Muscles of the Head and Neck

Did you know that there are over 20 neck muscles and 20 muscles of the face and cranium? Massage therapists frequently work on clients’ cervical and facial muscles in order to relieve areas of muscle tension, reduce headaches and other painful conditions, correct abnormal posture, improve cervical range of motion, and assist with general relaxation. So it is beneficial for massage therapists to have a good understanding of the anatomy of the head and cervical regions.

What are the muscles of the head and neck? The muscles of the head and neck include the facial muscles, the muscles of the cranium, and the muscles of the anterior, lateral and posterior cervical regions. These muscles perform functions such as facial expression, chewing and swallowing, movement of the eyes, and movement of the head and cervical spine. Cervical muscles may be contained entirely within this region, or they may originate in the upper thoracic region. Muscles of the head and neck include the sternocleidomastoid (SCM), scalenes, masseter, suboccipital muscles, platysma, pterygoids, splenius capitis and cervicis, levator scapula, and temporalis.

Neck muscles have the primary function of supporting, stabilizing and moving the head and cervical spine. Some of these muscles also integrate with the structures of the upper thoracic and upper extremity regions to elevate the upper ribs and help move the shoulder girdle. Craniofacial muscles move the jaw and soft tissues of the face to enable a person to perform many functional activities such as communicating, eating, and drinking.

The cervical and facial muscles included in this resource are those that a massage therapist is most likely to need to know for work and for the Massage & Bodywork Licensing Exam (MBLEx). There are many small muscles that are only briefly mentioned here but are not included in the origin, insertion and action (OIA) muscle table because they are not likely to appear on the massage licensing exam. Some of these excluded head and neck muscles are the extraocular muscles that move the eyeball and eyelids, the hyoid muscles, the muscles of facial expression, and the muscles of deglutition (swallowing). This muscle reference is part of our muscle OIA series. You can find links to muscle tables covering other areas of the body on our massage student resources page.

Head and neck muscles for massage therapists

It is important for massage therapists to learn the locations of muscles and other anatomical structures of the neck and head well for three main reasons:

1. Clients frequently request neck massage for relaxation or to relieve muscle tension
2. Many conditions are associated with dysfunction of the cervical and facial muscles
3. There are several areas of caution (endangerment sites) located at the head and neck

1. Neck massage is commonly requested

First, the muscles of the neck and head are one of the most commonly requested areas of the body that clients ask to be massaged. Most clients have some overly tense or even painful muscles in the cervical area, and they appreciate a great neck massage. Increased muscle tension, or hypertonicity, may be the result of abnormal posture, or just it may just be a response to emotional stress. So whether you’re providing Swedish massage, deep tissue massage, chair massage, general relaxation massage, Indian head massage, or virtually any type of massage, setting aside some time to massage the muscles of the neck and head will be much appreciated.

Tense muscles of neck and head can create problems if not addressed. These problems include: compression of the nerves of the brachial plexus, decreased range of motion of the cervical spine, TMJ disorder, tension headaches, and development of trigger points. Most clients appreciate a great neck massage even if they have no noticeable problems related to the muscles of the neck.

2. Many conditions are associated with head and neck muscle dysfunction

There are many medical conditions that are associated with neck pain, muscles tension or other dysfunction of the head and neck muscles. Dysfunction of these muscles can be caused by damage to the peripheral nerves, brain damage, traumatic muscle injury, or infection that affects these structures.

In some cases, the dysfunctional muscle may be the cause of the problem. For example, a muscle strain injury that results in pain and a loss of cervical range of motion. A specific example of this is whiplash. This mechanical trauma to the muscles and other tissues (e.g. connective, nerve, bone, disc) often causes neck pain that refers to the surrounding areas. It may also cause a loss of ROM, paresthesia in the upper extremities, and other potential problems. General tension of cervical muscles can compress nerves of the brachial plexus and cause muscle weakness, numbness or other paresthesias at the upper extremities.

In other cases, pain, muscle tension or dysfunction may be the result of an underlying condition. For example, tight and shortened suboccipital muscles may be the result of a forward head posture. Another example is Bell’s palsy, a condition where the facial nerve (CN VII) becomes impaired due to irritation, inflammation, infection or other reason. This results in weakness or even paralysis of the muscles on one side of the face. Other conditions that can result in facial muscle dysfunction include stroke and facial spasms.

3. Several areas of caution for massage are located at the head and neck

Massage therapists studying the muscles of the head and neck must also be familiar with the massage endangerment sites (AKA massage areas of caution) within this area. There are several vulnerable areas and delicate structures that can be damaged by the aggressive massage techniques. Some of the areas of caution for the head and face include the eyes and the styloid process of the temporal bone. The face in general is an area of caution and should be massaged gently because of the facial nerve, trigeminal nerve, temporal artery and glands.

The anterior and lateral cervical region contains several vulnerable structures that may be injured by deep massage or bodywork techniques. The carotid artery and jugular vein are located here. A specific area of the carotid artery known as the carotid sinus is a baroreceptor (blood pressure sensor) that can trigger a dangerous drop in blood pressure if massaged. There are also several cranial nerves in this cervical area that can be damaged. These include the facial, glossopharyngeal, vagus, accessory, phrenic and hypoglossal nerves. Other vulnerable structures located here include the hyoid bone, trachea, submandibular glands, thyroid gland and cartilage, subclavian artery and vein, and cervical lymph nodes.

There are fewer vulnerable structures on the posterior aspect of the head and neck. The occiput of the head and the suboccipital region contain the suboccipital and vertebral nerves, as well as the vertebral artery. Massage therapists must avoid excessive pressure here, and use only gentle range of motion and stretching techniques in this area.

There is a fourth reason that massage students should learn muscles of the head and neck well, and that is because this material is covered on the MBLEx massage exam. Questions from several MBLEx content areas such as kinesiology, anatomy, and client assessment will require knowledge of the origin, insertion or action of specific muscles of the head or neck.

Overview of facial, cranial and cervical muscles and muscle groups

The muscles of the cervical region can be divided into anterior, lateral and posterior groups based on their general position in the neck. These cervical muscles may be further classified by their other characteristics such as their function, depth (e.g. deep cervical flexors), or their specific location (e.g. suprahyoid muscles, or suboccipital muscles). *A muscle may be included more than one muscle group.

Because of the line of pull, muscles on the anterior aspect of the neck create cervical (forward) flexion. The lateral cervical muscles create lateral flexion, or sidebending of the neck. And the muscles of the posterior cervical spine create cervical extension. These are the general actions for the three main groups of cervical muscles, however there are some exceptions. For example, the lateral cervical muscles may also create cervical extension or flexion. Cervical rotation is created by muscles in each of the three main groups. Cervical muscles may also perform additional functions such as moving the scapula or elevating the ribs to assist with breathing.

***MBLEx study tips: (1) Remember that a muscle only creates movement at a joint if it crosses the joint. (2) Deeper muscles tend to be shorter and cross fewer joints than superficial muscles. (3) Deep muscles tend to contribute more to joint stability than superficial muscles.

Muscle groups of the cervical region

• Anterior cervical muscles.
  • Superficial anterior neck muscles. Sternocleidomastoid (SCM), platysma.
  • Deep anterior vertebral muscles (cervical flexors): Longus colli, longus capitis, rectus capitis anterior and lateralis.
  • Hyoid muscles.
    • Suprahyoid muscles. Digastric, mylohyoid, stylohyoid, geniohyoid.
    • Infrahyoid muscles. Sternohyoid, sternothyroid, omohyoid, thyrohyoid.
  • Muscles of deglutition (swallowing). These include many small muscles of the face and cervical region.
• Lateral cervical muscles.
  • Scalene muscles. These are the three lateral vertebral (paravertebral) muscles: anterior scalene, middle scalene, and posterior scalene.
• Posterior cervical muscles.
  • Superficial posterior neck muscles. Splenius capitis and cervicis.
    • Extrinsic neck muscles. Upper trapezius and levator scapula. These muscles cross over into the upper thoracic region.
  • Transversospinalis group. Semispinalis capitis and cervicis, rotatores cervicis, multifidus.
  • Intervertebral muscles. Interspinales and intertransversarii.
  • Suboccipital muscles. Rectus capitis posterior major and minor, Obliquus capitis superior and inferior.

***Muscle memorization tip: Remember that many muscles are named according to their location, attachment points, size, shape, or some other physical characteristic. “Capitis” means of the head, and “cervicis” means of the neck.

Muscle groups of the face and cranium

Massage therapists should have a basic knowledge of the facial muscles and their functions. There are about 20 craniofacial muscles of the face and cranium. They play an important role in chewing (mastication), drinking, talking, singing, whistling, and nonverbal communication. These muscles work together to control the movement of the lips, forehead, eyebrows, eyelids, ears, cheeks, chin and nose.

• Facial muscles of expression. These muscles are innervated by the facial nerve, which is the 7th cranial nerve (CN VII). The facial nerve is a mixed nerve, which means that it performs motor (efferent) and sensory (afferent) functions. It arises from the brainstem and has five main branches: temporal (frontal), zygomatic, buccal, marginal mandibular, and cervical. The muscles of facial expression receive their blood supply from the facial artery.
  • Occipitofrontalis. Raises the eyebrows and wrinkles the forehead.
  • Auricular muscles. Group of three small muscles that move the ears (up, down, forward)
  • Orbital muscle group (around the eyes)
    • Orbicularis oculi. Closes the eye, blinking, controls muscles of tear (lacrimal) duct.
    • Corrugator supercilii. Drawing the eyebrows downward and medially to shield the eyes.
    • Depressor supercilii. Depression of the eyebrows.
  • Nasal muscle group (around the nose)
    • Nasalis. Depresses the nostrils.
    • Depressor septi nasi. Widens the nostrils.
    • Procerus. Drawing the medial part of the eyebrows downward (as in frowning), and assists in flaring nostrils.
  • Oral muscle group (around the mouth)
    • Orbicularis oris. Closes the mouth, puckers the lips.
    • Levator anguli oris. Elevates the angles of the mouth (as in smiling).
    • Depressor anguli oris. Depresses the angles of the mouth (as in frowning).
    • Zygomaticus major. Pulls the angles of the mouth superiorly and laterally (as in smiling).
    • Zygomaticus minor. Elevation of the upper lip and angles of the mouth.
    • Levator labii superioris. Elevation of the upper lip.
    • Depressor labii inferioris. Depresses the lower lip.
    • Risorius. Draws the angle of the mouth backwards.
    • Mentalis. Protrusion of the lower lip. Elevation and wrinkling of the chin.
    • Buccinator. Compresses the cheeks against the teeth (*see muscle table below).
    • Platysma. Depresses the corners of the mouth and the jaw. Tenses skin of neck (*see muscle table below).
• Muscles of mastication. These facial muscles are most involved in chewing of food. They are assisted by the muscles of facial expression that controls the lips and cheeks (secondary or accessory muscles of mastication). The muscles of mastication are primarily innervated by the trigeminal nerve, which is the 5th cranial nerve (CN V). The origins, insertions, actions and innervations of these are included in the muscle table below.
  • Masseter. Elevation and protrusion (protraction) of the mandible.
  • Lateral pterygoid. Depression (opens mouth), protrusion and lateral excursion (rotation) of the mandible.
  • Medial pterygoid. Elevation, protrusion and lateral excursion of the mandible.
  • Temporalis. Elevation and retraction of mandible.
• Extrinsic eye muscles. Also called extraocular muscles, this group of six muscles control the movement of the eye. You are unlikely to see any specific questions about these muscles on the MBLEx. Just be aware that they exist, and their basic function as a group is to stabilize the eyeball, coordinate eye movement, and rotate the eye (upward, downward, inward, outward).
  • Medial rectus, lateral rectus, superior rectus, inferior rectus, superior oblique, inferior oblique.

Muscle OIA of the head and neck

Muscle	Origin	Insertion	Action	Innervation
Buccinator	Alveolar process of maxilla and alveolar part of mandible	Merges with fibers of orbicularis oris	Pulls the corner of mouth laterally, and compresses cheek against the teeth	Facial nerve (CN VII)
Levator scapulae	Transverse processes of C1-4 vertebrae	Medial (vertebral) border of scapula, between the superior angle and scapular spine	Elevation and downward rotation of scapula	Dorsal scapular nerve (C5), and cervical nerves (C3,4)
Longus capitis	Transverse processes of C3-6	Base of occipital bone	Bilateral contraction: flexion of head and neck Unilateral contraction: cervical rotation to same side.	Spinal nerves C1-3
Longus colli	Anterior surfaces of transverse processes and vertebral bodies of T3 to C5	Anterior arch of atlas, anterior tubercles of C5,6, anterior surfaces of bodies of vertebrae C2-4	Bilateral contraction: flexion of neck Unilateral contraction: lateral cervical flexion to same side, and cervical rotation to same side.	Spinal nerves C2-6
Masseter	Inferior border of zygomatic arch, and maxillary process of zygomatic bone	Lateral surface of ramus of the mandible	Elevation of mandible (closes jaw), and protrusion of mandible	Nerve to the masseter, from the mandibular division of the trigeminal nerve (V)
Obliquus capitis superior	Superior surface of transverse process of the atlas (C1 vertebra)	Occipital bone between the superior and inferior nuchal lines	Extension of upper neck. Lateral flexion of head and neck to the same (ipsilateral) side.	Suboccipital nerve (C1)
Obliquus capitis inferior	Apex of spinous process of the axis (C2 vertebra)	Inferior and dorsal part of transverse process of the atlas	Extension of upper neck. Rotation of head and neck to the same (ipsilateral) side.	Suboccipital nerve (C1)
Platysma	Fascia overlying the superior thorax and calvicular regions	Inferior border of mandible and skin of lower face	Draws the corners of the mouth down, depresses the mandible, and tenses skin of the anterior neck.	Facial nerve (CN VII)
Pterygoid, lateral	Superior head: greater wing of sphenoid Inferior head: lateral pterygoid plate of sphenoid bone	Superior head: capsule and articular disk of the temporomandibular joint (TMJ) Inferior head: neck of the mandible	Bilateral contraction: depression (opens jaw) and protrusion of mandible Unilateral contraction: lateral excursion for grinding actions of chewing	Mandibular branch of trigeminal nerve (CN V)
Pterygoid, medial	Superficial part: tuberosity of maxilla, palatine bone Deep part: lateral pterygoid plate of sphenoid bone	Medial surface of the mandibular ramus	Bilateral contraction: elevation of mandible (closes jaw), and protrusion of mandible Unilateral contraction: lateral excursion of mandible	Mandibular branch of trigeminal nerve (CN V)
Rectus capitis anterior	Anterior surface of lateral mass and transverse process of atlas (C1 vertebra)	Inferior surface of basilar part of occipital bone	Flexion of neck at the atlanto-occipital joint (C0-C1)	Spinal nerve C1,2
Rectus capitis lateralis	Superior surface of transverse process of atlas (C1 vertebra)	Inferior surface of jugular process of the occipital bone	Lateral flexion (sidebending) of neck at the atlanto-occipital joint (C0-C1)	Spinal nerve C1,2
Rectus capitis posterior major	Spinous process of axis (C2 vertebra)	Lateral part of inferior nuchal line of the occipital bone	Extension of upper neck, rotation to same side	Suboccipital nerve (C1)
Rectus capitis posterior minor	Posterior tubercle of atlas (C1 vertebra)	Medial part of inferior nuchal line of the occipital bone	Extension of upper neck	Suboccipital nerve (C1)
Scalene, anterior	Anterior tubercles of transverse processes of C3-6	Scalene tubercle on the inner border of the first rib	Bilateral contraction: Cervical flexion; elevation of first rib. Unilateral contraction: ipsilateral flexion and contralateral rotation of the cervical spine	Anterior rami of spinal nerves C4-6
Scalene, middle	Posterior tubercles of the transverse processes of C2-7	Upper surface of first rib	Bilateral contraction: cervical flexion; elevation of first rib. Unilateral contraction: ipsilateral flexion and contralateral rotation of the cervical spine	Anterior rami of spinal nerves C3-8
Scalene, posterior	Posterior tubercles of the transverse processes of C5-C7	Outer surface of second rib, posterior to attachment of serratus anterior	Bilateral contraction: cervical flexion; elevation of second rib. Unilateral contraction: ipsilateral flexion and contralateral rotation of the cervical spine	Anterior rami of spinal nerves C6-8
Splenius capitis	Ligamentum nuchae and spinous processes of C7-T3	Mastoid process of the temporal bone, and lateral third of superior nuchal line of the occipital bone	Bilateral contraction: extension of head and neck Unilateral contraction: lateral cervical flexion; cervical rotation to same side (ipsilateral)	Spinal nerves C2-C3
Splenius cervicis	Spinous processes of T3-6	Transverse processes of C1-3	Bilateral contraction: extension of cervical spine Unilateral contraction: lateral cervical flexion and rotation to same side	Spinal nerves C3-C6
Sternocleidomastoid (SCM)	Sternal head: anterior surface of manubrium Clavicular head: superior surface of medial third of clavicle	Mastoid process of the temporal bone, and lateral half of superior nuchal line of the occipital bone	Bilateral contraction: cervical flexion Unilateral contraction: lateral cervical flexion to same (ipsilateral) side, and cervical rotation to opposite (contralateral) side.	Spinal accessory nerve (CN XI) and spinal nerves C2,3
Temporalis	Temporal fossa and fascia	Coronoid process of mandible	Elevation and retraction of mandible	Mandibular division of trigeminal nerve (CN V)