The upper neck is a meeting point for movement, sensory information, and the structures surrounding the brain and spinal cord. Small muscles help orient the head, connective tissues transmit forces, and cerebrospinal fluid moves through spaces within the nervous system. Research into a structure called the myodural bridge complex is expanding our understanding of how these processes may interact.
Two reviews provide complementary perspectives. Zhang and colleagues’ 2026 paper examines the anatomy, development, proposed functions, and possible clinical significance of the myodural bridge complex. Frost and Barclay’s 2024 review places this structure within the broader mechanics of the nervous system, with particular attention to hypermobility and Ehlers-Danlos syndromes. Together, they offer a compelling area of investigation while identifying questions that still require clinical research.
The myodural bridge complex consists of connective-tissue attachments linking certain deep muscles beneath the skull and associated structures with the spinal dura mater in the upper neck. The dura is the tough outermost membrane surrounding the brain and spinal cord. “Myo” refers to muscle, and “dural” refers to the dura. The name describes a physical connection between tissues often discussed separately.
These attachments have been demonstrated through anatomical investigation. Their existence is better established than the full extent of their physiological and clinical roles. Researchers are examining how they transmit force, influence dural movement, and potentially interact with cerebrospinal fluid dynamics. Understanding that distinction helps us appreciate the research without turning an anatomical finding into an explanation for every symptom.
One proposed function is supporting the dura during head and neck movement. As the spine changes position, neural tissues and their surrounding membranes must accommodate changes in length, shape, and mechanical loading. The myodural bridge may help regulate local tension and limit excessive dural folding. Zhang and colleagues describe anatomical and experimental findings supporting this possibility, while emphasizing the need for further functional validation in humans (Zhang et al., 2026).
A second area of interest is proprioception: the sensory information that helps the nervous system estimate body position and movement. The deep suboccipital muscles contain a high density of muscle spindles, receptors involved in detecting changes in muscle length. Researchers have proposed that connections through the myodural bridge could participate in feedback between dural mechanics and muscle control. The specific feedback mechanism remains a hypothesis requiring further investigation.
This research also intersects with cerebrospinal fluid, or CSF, which surrounds and supports the brain and spinal cord. Its movement reflects several interacting influences, including cardiovascular and respiratory activity. Experimental studies reviewed by Zhang and colleagues suggest that suboccipital muscle activity and myodural connections may contribute additional mechanical influences. Some of these findings come from animal models and cannot be assumed to operate identically in people.
These observations create important research questions. They do not establish that an adjustment, massage technique, or exercise restores CSF circulation, improves brain waste clearance, or treats a neurological disease through the myodural bridge. Those claims would require direct evidence showing that a particular intervention produces the proposed physiological change and a meaningful clinical benefit.
Frost and Barclay broaden the discussion through the concept of neuraxial biomechanics. The neuraxis refers principally to the brain and spinal cord along the body’s central axis. Their review considers these neural structures together with the membranes, connective tissues, blood vessels, and fluids that surround and support them. Everyday movement requires these tissues to accommodate mechanical changes while maintaining their functions (Frost & Barclay, 2024).
This provides a systems perspective on movement. Muscles and joints operate alongside tissues that must glide, deform, transmit force, and respond to pressure changes. The authors propose that altered connective-tissue properties may affect these relationships, particularly in hypermobile patients. The clinical significance of a particular interaction, however, must be investigated rather than inferred from the fact that anatomical continuity exists.
Headache is one area receiving attention. The 2026 review discusses research examining differences in suboccipital muscle structure, myodural tissue changes, and headache-related outcomes. Findings vary between headache types and studies. Some report muscle enlargement, others report atrophy, and others find no significant difference in particular measurements. These observations do not establish a single “myodural headache” diagnosis or show whether tissue differences are causes, consequences, or associated features.
For patients, the useful implication is that a headache evaluation may need to consider relevant neck findings alongside the broader clinical picture. Headache characteristics, associated symptoms, medical history, examination, and the need for referral remain central. Tenderness beneath the skull or a limited movement pattern cannot independently identify the myodural bridge as the source.
Dizziness presents a similar challenge. Neck sensory information participates in the wider control of orientation and movement, and the reviews discuss possible relationships between cervical function and dizziness. Yet dizziness has many potential causes, including vestibular, neurological, cardiovascular, and medication-related conditions. Neck pain and dizziness occurring together do not prove that one caused the other. A comprehensive evaluation helps determine which findings are relevant and which need further investigation.
Hypermobility adds another layer of complexity. A person may have substantial joint range while experiencing pain, fatigue, or difficulty controlling movement. Frost and Barclay examine how altered connective-tissue properties could influence the demands placed on neural tissues and their supporting structures. Their review discusses upper cervical instability, CSF pressure disorders, and other diagnoses that may occur in hypermobile populations, while acknowledging important diagnostic uncertainties and research gaps.
Hypermobility itself does not establish that any of these conditions is present. Nor does a collection of overlapping symptoms identify a particular structural disorder. The practical message is to take the patient’s experience seriously, assess carefully, and coordinate specialist evaluation when the presentation warrants it. Greater range of motion should not automatically lead to a prescription for more stretching or forceful treatment.
Both papers also discuss Chiari malformation and related cranio-cervical conditions. Research into the myodural bridge may eventually help clarify aspects of their biomechanics or inform specialist treatment. These discussions do not demonstrate that routine manual therapy corrects Chiari malformation, resolves a CSF leak, or treats tethered cord syndrome. Such conditions require appropriate medical evaluation and condition-specific management.
For rehabilitation and movement care, these reviews support a thoughtful, research-informed perspective rather than a new universal treatment protocol. Relevant clinical questions include how the neck moves, how symptoms respond to position or activity, what strength and endurance are available, and whether neurological or other findings require further evaluation. Treatment decisions should rely on the evidence for the condition and the individual’s response.
Functional Movement Systems assessments can contribute information about selected movement patterns, but they do not measure myodural function, dural tension, or CSF flow. An SFMA finding may help organize further musculoskeletal examination. It cannot confirm that symptoms originate from a myodural abnormality. Similarly, improvement after treatment does not independently prove the mechanism through which improvement occurred.
At Arête Health, the relevance of this research lies in connecting disciplines while keeping clinical reasoning accountable. A person with headaches, dizziness, neck symptoms, or hypermobility may need assessment across several systems. Our approach considers the individual’s medical history, movement capabilities, neurological findings, daily demands, and recovery, then identifies which actions are appropriate and which questions need another specialist’s expertise.
An eco-bio-psychosocial perspective also keeps anatomy within the person’s life. Workstation demands, sleep, previous injury, confidence, social support, and access to care may affect symptoms and the feasibility of rehabilitation. These influences deserve attention without being used to dismiss symptoms or assume that every problem shares one underlying cause.
The myodural bridge is an example of how anatomical research can expand clinical questions. Its established connections and proposed functions invite further study of the relationship between movement and neurological physiology. For patients, the benefit should be increasingly thoughtful evaluation, clearer explanations, and care that distinguishes established knowledge from promising hypotheses.
Frost, N., & Barclay, S. J. (2024). Neuraxial biomechanics, fluid dynamics, and myodural regulation: Rethinking management of hypermobility and CNS disorders. Frontiers in Neurology, 15, Article 1479545. https://doi.org/10.3389/fneur.2024.1479545
Zhang, L., Song, X., Chen, C., Ma, W., Zhang, J.-F., Zheng, N., & Sui, H.-J. (2026). The myodural bridge complex: A comprehensive review of morphology, physiology, developmental biology and pathology. Frontiers in Medicine, 13, Article 1790220. https://doi.org/10.3389/fmed.2026.1790220