Overview

The neck is the part where there is a collection of structures that connects the head to the torso (it is the part where the head, legs and hands connect, it includes shoulders, chest, lower abdomen, back and buttocks). The neck is a complex structure which includes bones, muscles, nerves, blood vessels, lymphatics and other connective tissues. 

A Stiff neck is a condition where the pain or soreness makes the movement and usage of the neck difficult. It can be a temporary symptom but can also be a symptom of serious infection (meningitis) which needs treatment immediately. A stiff neck is a very common symptom of many underlying health conditions.

Commonly neck stiffness is a symptom of overusing the neck or due to sleeping in an unusual position. When the neck is sore the person may have difficulty in moving the head to one side, but when the neck pain involves compression of nerves it can cause numbness, tingling sensation or weakness of the hand.

Understanding neck

The neck is a complex structure which includes many bones, muscles, blood vessels, lymphatics and connective tissues. The cervical spine is the bony part of the neck which helps in connecting the head to the torso and also allows normal neck movement. Neck includes the following: 

• Vertebrae: The bones in the neck are known as vertebrae. The spine in the neck area is known as the cervical spine, there are seven vertebrae in the neck to support the head, protect the spinal cord and help in the movement of the head.
• Muscles: There are 20 neck muscles (skeletal muscles), they are voluntary muscles (where the person controls the movement) which are attached to the bones by tendons.
• Ligaments: They are tissues that help to connect bones, joints and organs together. They help the joints to move in any direction, hold them together and prevent the joints from dislocating.
• Cervical disc: The disc gives the spine the flexibility to move and also it acts as a shock absorber, which helps the spine to handle stress.
• Nerves: Nerves are called neurons which are present all over the body, especially in the brain and spinal cord. Nerves together with the brain and spinal cord lay the foundation of the nervous system. The nerves outside the brain and spinal cord are called the peripheral nervous system. Nerves send electrical impulses between the brain and the body, this helps in feeling sensation and movement.¹

Causes of stiff neck

The most common cause of neck pain is due to muscle strain, tension or daily activities. The other causes of neck pain are: 

Muscle and ligament issues

1. Whiplash (Neck strain or neck sprain): It is a condition that happens when a sudden change of movement forces the neck and upper spine to move in ways that cause injury. This commonly happens due to sudden changes in movement and can also happen during sports.
2. Sleeping in an uncomfortable position
3. Working in a computer by placing the monitor too high or too low
4. Looking at the phone or tablet screen for too long in a downward position
5. Increased stress and anxiety, which can lead to tension in the neck
6. Lifting heavy objects with poor posture

Injuries or trauma

1. Accidents: A fracture or other severe injury to the neck can cause spinal cord damage
2. Sports injuries: Often they can be acute (sudden onset) or chronic (injury develops over time). People often get hurt while participating in sports events, doing any exercise or any physical activities.

Arthritis

Arthritis is the condition causing swelling and tenderness of one or more joints, it shows symptoms like joint stiffness and pain which worsen with age. Arthritis which includes neck stiffness are: 

1. Cervical spondylosis: It is the condition affecting the bones in the cervical spine (vertebrae, bones in the neck). Cervical spondylosis causes neck pain, stiffness, muscle spasms, dizziness, and headache.
2. Rheumatoid arthritis is an autoimmune disease that affects the different body systems, where it attacks the tissue lining of the joints. It may show symptoms like pain and inflammation in the fingers, hands, wrists and knees.
3. Post-traumatic arthritis arthritis is the inflammation affecting the joints due to the after-effects of any trauma that happened before.

Meningitis

Meningitis is a condition causing inflammation in the area surrounding the brain and the spinal cord (meninges). Meninges are the three membrane layer that covers and protects the brain and the spinal cord. Meningitis can be caused by infectious diseases, like viruses and bacteria and also by non-infectious diseases like cancer and head injury.²

Symptoms

A stiff neck comes along with some common symptoms like: 

• Muscle tightness and spasms
• Decreased movement of the head
• Headache feels in the back side of the head
• Numbness and weakness in the arm
• Pain in the neck worsens with movement
• Difficulty in sleeping

Diagnosis

To diagnose a neck sprain the doctor will conduct a physical examination, where the doctor asks questions about any medical history, asks about injury or fall, and examines the area of pain by touching and seeing.³

• Complete blood test: To check for evidence for any infections that may be causing neck pain.
• X-ray: X-ray provides images of dense structures like bones, but cases like neck sprain or strain cannot be seen in X-ray as they involve ligaments and muscles. But it helps the doctor to rule out conditions like fractures and arthritis.
• CT scan: Computerised tomography (CT) scan provides images from different directions and gives a detailed cross-sectional view of the structures inside the neck.
• MRI: Magnetic resonance imaging (MRI) scan uses radio waves and strong magnetic fields to create detailed images of the bones and the soft tissues.
• Electromyography (EMG): This is a test which helps in diagnosing whether the neck pain is related to pinched nerves. In this test, they use fine needles, which are inserted through the skin into the muscles. This test measures the speed of the nerve conduction to check whether the nerves are working properly. 

Treatment and management

Treatment is given according to the severity of the neck pain and the stiffness. Usually, an orthopaedic surgeon and neurologist is the doctor who examines the stiff neck and examines the cause of the condition.⁴

• Medicine: Most commonly the stiff neck is treated by giving anti-inflammatory drugs, such as ibuprofen or acetaminophen. These medicines help reduce inflammation and pain.
• Therapy
  • Physical therapy:  A physiotherapist is the person who conducts therapy, where they explain correct posture, alignment and neck exercises.
  • Transcutaneous electrical nerve stimulation (TENS): In this technique electrodes are placed near the area affected and tiny electrical impulses are given to relieve the pain.
  • Neck collar: Neck collar supports the neck and decreases the pain by taking the pressure off the neck.

• Surgery: Surgeries are not commonly needed in case of neck pain, but in some cases to relieve spinal cord compression and nerve root compression surgery is recommended.⁵

Lifestyle changes

While taking anti-inflammatory drugs, lifestyle changes can also reduce neck pain and can reduce the risk of getting a stiff neck by following these: 

1. Applying heat and cold packs alternatively helps in reducing inflammation and pain. Should use an ice pack first then use the heat pack
2. Doing simple neck exercises at home reduces inflammation and increases the mobility of the neck.
3. Practising good posture while at work, watching television, or using a mobile phone helps reduce the occurrence of a stiff neck
4. Taking breaks in between while working for a long time, helps in stretching the neck muscles.
5. Avoid alcohol consumption and smoking
6. Avoid carrying a heavy strap bag over the shoulder, this reduces the risk of developing a stiff neck.

FAQs

How to treat a stiff neck

A stiff neck is treated at home by taking pain reliever medicines, applying an ice pack and alternating with a hot pack in the affected area, by simple neck exercise, or by taking complete rest for a day which helps in reducing the stress in the affected area and also helps in reducing the inflammation and the pain.

How long does a stiff neck last

A stiff neck caused by tension or strain usually goes away on its own within a few days. A stiff neck that continues longer than a week often responds to exercise and neck therapy. 

What not to do while having a stiff neck

When someone has a stiff neck, that person should avoid continuous motion as it can elevate the pain and the person should not move or turn the neck very quickly.

When should I consult a doctor?

Usually, the stiff neck and symptoms go away on their own in a day, but if the pain, swelling and stiffness last more than a day it is advised to consult a doctor.

Summary

A stiff neck is a condition where the pain or soreness makes the movement and usage of the neck difficult. It can be a temporary symptom but can also be a symptom of serious infection (meningitis) which needs treatment immediately. A stiff neck is a very common symptom of many underlying health conditions. Commonly neck stiffness is a symptom of overusing the neck or due to sleeping in an unusual position. When the neck is sore the person may have difficulty in moving the head to one side, but when the neck pain involves compression of nerves it can cause numbness, tingling sensation or weakness of the hand. Treatment is given according to the severity of the neck pain and the stiffness, in some cases, it usually goes away on its own.