What is Causing My Stiff Neck?

As a physical therapist, one of the most common complaints I hear is someone who has a “tight” or painful neck that just won’t let up. This can be an incredibly frustrating situation because their neck, shoulders, and upper back remain tight no matter how much stretching they do. Very often, when we start the conversation, the patient is quick to admit that they carry a great deal of stress and also probably have poor posture that they feel they need to work on. Is this starting to sound like you?!

It is very tempting at this point to blame a lack of progress on not enough stretching, posture not being good enough, or needing to add massage, dry needling, or other mobilizations/manipulations. And trust me, I really like when I can get in there with some hands on work and make big changes. These types of treatments are often included at various stages in the overall healing process, but they are not the real solution! For the real solution, we have to first identify the real problem, or the root cause. This is not intended to be comprehensive, but to touch on the most common presentations and causes of neck tightness.

So why wouldn’t stretching help my stiff neck?! If something is tight we should stretch it out…right?

I wouldn’t want to say that it can’t help as a small part of the overall treatment, but it is not the entire solution! Most often, a feeling of tightness does not mean that your muscles are actually short or that you have decreased motion. Frequently, your muscles will feel tight because they are in a state of being “turned on” to protect a joint, nerve, ligament, or other structure from being injured. Your nervous system is designed to alert your brain of any potential danger, such as sharp rocks, hot stoves etc. When your brain gets the message that something is going to injure you, it then responds by telling your muscles how to react to avoid getting hurt. The same thing is happening when your muscles are trying to protect other areas, it just happens on a much lower scale. So rather than a quick and sudden reaction to get away from the hot stove, your muscles “turn on” to provide more stability or protection to your joints. We call this a state of guarding, when your muscles just don’t seem to want to relax. We will need to work together to find out why your muscles are guarding.

So lets talk about a few possible causes. First, posture very well could be one of the biggest issues here. Before you get too discouraged because you know you have been working on this for years, I never tell anyone they need to simply improve to a perfectly upright position and stay there for the rest of their lives. IT IS OKAY TO SLOUCH! It is okay to kick your feet up and be lazy sometimes, and fortunately for most of us, it is okay to look down at your cell phone. While “fixing” your posture is important, the best posture is one that is constantly changing. What this means is that we are not meant to be in one place, and one posture for prolonged periods of time. So looking down at your phone to play a few levels of candy crush is not going to injure your neck, but playing for an hour at a time…that is a different story. If your work requires you to be on a computer for 8 hours a day, we will have to work together to find several different postures that can work for you along with frequency of breaks, stretching and exercises to help keep your muscles and joints healthy and moving.

Now we will cover some of the other common causes of neck tightness.

One of these are weakness in the muscles of the neck, shoulder blades, and upper back. Strength is often seen as the enemy to flexibility, but more often than not, having more strength around a joint will allow it to move much more freely. One way to think about this would be if the steering in your car was very loose, causing your car to float from side to side as you are driving down the road. Your response, hopefully, would be to grip tighter on the steering wheel to maintain control. This is what is happening when the muscles around your neck are tightening up because the joints are not as stable as they should be. It is not that they are not flexible enough, in fact, it might be that they are actually TOO flexible. If you take that same car and tighten the steering, it will still be able to make the same turns, but now you don’t have to hold on as tight when you are just driving in a straight line. Now your muscles can just relax and work at a much lower percentage of their maximum capability. And as luck would have it, we know some pretty simple exercises to achieve this goal!

A third cause would be nerve irritation. As I mentioned earlier, the nervous system is adept at protecting the structures of the body, and the structures it might want to protect the most is itself. When a nerve is getting irritated, pinched, or stretched (the causes of which are outside the scope of this blog), the brain will respond by telling the joints to not move as much. A severe injury to a nerve can interrupt the lines of communication from the brain to the rest of the body. The resulting muscle spasms and tightness in this situation may feel better when you stretch, then get worse or feel even tighter shortly afterwards.

So if you have a tight neck, have been stretching for years, and aren’t making any headway (no pun intended), it is time to try a different approach. It is time to find what the real cause of your pain is, and to move away from treating the symptoms.

As timing would have it, an article was just published today in JOSPT, so if you care to learn more and dive into some of the science behind it, you can check it out here https://www.jospt.org/doi/full/10.2519/jospt.2020.8821.