Upper Cervical Therapy
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Anatomical Piece of Advice of the Upper Cervical Asymmetry

Since midst of the year 2009, we could repeatedly acertain the following features in anatomical head-neck-dissectations of the Anatomy of Göttingen: 

  • On the left, the Venter posterior musculi digastrici takes its course behind the Processus transversus atlantis, on the right, in front of it. 
  • At the level of the Processus transversus atlantis, the Venter posterior musculi digastrici is hardly as thick as a little finger, and has a connective tissue with the Processus transversus atlantis. 
  • On the left, that connective tissue is broader, softer and the Venter posterior musculi digastrici could be moved from behind to the front, respectively, be turned around. 
  • However, on the right, the Venter posterior musculi digastrici is so tightly und narrowly connected to the atlas that turning it backwards behind the Processus transversus atlantis is quite impossible. 
  • In some of the cases, a clearcut notch in the area of the left Arcus posterior atlantis could be noticed, which resulted from the pressure of the Venter posterior musculi digastrici.   

The fascia of the posterior digastric muscle is connected with the tip of the atlas process (Processus transversus atlantis) on both sides with strong connective tissue. On the right side, the connective tissue is short and narrow. Therefore, the muscle can not be turned behind the atlas process.

On the left side, the situation is qualitatively different: The connective tissue connecting the fascia to the atlas process is longer and thinner. Therefore, the muscle can be turned around the atlas process. The muscle belly can either take its course behind the atlas process in its evolutionarily determined place at the outer end of the insertion of the Musculus obliquus capitis inferior, or, alternatively,  in an groove formed within the posterior arch of the atlas, or else, as mentioned above, in front of the atlas process.

In general, all muscle conductions are indeed mobile, but cannot be changed in their relation to each other. Here is a unique muscle-rearrangement option that can also be performed in vivo and forms the basis of the upper cervical therapy.

In this historical representation, the digastric muscle is denoted with number 5 and called 'digastric mandible muscle '. Eisler, Paul: The Muscles of the Trunk (1902), p. 275
In this representation, the digastric muscle bears the term 'digastric'. Against Baur, C. (1903). Textbook of Human Anatomy. p. 380

Two elder descriptions in original language follow:

  • M. digastricus mandibulae, zweibäuchiger Unterkiefermuskel. Der Muskel besteht aus zwei Bäuchen, die durch eine Schaltsehne verbunden werden. Er zieht von der Incisura mastoidea zur Kinngegend und erlangt auf dem Wege dahin unter winkeliger Ablenkung eine Anheftung an der Seite des Zungenbeinkörpers. Der hintere Bauch entspringt in der Incisura mastoidea des Schläfenbeins teils fleischig, teils sehnig auf einem langelliptischen, gut markierten Knochenfeld; bei schmaler Incisura greift der Ursprung verschieden breit auf die Medialfläche des Processus mastoides über. Die Bündel wenden sich vor-, ab- und medianwärts und bilden einen transversal abgeplatteten Muskelbauch, der sich nach der Sehne zu allmählich verjüngt infolge der fiedrigen Anordnung der Bündel. Eisler, Paul (1902). The muscles of the trunk (pp. 274-284). Published by Gustav Fischer, Jena.
  • M. biventer inferioris (Digastricus). Er repäsentiert eine oberflächliche Lage der über dem Zungenbein befindlichen Muskeln. Sein hinterer Bauch entspringt aus der Incisura mastoidea des Schläfenbeins und tritt, von der Insertion des M. sternocleidomastoideus bedeckt, schräg vor- und abwärts, um allmählich verschmählert in eine starke, cylindrische Sehne überzugehen. Diese läuft über dem großen Zungenbeinhorne hinweg und lässt den zweiten Bauch entspringen. Dieser vordere, zweite Bauch verläuft vorwärts zum Unterkiefer, wo er sich kurzsehnig in der Fossa digastrica inseriert. Der Muskel beschreibt einen abwärts convexen Bogen, welcher die Glandula submaxillaris umzieht. Durch den die Zwischensehne umgreifenden Stylohyoideus wird er in seiner Lage gehalten, aber nicht eigentlich fixiert. Dieses kommt vielmehr auf andere Art zustande, entweder dadurch, dass der vordere Bauch nur teilweise aus der Zwischensehne hervorgeht, zum anderen Teil sehnig vom Körper des Zungenbeins entspringt, oder dass von der Zwischensehne her eine Abzweigung zum Zungenbein tritt, oder es findet von der Fascie des Biventer eine aponeurotsiche Fortsetzung zum Zungenbein statt. Gegenbaur, C. (1903). Textbook of Human Anatomy (pp. 379-381). Published by Wilhelm Engelmann, Leipzig.

It is thus clear that anatomical evidence would not be so easy because it is a very complex muscle that is represented but with difficulty in anatomical sections due to its quality and course. One must always be aware that the upper cervical asymmetry is a highly reversible phenomenon: Post-mortem, an asymmetric digastric muscle conduction can easily become symmetrized. This is probably the rule in anatomical specimens. If in living people digastric muscle conduction was easily reversible, this must also be the case in the deceased through adequate manipulation. No wonder that, to date, macro-anatomical research has not taken notice of the asymmetric digastric muscle conduction. The present, sufficiently documented pool of cases was necessary to notice the phenomenon at all. Only by means of the discovery of the reversibility of the digastric muscle conduction in living people, the question of the anatomical substrate and its representability was raised.


The high reversibility of upper cervical asymmetry has led to the fact, that the latter could not be discovered in centuries of anatomical specimens. Rather, only the current clinical evidence resulted in the postulate of asymmetric digastric muscle. In this context, it was repeatedly noted on anatomical head-&-neck specimens that the posterior digastric muscle could solely be folded around the left atlas extension. In addition, traces of the passage of the posterior digastric muscle were found on the left posterior arch of the atlas in individual cases.