Stiff Neck

A stiff neck is usually caused by a muscle strain or conditions that affect the joints in your spine, such as osteoarthritis or a facet joint injury.

Muscle strains in the neck typically occur after a specific event, such as lifting a heavy object or sleeping in an awkward position. Stiffness from arthritis has a more gradual onset and often gets worse over time. Less commonly, a stiff neck can occur from infections in your spinal cord and brain.

This article will discuss the possible causes of a stiff neck, what this symptom feels like, and how it is treated.

Symptoms of a Stiff Neck

The main symptom of a stiff neck is difficulty moving your head. This stiffness might also cause pain in the muscles of your neck or put pressure on the nerves that exit the spinal cord in your neck. These nerves provide sensation to your arms. When they are compressed, you might also feel tingling, numbness, or pain shooting down your arm.

You might also experience other symptoms with a stiff neck, such as a grinding or popping sensation when you move your head.

Causes of a Stiff Neck

A stiff neck can be caused by:

• Muscle strains
• Spinal joint issues
• Infection
  

Muscle Strain

A muscle strain often affects one side of the neck. With this injury, you might only experience stiffness when you move your neck in particular directions. For example, a muscle strain on the left side of your neck is most likely to cause difficulty when turning your head to the right or tipping your right ear over your right shoulder.

Oftentimes, your muscle might feel "hard" when you touch it, or you might notice lumps in the muscle, called trigger points.

Spinal Joint Issues

Your cervical spine is made up of seven stacked bones called vertebrae. The joints between these bones are called facet joints.

Conditions that affect the facet joints in your spine can also cause specific symptoms, depending on which joints are affected. If you injure a facet joint on the left side, you'll likely have pain when you tip your left ear over your left shoulder; this compresses the affected joint. Neck stiffness from facet joint injuries often occurs because the muscles try to "protect" the injured area from moving.

Cervical osteoarthritis, also called cervical spondylosis, is a condition that can develop as a side effect of aging. In fact, more than 85% of people have this condition after the age of 60. However, not all people with this condition will have symptoms.

Osteoarthritis is a "wear and tear" condition. Discs, or cushion-like structures between your vertebrae, eventually lose fluid and begin to flatten out. This places more pressure on your facet joints, which can cause bone spurs to develop. This makes the space in your joints smaller, leading to stiffness and loss of motion.

Joint issues that cause neck stiffness are diagnosed with imaging, such as X-rays, computed tomography (CT scans), or magnetic resonance imaging (MRIs).

Infection

Neck stiffness can also develop from infections.

Your spinal cord and brain are covered with protective membranes called meninges and cushioned by a fluid called cerebrospinal fluid (CSF). Meningitis is a condition that occurs when your meninges become inflamed and swollen, which can develop from an infection in your cerebrospinal fluid.

Meningitis is often caused by bacterial infection but can also occur from viruses, fungi, or parasites. Meningitis can also occur with other medical conditions such as lupus, cancer, head injury, or post-brain surgery.

Inflammation of your meninges causes pain with neck movement, which leads to stiffness. One sign of meningitis is nuchal rigidity or difficulty bending your neck forward.

Infections that cause neck stiffness are diagnosed by testing blood and cerebrospinal fluid.

How to Treat a Stiff Neck

Treatment for stiff neck depends on the underlying cause.

Medications

A stiff neck caused by muscle strains or joint dysfunction is often treated with pain-relievers and anti-inflammatory medications. Over-the-counter (OTC) medications can include Tylenol (acetaminophen) for pain and nonsteroidal anti-inflammatory drugs (NSAIDs) such as Aleve (naproxen) or Advil (ibuprofen).

Prescription medications are also used to treat a stiff neck. These can include muscle relaxers and oral corticosteroids.

Anti-inflammatory medications are sometimes injected into specific areas of your neck, such as a trigger point (knot) in your muscle or a facet joint. Medications to reduce pain and inflammation can also be given through epidural injection to decrease symptoms caused by nerve irritation.

Meningitis is treated with medications. Bacterial meningitis is treated with antibiotics. Meningitis that is caused by a virus usually resolves without treatment, but antiviral medications are sometimes given for specific viruses, such as herpes or influenza. Fungal meningitis is treated with antifungal medications.

Home Remedies

Neck stiffness can often be treated with home remedies to decrease pain and improve range of motion. These can include:

• Heat or ice: Heat and ice can both help with neck stiffness. Ice should be used for two to three days to decrease inflammation and pain after a specific injury, such as a muscle strain. After that point, heat can be used to increase blood flow to your neck and reduce stiffness. Chronic problems such as arthritis or facet joint pain can be treated with heat or ice.
• Range of motion exercises: Gentle stretching and range of motion exercises can decrease neck stiffness. Be sure to avoid any movements that increase your pain. Slowly bring your chin to your chest, look up toward the ceiling, bend your left ear to your left shoulder (repeat on the right), and rotate your head in each direction to look over your shoulder.

Surgery

Conservative treatment is usually performed for at least six to eight weeks before surgery is considered to treat joint conditions, such as cervical osteoarthritis, that cause neck stiffness. Procedures can include spinal decompression, disc replacement, or spinal fusion.

Are There Tests to Diagnose the Cause of a Stiff Neck?

A healthcare provider will take your report of symptoms, medical history, and list of medications. They will perform a physical examination. This will check the range of motion in your neck and look for areas of tenderness. A neurological examination may also be performed.

If the cause is not apparent, further testing may include:

• X-ray: Assesses bone health, looks for fractures, dislocations, or signs of arthritis
• Computed tomography (CT) scan: A three-dimensional X-ray study
• Magnetic resonance imaging: Detailed imaging can also assess soft tissues (ligaments, tendons, etc.)
• Nerve conduction studies or electromyography (EMG)
• Lumbar puncture (spinal tap) with CSF examination and culture: To assess suspected meningitis
• Blood and urine tests

When to See a Healthcare Provider

See a healthcare provider for neck stiffness if:

• You have had a head injury or blow to the head.
• You can't touch your chin to your chest because of neck stiffness.
• Neck stiffness is not improving after a few days of home remedies
• Neck stiffness is accompanied by pain or tingling in your arm, leg weakness, or loss of coordination.

Seek immediate medical attention if you develop neck stiffness and have signs and symptoms of meningitis, such as a sudden headache, fever, confusion, sensitivity to light, nausea, or vomiting.

Summary

Neck stiffness is commonly caused by muscle or joint issues, such as arthritis. These conditions cause pain and limited range of motion. Less often, neck stiffness is caused by infection.

Muscle strains and arthritis can be treated with home remedies, medications, and physical therapy. For severe cases of arthritis, surgery might be required. Infections are treated with medications to target the source of the infection.

If your neck pain came on suddenly, especially with a fever or from an unknown cause, seek immediate medical attention to rule out infection.