Longissimus Capitis: Origin, Insertion, Nerve, Action & Headaches

The Longissimus Capitis is the cranial portion of the Longissimus muscle column (part of the Erector Spinae). It is a long, slender muscle that runs up the neck to attach directly to the skull. It is a key muscle for keeping the head upright and turning it side-to-side.

[Image of Longissimus Capitis anatomy]

Quick Anatomy Snapshot

Group	Erector Spinae (Intermediate Column).
Origin (Proximal)	Transverse Processes of T1-T5 and articular processes of C4-C7.
Insertion (Distal)	Posterior margin of the Mastoid Process (Temporal Bone), deep to Splenius Capitis and Sternocleidomastoid.
Nerve Supply	Lateral branches of the Posterior Rami of cervical and thoracic spinal nerves.
Primary Actions	Bilateral: Extension of the head and neck. Unilateral: Lateral flexion and Rotation of the head to the same side.

Deep Dive: The Longest Connection

The Longissimus ("The Longest") column is the intermediate pillar of the Erector Spinae group, sandwiched between the Iliocostalis (lateral) and Spinalis (medial).

1. Capitis Connection

The Longissimus muscle spans almost the entire length of the spine, but only the Capitis portion reaches the skull. It inserts onto the Mastoid Process, which is the prominent bony lump behind your ear.

2. Layering

In the neck, the Longissimus Capitis lies:
• Deep to: Splenius Capitis and Sternocleidomastoid (SCM).
• Superficial to: Semispinalis Capitis and the Suboccipital muscles.
It acts as a sandwich layer between the superficial neck movers and the deep stabilizers.

Physio Corner: Clinical Relevance

💪 Functional Fact: While the SCM rotates the head to the opposite side, the Longissimus Capitis rotates the head to the same side. They work as a synergistic pair during rotation (e.g., Right Longissimus + Left SCM = Turn head to Right).

Palpation

Palpation is tricky because it is covered by the Splenius. Locate the Mastoid Process behind the ear. Slide your fingers inferiorly and slightly medially. Have the patient gently extend and rotate their head toward you. The muscle felt tightening deep to the Splenius is the Longissimus Capitis.

⚠️ Clinical Pathology: Cervicogenic Headache
Trigger points in the Longissimus Capitis are a frequent cause of tension headaches. They typically refer pain to the area behind the ear (mastoid) and can radiate slightly forward above the ear (temporal region).

Manual Muscle Testing (MMT)

We test "Capital Extension" (moving the skull on the neck).

Testing Tip: The patient should lift the chin ("look up"), not just push the neck back. Stabilize the thoracic spine.

Step-by-Step Procedure (Oxford Scale)

Grade	Patient Action & Resistance
Grade 3, 4, 5 (Against Gravity)	Position: Prone (face down), head off the edge of the table. Action: Patient extends the head (looks at the wall), holding the chin up. Resistance: Applied to the occiput, pushing down into flexion. Grade 3: Full range against gravity. Grade 4/5: Holds against moderate/strong resistance.
Grade 0, 1 (Palpation)	Action: Palpate below the mastoid process. Cue: "Try to tilt your head back." Grade 1: Deep tension felt. Grade 0: No activity.

Frequently Asked Questions

Does it rotate to the opposite side?

No. It rotates to the Same Side (Ipsilateral). If the Right Longissimus contracts, the head turns to the Right. This distinguishes it from the Trapezius and SCM.

Is it a primary mover or stabilizer?

Both. It is a strong extensor (prime mover), but in upright posture, it works constantly as a stabilizer to prevent the head from falling forward (counteracting gravity).

What sits lateral to this muscle?

The Iliocostalis Cervicis lies immediately lateral to the Longissimus Capitis in the neck region.

Test Your Knowledge: Longissimus Capitis Quiz

1. Where does the Longissimus Capitis insert?

2. Which column of the Erector Spinae does it belong to?

3. What is the unilateral action of Longissimus Capitis?

4. Which muscle lies immediately superficial to the Longissimus Capitis?

5. Where does the Longissimus Capitis originate?

6. Trigger points in this muscle typically refer pain to:

7. Which nerve supplies this muscle?

8. Longissimus Capitis works with which muscle to rotate the head to the same side?

9. What action does it perform bilaterally?

10. True or False: Longissimus Capitis attaches to the Nuchal Ligament.

References

• Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2018). Clinically Oriented Anatomy. 8th ed. Philadelphia: Wolters Kluwer.
• Standring, S. (2016). Gray's Anatomy: The Anatomical Basis of Clinical Practice. 41st ed. Elsevier.
• Travell, J. G., & Simons, D. G. (1999). Myofascial Pain and Dysfunction: The Trigger Point Manual. 2nd ed. Williams & Wilkins.