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 its movement. Neck stiffness can range from a mild discomfort and slight problem in moving the neck to severe pain and the inability to move or bend the neck at all.
The muscles and bones of the neck have to support the weight of the head, and turn the head whenever necessary. Neck stiffness can occur by itself, or with neck pain. Neck pain may come from any structure of the neck including the vertebrae and muscles of the upper back, or from the blood vessels or lymph nodes in the area.
Any type of injury or illness can result in a stiff neck. A person with a stiff neck moves it more slowly and carefully, leading to painful muscle spasms. Neck stiffness can also lead to strained ligaments and pain that travel from the neck into the back and arms.
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 professional will want to know: 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?
The cause of neck stiffness can vary greatly. Some of the causes of neck stiffness include: sleeping on a pillow the wrong waya sudden turn of the neckstress, which can cause the neck muscles to tighten and become stiffinjury, such as a whiplash as a result of a car crash cervical arthritis, an inflammatory condition affecting the upper spine and possibly other parts of the bodyencephalitis, a serious inflammation affecting the brain.meningitis, a viral or bacterial infection affecting the membranes surrounding the spinal cord and brain.subarachnoid hemorrhage, that is, bleeding into the space surrounding the brainankylosing 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 motionrheumatoid 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.
Some ways to prevent neck stiffness include: staying fit and exercising to keep the muscles of the neck stronger and more resistant to injuryavoiding exposure to someone who has meningitisdriving defensively to avoid motor vehicle crashes 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.
In diagnosing a stiff neck and its causes, a healthcare professional 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 professional 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.
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 crash 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.
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 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, chiropractic therapy, pain or anti-inflammatory medications, 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.
Side effects to treatment depend on the treatment used. Antibiotics can cause stomach upset, rash, allergic reactions, or other side effects. Surgery on the neck can be complicated by bleeding, infection, paralysis, or an allergic reaction to the anesthetic.
A person whose symptoms have disappeared following treatment for a non-life-threatening condition may not need any further care. A person who underwent surgery may need close monitoring and physical therapy. After a bout with meningitis, an individual may need intensive care for many weeks
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, or 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 professional.
Professional Guide to Signs and Symptoms, Springhouse, 1997.
Mayo Clinic Family Health Book, David E. Larson, 1996
