The stiff neck


The fact that the expression “a pain in the neck” is used to describe anything that’s unpleasant or disagreeable says a lot about problems of the cervical spine. Symptoms can include severe pain, immobility, headache, arm pain and even dizziness and visual disturbance in some cases.
Causes of stiff neck
A stiff neck which comes on suddenly may result from muscle injury, muscle spasm, facet joint dysfunction or disc injury. More long term pain can be due to degenerative changes in the spine associated with aging e.g. spondylosis. Occasionally diseases such as meningitis or chronic conditions like polymyalgia rheumatica and fibromyalgia syndrome may be responsible.
As a general rule if the pain goes on for more than a week, it is sensible to let a qualified practitioner assess it.
A good clinical examination including a neurological work up should help to reach a diagnosis. If there are any so called “red flags” evident then further investigation may be required. I recently saw a patient who had a very painful neck and arm which initially looked treatable. However on neurological testing it became apparent from the findings that he had spinal cord compression. I didn’t treat him but immediately referred him for an MRI scan and subsequently he had spinal surgery to remove a disc which would gradually have taken away the use of his legs. I hasten to add that this was very unusual and I have only seen two such cases in 25 years in practice.
A lot of cases of “wry neck” sort themselves out in a few days. Even in cases where there is a lot of wear and tear hands on treatment is very often helpful. In the modern world there is a move away from overly vigorous neck manipulation towards more gentle techniques. In most of these cases I use soft tissue work and/or acupuncture combined with steady mobilization and specific exercises to produce the desired result.