Stiff neck

Attention

Always consider meningitis in people complaining of a stiff neck

  • Exclude more serious neck injury or injury (eg meningitis, vascular problem or fracture if trauma)
    • Meningitis
    • Vascular — ask about the 5D’s (dizziness, double vision, dysarthria (difficulty speaking) or dysphagia (difficulty swallowing), drop attacks) and 3 N’s (nausea, nystagmus, numbness around the mouth) — if present medical consult
    • Fracture — if a history of trauma, follow the Canadian C-spine rule to see if X-ray is needed or not
    • Screen for neurological symptoms (eg pins and needles, numbness or weakness in the arms) if neurological symptoms — medical consult
  • Acute torticollis (wry neck) — sudden onset of severe neck pain with spasm of neck muscles. Causes person to bend or twist neck and head away from painful side
  • May be caused by holding awkward position, often from day before (eg long distance driving), often occurs in children after sleeping
  • Usually occurs on one side of neck, resolves by itself within a few days
  • Common in young people — 12–30 years
  • Do not drive when suffering from this condition
  • For neck pain or stiffness due to idiopathic (non-traumatic) cause or traumatic cause (eg after a sporting injury or car accident) 
    • Keep posture as normal as possible
    • Keep moving neck as much as pain will allow — gentle exercise will speed up recovery

Active movement and manual traction

Attention

  • If person has pins and needles or numbness during procedure — medical consult

What you need

  • Hot pack or ice pack — use what person tolerates best

What you do

  • Lie person down in comfortable position with pillow supporting head
  • Put hot/ice pack under neck
  • Have person turn head toward painful side as far as possible and as pain allows, then return head to centre
  • Have turn head towards non-painful side as far as possible, then return head to centre
  • Repeat 10 times each side, with each repetition try to go a little further in each direction.
  • If no improvement — have the rest where comfortable and advise simple pain relief (analgesia). Then try again a few hours later

Note: If this procedure does not relieve symptoms — try hold–relax procedure

Hold–relax

Attention

  • Can be taught to person to do at home
    • Turn head toward or away from painful side, depending on which hurts less
    • Turning toward pain described, but technique the same for both

What you do

  • Person sits in comfortable chair
  • Turn head slowly and gently toward painful side until it starts to become uncomfortable, then stop
  • Put one hand against side of head opposite to painful side
  • Use other hand to steady neck — Figure 10.87

Figure 10.87  
  • Ask person to turn head against pressure of your hand — not push sideways
  • Keep even, firm pressure against head so that they just can’t turn their neck, not so hard that you move their head
  • At the same time, ask person to take a deep breath and hold it, look upward to side where your hand rests
  • Count 10 seconds then ask person to relax and breathe out
  • Person should now be able to turn their head a little more toward painful side without your help
  • Do this again 3–5 times in a row — there should be a great improvement in tension and pain
  • Physiotherapy referral may be useful

Supporting resources