The rectus capitis posterior major (RCPMaj) is a clinically relevant target. It has been implicated in headache via nociceptive convergence at the trigeminal cervical nucleus and myodural bridging with the spinal dura.
Yet until recently, no guidelines on needle length or angle existed for dry needling, despite well-documented risks in this region, including proximity to the vertebral artery, puncture of the greater occipital nerve, and penetration of the spinal cord.
In a cadaveric investigation published in Musculoskeletal Science and Practice, my co-investigators and I examined 25 embalmed cadavers to establish those guidelines.
Our recommendations:
– Insertion point: midway between the C2 spinous process and C1 transverse process
– Needle angle: ≤45° relative to the frontal plane, advancing cranially toward the occiput
– Needle length: no longer than 40 mm
These parameters increase the likelihood of reaching the RCPMaj while mitigating penetration of deeper structures.
This is cadaveric work, and we were deliberate about stating that limitation clearly. Clinical generalizability and in vivo accuracy still need to be established— and that work is currently underway. Data collection for a validation study is underway, and I look forward to sharing the findings with the dry needling community through IDNETAG.
If you’re needling this region, the anatomy warrants your attention.
Click this link to read the article: Guidelines to minimize risk when dry needling the rectus capitus posterior major muscle.
Kearns G, Lierly M, Gilbert K …Guidelines to minimize risk when dry needling the rectus capitus posterior major muscle. Musculoskeletal Science & Practice, 2025; 76
