase of head retraction exercises may be to strengthen RCPm muscles through eccentric contractions, and that the main benefit of the final phase of retraction may be to stretch the muscles as the final position is held.