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Postural balance is an essential capacity for functional autonomy and the performance of activities of daily living, relying on the continuous integration of visual, vestibular, and somatosensory information. Within this system, the upper cervical region plays a particularly important role, as it contributes to the orientation of the head in space and to the coordination between the head, eyes, and trunk. Due to their deep location between the occiput, atlas, and axis, the suboccipital muscles have a high proprioceptive significance and are frequently associated with cervical position control and sensorimotor regulation.
Changes in muscle tension, stiffness, or dysfunction in this region may alter the quality of afferent information transmitted to the central nervous system, potentially interfering with postural stability, head position awareness, body sway, and center of pressure control. In this context, the suboccipital inhibition technique is used in osteopathic practice as a manual intervention aimed at reducing myofascial tension, promoting relaxation of the upper cervical musculature, and potentially normalizing proprioceptive input.
Postural balance is a fundamental component of human motor function and is essential for maintaining functional autonomy and performing activities of daily living. It relies on the continuous and dynamic integration of sensory inputs from the visual, vestibular, and somatosensory systems, which are processed by the central nervous system to generate appropriate motor responses. These responses allow the body to maintain the center of mass within the base of support through constant postural adjustments.
Within this complex sensorimotor system, the upper cervical region plays a critical role in postural control. This region is responsible for the precise orientation of the head in space and contributes significantly to the coordination between the head, eyes, and trunk. The suboccipital muscles-namely the rectus capitis posterior major and minor, and the obliquus capitis superior and inferior-are deeply located between the occiput, atlas, and axis, and are characterized by a high density of muscle spindles. This anatomical feature suggests a strong proprioceptive function, making these muscles key contributors to cervical position sense and sensorimotor regulation.
In addition to their proprioceptive role, the suboccipital muscles are anatomically and functionally connected to the dura mater through the myodural bridge. This structure is thought to play a role in both mechanical and sensory integration, linking muscular activity with the central nervous system. Furthermore, the upper cervical region contains joint mechanoreceptors that provide additional afferent input, contributing to reflex mechanisms such as the cervico-ocular, cervico-collic, and tonic neck reflexes, which are essential for maintaining postural stability and gaze control.
Alterations in muscle tone, increased stiffness, or dysfunction in the suboccipital region may disrupt the quality of afferent information transmitted to the central nervous system. Such disturbances can impair proprioceptive accuracy and interfere with postural control mechanisms, potentially leading to increased body sway, altered head positioning, and changes in center of pressure (CoP) behavior. Since CoP displacement reflects the neuromuscular strategies used to maintain balance, it serves as an objective measure for assessing postural stability.
The suboccipital inhibition technique is commonly used in osteopathic practice as a manual intervention aimed at reducing myofascial tension in the upper cervical region. By promoting muscle relaxation and potentially restoring normal proprioceptive input, this technique may contribute to the optimization of postural control mechanisms. Previous studies have demonstrated its effects on cervical mobility, pain reduction, and flexibility; however, evidence regarding its immediate impact on postural balance remains limited and inconclusive.
Given the theoretical and neurophysiological rationale supporting the role of the suboccipital region in postural regulation, further investigation is warranted. The present study aims to evaluate the immediate effects of the suboccipital inhibition technique on postural balance in healthy young adults, using objective measures derived from center of pressure analysis, specifically Mean CoP and Mean Velocity.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Experimental Group | Experimental | The intervention group received the suboccipital muscle inhibition technique, in which the investigator applied a sustained pressure to the patient's suboccipital muscle region for 4 minutes. |
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| Control Group | Placebo Comparator | In the control group, a clavicular palpation technique was performed, without any therapeutic intent. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Placebo Technique | Other | For the placebo technique, the participant remained in the supine position on the osteopathic table, with the upper and lower limbs extended, the cervical spine in a neutral position, and the eyes closed. The therapist placed the hands in the clavicular region, performing only passive manual contact, without applying pressure, mobilisation, or any therapeutic intent. This technique was used to reproduce the manual contact present in the intervention, without producing specific therapeutic effects. The application also lasted 4 minutes. |
| Measure | Description | Time Frame |
|---|---|---|
| Mean Center of Pressure (Mean CoP) Displacement Assessed Using a Force Platform | Mean center of pressure displacement will be assessed using a force platform during [static balance task]. Lower COP displacement indicates better postural stability.assessment period. | Immediately after the intervention |
| Mean Standing Velocity Assessed During Quiet Standing | Mean velocity during quiet standing will be assessed using [measurement device/system name]. Participants will stand in an upright position while postural sway is recorded. Mean velocity will be calculated as the average velocity of the center of pressure (COP) displacement over the assessment period and expressed in [units, e.g., mm/s]. Lower values indicate reduced postural sway and better postural stability. | Immediately after the intervention |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Natalia MO Campelo | Contact | +351222061000 | nmc@ess.ipp.pt |
| Name | Affiliation | Role |
|---|---|---|
| Natalia MO Campelo | Escola Superior de Saúde do Porto | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Background | Siatkowski, Idzi. "The Impact of Suboccipital Muscle Inhibition on Postural Stability in Young Individuals." Fizjoterapiapolska.pl, 2024, fizjoterapiapolska.pl/en/article/wplyw-inhibicji-miesni-podpotylicznych-na-stabilnosc-posturalna-u-mlodych-osob/. | ||
| Background | Smith, Lucie, and Manoj Mehta. "The Effects of Upper Cervical Complex High Velocity Low Amplitude Thrust Technique and Sub-Occipital Muscle Group Inhibition Techniques on Standing Balance." International Journal of Osteopathic Medicine, vol. 11, no. 4, Dec. 2008, p. 162, https://doi.org/10.1016/j.ijosm.2008.08.020. | ||
| Background | Kaur, Harsirjan. "Optimising Therapeutic Benefits: Suboccipital Muscle Inhibition Technique for Enhanced Balance and Alleviation of Pain Intensity in Individuals with Chronic Neck Pain." Chettinad Health City Medical Journal, vol. 13, no. 01, 30 Mar. 2024, pp. 81-86, https://doi.org/10.24321/2278.2044.202414. Accessed 14 Sept. 2024. | ||
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| Intervention Technique | Other | For the application of the suboccipital inhibition technique, the participant was positioned in the supine position on an osteopathic table, with the upper and lower limbs extended, the cervical spine in a neutral position, and the eyes closed. The therapist was seated at the head of the table, with the feet firmly supported on the floor. The technique was performed by placing the 2nd, 3rd, and 4th fingers of both hands in the region between the occiput and the atlas, at the level of the suboccipital musculature, with the metacarpophalangeal joints flexed at approximately 90°. After correct positioning, a gentle and sustained pressure was applied, combined with a slight cephalic traction, in order to promote relaxation of the suboccipital muscles. The technique was applied for 4 minutes. |
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| Background |
| Campbell D, Murphy BA, Burkitt J, La Delfa N, Sanmugananthan P, Ambalavanar U, Yielder P. Cervico-Ocular and Vestibulo-Ocular Reflexes in Subclinical Neck Pain and Healthy Individuals: A Cross-Sectional Study. Brain Sci. 2023 Nov 18;13(11):1603. doi: 10.3390/brainsci13111603. |
| 36360901 | Background | Molina-Alvarez M, Arribas-Romano A, Rodriguez-Rivera C, Garcia MM, Fernandez-Carnero J, Armijo-Olivo S, Goicoechea Garcia C. Manual Therapy Effect in Placebo-Controlled Trials: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022 Oct 28;19(21):14021. doi: 10.3390/ijerph192114021. |
| 34072454 | Background | Kang HS, Kwon HW, Kim DG, Park KR, Hahm SC, Park JH. Effects of the Suboccipital Muscle Inhibition Technique on the Range of Motion of the Ankle Joint and Balance According to Its Application Duration: A Randomized Controlled Trial. Healthcare (Basel). 2021 May 29;9(6):646. doi: 10.3390/healthcare9060646. |
| 21912824 | Background | Nayak SR, Swamy R, Krishnamurthy A, Dasgupta H. Bilateral anomaly of rectus capitis posterior muscles in the suboccipital triangle and its clinical implication. Clin Ter. 2011;162(4):355-6. |
| 36556992 | Background | Sung YH. Suboccipital Muscles, Forward Head Posture, and Cervicogenic Dizziness. Medicina (Kaunas). 2022 Dec 5;58(12):1791. doi: 10.3390/medicina58121791. |
| 29427867 | Background | Wannaprom N, Treleaven J, Jull G, Uthaikhup S. Neck muscle vibration produces diverse responses in balance and gait speed between individuals with and without neck pain. Musculoskelet Sci Pract. 2018 Jun;35:25-29. doi: 10.1016/j.msksp.2018.02.001. Epub 2018 Feb 5. |
| Background | Zamara, Weronika, et al. "The Impact of Suboccipital Muscle Inhibition on Postural Stability in Young Individuals." Fizjoterapia Polska, vol. 24, no. 1, 20 Mar. 2024, pp. 42-47, https://doi.org/10.56984/8zg2ef8369. |
| 23073629 | Background | Proske U, Gandevia SC. The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force. Physiol Rev. 2012 Oct;92(4):1651-97. doi: 10.1152/physrev.00048.2011. |
| 26847014 | Background | de Vries J, Ischebeck BK, Voogt LP, Janssen M, Frens MA, Kleinrensink GJ, van der Geest JN. Cervico-ocular Reflex Is Increased in People With Nonspecific Neck Pain. Phys Ther. 2016 Aug;96(8):1190-5. doi: 10.2522/ptj.20150211. Epub 2016 Feb 4. |