Overview

Subnuchal bursitis is a relatively rare inflammatory condition affecting the subnuchal bursa, a small fluid-filled sac located between the nuchal ligament and the spinous processes of the upper cervical vertebrae, typically around the C1-C3 levels. The primary function of this bursa is to reduce friction between tissues during neck movement, allowing smooth flexion, extension, and rotation. When this bursa becomes irritated or inflamed, it leads to Subnuchal bursitis, a painful disorder that restricts neck mobility and contributes to chronic discomfort in the posterior neck region.

Though less common than shoulder or knee bursitis, Subnuchal bursitis can significantly affect daily activities such as looking up, turning the head, or maintaining posture for long periods, especially in individuals with poor ergonomics or repetitive strain to the neck.

At DMPhysios, a renowned physiotherapy clinic in Noida specializing in spine and sports conditions, clinicians often encounter cases where neck pain or stiffness is misdiagnosed as cervical spondylosis or muscle strain. In reality, the underlying cause can sometimes be Subnuchal bursitis, emphasizing the importance of accurate diagnosis and patient-centered rehabilitation.

Symptoms

The symptoms of Subnuchal bursitis can closely mimic other cervical conditions, making it crucial to identify specific patterns and associated signs. Common symptoms include:

1. Localized Pain – A dull, aching pain is typically felt at the base of the skull or upper neck region. The discomfort may radiate slightly into the occipital area but rarely extends to the shoulders or arms.
2. Tenderness on Palpation – The area just below the occipital ridge is often tender to touch.
3. Swelling and Warmth – Mild swelling or a feeling of fullness at the back of the neck may be present due to inflamed bursal tissue.
4. Restricted Neck Motion – Particularly painful during neck extension (looking up) or rotation.
5. Headache or Occipital Neuralgia-like Pain – Chronic Subnuchal bursitis may cause tension-type headaches or radiating pain due to irritation of nearby nerve endings.
6. Pain on Pressure or Sustained Posture – Activities like working long hours at a desk, using mobile devices, or sleeping in awkward neck positions often exacerbate the pain.

Types of Subnuchal Bursitis

While medical literature does not define distinct subtypes of Subnuchal bursitis, it can be categorized based on the underlying cause and chronicity:

1. Acute Subnuchal Bursitis – Arises suddenly, often due to trauma, infection, or repetitive mechanical stress. Symptoms appear abruptly with localized inflammation and tenderness.
2. Chronic Subnuchal Bursitis – Develops over time from repetitive overuse, postural strain, or biomechanical imbalances. It may cause persistent stiffness and recurrent pain episodes.

At DMPhysios, physiotherapists often classify Subnuchal bursitis cases this way to design targeted treatment plans, addressing both acute inflammation and the long-term biomechanical contributors.

Causes

The primary mechanism behind Subnuchal bursitis is frictional irritation or pressure over the subnuchal bursa. Common causes include:

1. Repetitive Neck Movements – Frequent flexion, extension, or rotation of the neck (common in athletes, desk workers, or students).
2. Poor Posture – Chronic forward head posture increases tension on the nuchal ligament and the subnuchal region.
3. Direct Trauma – A sudden impact or blow to the back of the neck can cause localized inflammation.
4. Prolonged Immobilization – Keeping the neck in one position for extended periods, such as reading in bed or using a laptop without proper ergonomics.
5. Infections or Inflammatory Diseases – Though rare, infections or systemic inflammatory conditions like rheumatoid arthritis may involve the subnuchal bursa.
6. Degenerative Changes – Age-related wear and tear in cervical structures can contribute to secondary bursal irritation.

Risk Factors

Certain individuals are more susceptible to developing Subnuchal bursitis. Risk factors include:

• Occupational posture stress (e.g., IT professionals, office workers, dentists, or drivers)
• Athletes who perform repetitive neck movements (wrestlers, gymnasts, swimmers)
• Improper sleeping posture or use of overly high pillows
• Cervical spondylosis or degenerative neck disorders
• Previous neck injuries or whiplash trauma
• Sedentary lifestyle and poor muscle endurance in the cervical stabilizers

At DMPhysios, physiotherapists conduct detailed postural and ergonomic assessments to identify these risk factors and educate patients on long-term neck health management.

Treatment

The treatment of Subnuchal bursitis focuses on relieving inflammation, reducing pain, and restoring full neck mobility. Depending on the severity, conservative management usually proves effective.

1. Rest and Activity Modification

Avoid movements or activities that aggravate the pain. Resting the neck allows inflammation to subside.

2. Cold and Heat Therapy

• Cold therapy (ice packs) during the acute phase helps control swelling and pain.
• Heat therapy (warm compresses) in the chronic phase promotes blood flow and muscle relaxation.

3. Medications

Doctors may prescribe:

• Non-steroidal anti-inflammatory drugs (NSAIDs) to control pain and inflammation.
• Corticosteroid injections in persistent cases to directly reduce bursal inflammation (performed under imaging guidance).

4. Posture Correction

Ergonomic education is vital. Adjusting workstation height, maintaining neutral neck alignment, and avoiding forward head posture reduce mechanical strain on the subnuchal bursa.

5. Soft Tissue Techniques

Manual therapy and myofascial release targeting the cervical paraspinal muscles, upper trapezius, and suboccipital region help reduce muscle tension and pressure on the bursa.

Physiotherapy Treatment

Physiotherapy plays a central role in both acute management and long-term recovery of Subnuchal bursitis. At DMPhysios in Noida, the physiotherapy approach is evidence-based and personalized to each patient’s condition.

1. Pain Management Phase

During the acute phase, the focus is on controlling inflammation and pain:

• Cryotherapy to minimize swelling.
• Accelerated Healing Therapy to promote tissue healing and reduce bursal inflammation.
• Gentle cervical mobilization techniques to maintain mobility without aggravating the bursa.

2. Mobility Restoration Phase

Once pain subsides:

• Neck Range of Motion (ROM) exercises are introduced gradually to improve flexibility.
• Suboccipital release techniques are performed to relieve tightness and pressure in the posterior neck muscles.
• Active and passive stretching of the upper trapezius, levator scapulae, and sternocleidomastoid muscles enhance neck mobility.

3. Strengthening and Stabilization Phase

Chronic Subnuchal bursitis often results from weak or imbalanced neck and shoulder girdle muscles. Strengthening these areas prevents recurrence.

• Isometric neck strengthening (flexion, extension, lateral flexion)
• Scapular stabilization exercises like rows and wall angels
• Chin tucks to correct forward head posture
• Deep cervical flexor training to enhance endurance of postural muscles

4. Postural and Ergonomic Retraining

Physiotherapists at DMPhysios educate patients on ideal postural habits:

• Maintain neutral neck alignment during work.
• Use ergonomic chairs and adjustable monitors.
• Take frequent breaks every 30–40 minutes to stretch and reset posture.

5. Techniques

For chronic or stubborn Subnuchal bursitis, advanced technologies may be used at DMPhysios:

• Dry Needling to release myofascial trigger points.
• Cupping or IASTM (Instrument-Assisted Soft Tissue Mobilization) to enhance circulation and reduce soft tissue adhesions.

6. Functional Rehabilitation

As recovery progresses, physiotherapists integrate functional exercises like:

• Dynamic neck control drills
• Proprioceptive training
• Sport-specific or occupational reconditioning to safely return patients to their activities without risk of recurrence.

Prevention

Preventing Subnuchal bursitis involves maintaining neck health and reducing repetitive strain. Key preventive strategies include:

1. Postural Awareness – Keep the ears aligned with shoulders while sitting or standing.
2. Ergonomic Adjustments – Optimize workstations with monitor height at eye level.
3. Regular Stretching – Incorporate daily neck stretches to maintain flexibility.
4. Strengthening Exercises – Strengthen cervical and upper back muscles for postural stability.
5. Breaks from Static Postures – Avoid prolonged sitting or looking down at devices.
6. Proper Sleep Support – Use pillows that maintain neutral neck alignment.
7. Early Physiotherapy Consultation – Seek expert care at DMPhysios at the first sign of neck pain to prevent progression into chronic Subnuchal bursitis.

Conclusion

Subnuchal bursitis may be rare, but its impact on neck function and quality of life can be significant. Early diagnosis and comprehensive management, especially physiotherapy, are essential for complete recovery. With proper treatment, posture correction, and preventive strategies, patients can return to their daily routines pain-free and confident.

At DMPhysios, a leading physiotherapy clinic in Noida specializing in spine and sports conditions, our patient-centered rehabilitation programs are designed to address the root cause of problems like Subnuchal bursitis, not just the symptoms. Our expert team combines manual therapy, advanced technology, and