Neck Stiffness

Overview, Causes, & Risk Factors

A stiff neck refers to a tightness or rigidity in the muscles supporting the neck. Nuchal rigidity refers to a stiffness that prevents bending of the neck and limits movement of the neck. Neck stiffness can be simply a mild discomfort and slight problem in moving the neck. Or it can be severe pain and the inability to move or bend the neck at all.

What is going on in the body?

The muscles and bones of the neck have to support the weight of the head and every turn the head makes. Neck stiffness can occur by itself or with neck pain. Neck pain may come from any structure of the neck. This includes the vertebrae and muscles of the upper back, the blood vessels of the neck, and lymph nodes in the neck.

Any type of injury or illness can result in a stiff neck. A person with a stiff neck may move the neck more slowly and carefully. This can lead to painful muscles spasms. Neck stiffness can also lead to strained ligaments and pain that travels from the neck into the back and arms.

What are the causes and risks of the condition?

The cause of neck stiffness can vary greatly. Some of the causes of neck stiffness include:

  • sleeping on a pillow the wrong way
  • a sudden turn of the neck
  • stress, which can cause the neck muscles to tighten and become stiff
  • injury, such as a whiplash as a result of a car accident
  • cervical arthritis, an inflammatory condition affecting the upper spine and possibly other parts of the body
  • encephalitis, a serious inflammation affecting the brain.
  • meningitis, a viral or bacterial infection affecting the membranes surrounding the spinal cord and brain.
  • subarachnoid hemorrhage, or bleeding into the space surrounding the brain
  • ankylosing spondylitis, an inflammation and inability to move some of the upper vertebrae, often caused by arthritis
  • neck sprain, which may be accompanied by pain, slight swelling, and restricted range of motion
  • rheumatoid arthritis
  • torticollis, a deformity of the neck caused by a shortening of the neck muscles. This condition causes the head to tilt to the affected side with the chin pointing to the other side.

    • Symptoms & Signs

    What are the signs and symptoms of the condition?

    Symptoms of neck stiffness can vary greatly. Symptoms may be mild, causing a slight problem in moving or turning the head and neck. Or the symptoms may be severe, causing great difficulty in moving, turning, or bending the neck.

    If the neck stiffness is due to a major injury or head trauma or if there is severe nuchal rigidity, emergency treatment may be needed.

    The healthcare provider will want to know more about the person's symptoms, such as:

  • When did the symptoms start and how long they have lasted?
  • Have the symptoms become worse since they started?
  • Where is the neck pain located?
  • Did any injury occur before the stiffness started?
  • Were there any symptoms before the neck stiffness started?
  • Are there any other symptoms now, such as vomiting, headache, fever, or decreased sensation or movement in other parts of the body?
  • Is there a history of high blood pressure, head injury, blood clots or aneurysm, recent infection, or recent dental work?
  • Is there any swelling in the hands or any tender joints?
  • Is there pain and tenderness in the neck?
  • Are the symptoms worse at certain times of the day?

    • Diagnosis & Tests

    How is the condition diagnosed?

    In diagnosing a stiff neck and its causes, a healthcare provider will obtain a medical history and a history of the events leading up to the neck stiffness. A physical exam will be done to diagnose the underlying cause. If a person has been injured, the healthcare provider will be careful during the examination so as to avoid further injury.

    If it is possible that the person has meningitis or a subarachnoid hemorrhage, emergency care is needed because these conditions are life-threatening. X-rays, blood tests, spinal taps, and possibly CT scans or magnetic resonance imaging (MRI) may need to be done to evaluate the possible cause of the stiff neck.

    Prevention & Expectations

    What can be done to prevent the condition?

    Some ways to prevent neck stiffness include the following:

  • staying fit and exercising to keep the muscles of the neck stronger and more resistant to injury
  • avoiding exposure to someone who has meningitis
  • driving defensively to avoid motor vehicle accidents
  • following sports safety guidelines for children, adolescents, and adults
  • seeking immediate medical care for a major injury, and using precautions when a person has been injured to decrease the likelihood of further injury

    • Many causes of stiff neck are not preventable.

    What are the long-term effects of the condition?

    The long-term effects of a stiff neck depend on the underlying cause. For example, a person who received a minor whiplash from a car accident may recover completely without any further effects. Torticollis may cause a person to suffer lifelong pain and a decreased ability to move about. A person with meningitis may recover from the infection, may suffer lifelong limitation in movement, or may die from the infection.

    What are the risks to others?

    The cause of the stiff neck will determine if others are at risk. A person who has injured his neck is not contagious. A person with an infection, such as meningitis, may be contagious to others.

    Treatment & Monitoring

    What are the treatments for the condition?

    Treatment for stiff neck depends on the underlying cause.

  • A person who has a stiff neck from sleeping wrong may need to use a different pillow at night.
  • A person who has a stiff neck from an injury may need physical therapy, pain medication, and hot or cold packs to reduce pain and stiffness.
  • A person with a stiff neck caused by stress may need counseling to learn stress management techniques.
  • Some neck injuries may be treated with a cervical collar to help support the head.
  • Emergency care and hospitalization may be needed for a person with a major injury or a life-threatening infection.
  • Oxygen, intravenous fluids, and antibiotics may be given. Close monitoring of vital signs, such as breathing, heart rate, and blood pressure may be necessary.
  • Surgery or traction may be necessary to treat injuries or relieve pressure on the neck or brain.

    • What are the side effects of the treatments?

    Side effects to treatment depend on the treatment used. Antibiotics can cause stomach upset, rash, allergic reactions, or other side effects. Surgery poses a risk of bleeding, infection, paralysis, or allergic reaction to the anesthesia.

    What happens after treatment for the condition?

    A person who feels fine after treatment may not need any further care. A person who underwent surgery may need close monitoring and physical therapy. A person who has meningitis may need intensive care for many weeks.

    How is the condition monitored?

    A person recovering from a stiff neck may need no further monitoring. A person who received intensive treatment and is recovering from a serious illness, such as meningitis, may need close monitoring. A person recovering from a major trauma or injury may need close monitoring to evaluate treatment and physical therapy to aid recovery. Any new or worsening symptoms should be reported to the healthcare provider.

    Attribution

    Author:Eileen McLaughlin, RN, BSN
    Date Written:
    Editor:Smith, Mary Ellen, BS
    Edit Date:08/09/00
    Reviewer:Gail Hendrickson, RN, BS
    Date Reviewed:07/05/01

    Sources

    Professional Guide to Signs and Symptoms, Springhouse, 1997.

    Mayo Clinic Family Health Book, David E. Larson, 1996