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Osteopathic Medicine

Osteopathic Manipulative Treatment: Suboccipital Release

Acute musculoskeletal pain is 1 of the most prevalent complaints in inpatient and outpatient settings. Many patients receive pharmacologic treatment for these complaints. Osteopathic manipulative treatment (OMT) allows providers to have another treatment option that is easily accessible. OMT involves manual manipulation of muscles and fascia to reduce pain and tension and help facilitate the body's restorative functions. Somatic dysfunction is defined as an imbalance within the musculoskeletal s

v1 · Reviewed Nov 8, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • Concern for neurovascular compromise
  • Focal neurologic deficit
  • Acute cervical fractures
  • dizziness
  • neurologic deficits on the physical exam
  • tissue texture changes
  • spinal alignment asymmetry
  • limited joint range of motion
  • tenderness
  • edema
  • erythema
  • sharp pain
  • neurologic and musculoskeletal exam of the neck and upper extremities
  • NSAID medications
  • Triptans are the first line for abortive treatment of migraines.
  • local anesthetics to treat acute headaches.
  • NSAIDs
  • heat
  • ice
  • strengthening
  • OMT techniques
  • Acute cervical fractures
  • Concern for neurovascular compromise
  • Focal neurologic deficit
  • Older patients or patients with more co-morbidities tend to respond better to indirect techniques.
  • Triptans are the first line for abortive treatment of migraines.
  • Other medications, such as amitriptyline, beta-blockers, and topiramate, have been used to prevent migraines.
  • injecting lidocaine or bupivacaine into the greater occipital branch of the suboccipital nerve.
  • After the treatment, it is important to re-assess the patient's symptoms.
  • It is not uncommon to have some transient fatigue and persistent symptoms.
  • The most common adverse reactions include headache, fatigue, and nausea.
  • Less commonly, there are risks of worsening pain and nerve compression.
  • The most feared complication of cervical manipulation is vertebral artery dissection.
  • Symptoms of this include dizziness, headache, and neck pain.
  • Vertebral artery dissection may also present with an insidious onset of symptoms and neurologic deficits on the physical exam.
  • review
    Osteopathic Manipulative Treatment: Suboccipital Release. StatPearls [Internet] — Emily Rowlands, Alexander Pozun — StatPearls Publishing, 2023

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov