OVERVIEW

What is a stiff neck?

A stiff neck, also known as "lost pillow" in Chinese, is medically diagnosed as acute cervical joint periarthritis or cervicodorsal myofasciitis. It is a common soft tissue disorder in the neck area.

It can occur at any age but is more prevalent among young and middle-aged adults. The incidence is relatively higher during winter and spring.

SYMPTOMS

What are the symptoms of a stiff neck?

• After waking up in the morning, sudden pain in the back of the neck or upper back may occur, restricting neck movement and making it difficult to rotate freely. Sometimes, bending forward or backward can also cause pain. The head may even remain stiff in an abnormal position, often due to improper sleeping posture the night before. Sudden neck pain and restricted movement may also occur after prolonged reading, computer use, or carrying heavy objects.

• The head may remain stiff in an abnormal position, tilting to one side. Turning the head to the opposite side can trigger sharp, stabbing pain, which may radiate to the head, neck, or shoulders.

• Stiff neck symptoms often affect one side of the neck, though both sides may be painful, with one side typically more severe than the other.

CAUSES

What are the causes of a stiff neck?

• Incorrect head and neck posture, such as poor sleeping position, excessively high pillows, prolonged writing, reading, or watching TV with the head lowered;

• Exposure of the shoulders during sleep, leading to cold stimulation of the neck and shoulders;

• Trauma, with a few cases caused by sudden neck twisting or carrying heavy loads on the shoulders.

What diseases should be considered for recurrent stiff neck?

People with cervical spondylosis, cervical joint misalignment, or chronic muscle strain in the neck are prone to recurrent stiff neck. Conversely, frequent stiff neck can contribute to cervical spondylosis, creating a vicious cycle.

DIAGNOSIS

How is a stiff neck diagnosed?

• No discomfort before sleep, but upon waking up, pain is felt in the back of the neck and upper back, with limited neck mobility and difficulty turning freely. In most cases, the patient may recall poor sleeping posture the previous night or a history of neck exposure to cold.

• There may be a clear trigger, such as sudden head movement or carrying heavy objects.

• A stiff neck often resolves on its own within 3–4 days. If symptoms persist for more than a week or are accompanied by nausea, vomiting, dizziness, blurred vision, hand numbness, limb weakness, palpitations, or chest pain, prompt medical attention is required to rule out cervical spondylosis, spinal cord-related conditions, or spinal canal tumors.

What tests are needed to diagnose a stiff neck?

If a stiff neck does not improve after a week, cervical X-rays or neck MRI scans may be performed to check for bone spurs, degenerative changes, joint misalignment, herniated discs, or thickened ligaments.

What precautions should be taken before a stiff neck examination?

Due to the strong magnetic field in an MRI, electronic devices and metal objects should not be brought into the scanning room. Patients with pacemakers, cardiac stents, or artificial metal valves cannot undergo this examination.

When should you seek immediate medical attention for a stiff neck?

A stiff neck is a self-limiting condition that usually resolves within a few days without lasting effects. However, if it recurs frequently or persists for more than a week, it may indicate an underlying cervical spine disorder.

TREATMENT

Which department should I visit for a stiff neck?

Orthopedics.

A stiff neck usually resolves on its own. If it persists for more than 1 week, you should visit the orthopedics department.

What are the treatment methods for a stiff neck?

Limit movement: Avoid forcibly bending, extending, or rotating the neck. Move gently and avoid excessive range of motion to prevent additional pain.

Local heat therapy: Apply a hot towel, hot water bottle, etc., to the painful area to improve blood circulation, relax tense muscles, and relieve pain. If necessary, infrared lamp therapy at a hospital can also be used.

Use pain relievers: If needed, topical pain relievers (e.g., flurbiprofen patches) can be tried first. For severe pain, oral pain relievers (e.g., celecoxib, etoricoxib) or localized injection therapy may be considered.

Massage (can provide relief but requires a professional): Avoid random or forceful neck rotations, as this may cause life-threatening injuries. Elderly patients with stiff necks, due to cervical spine degeneration and spinal canal stenosis, should avoid massage treatment.

DIET & LIFESTYLE

What should people with a stiff neck pay attention to in daily life?

• Rest adequately, avoid prolonged head lowering or sitting for long periods to reduce neck strain.

• Keep the neck warm. In summer, avoid direct exposure of air conditioning or fan drafts to the head and neck.

• Choose an appropriate pillow for sleeping.

• Avoid massaging the neck casually.

PREVENTION

How to Prevent a Stiff Neck?

The following two exercises can help prevent a stiff neck:

"Trapezius Stretch" can improve shoulder and neck flexibility and relieve discomfort caused by prolonged sitting or exercise.

"Chin Tuck Against Wall" helps correct forward head posture and reduces excessive pressure on the cervical spine, which is especially beneficial for office workers who sit for long periods.

Additionally, you should pay attention to the following points:

• Keep your neck warm and avoid cold exposure. In summer, avoid direct airflow from fans or air conditioners toward your shoulders and neck.
• Avoid using pillows that are too high. Choose a pillow that maintains the natural curve of your cervical spine. The pillow should have moderate firmness—too soft or too hard can cause discomfort.
• Change positions frequently. Prolonged periods in the same posture during sleep, writing, or desk work may lead to a stiff neck.
• Correct poor lifestyle habits, avoid prolonged sitting, and strengthen neck and back muscles. Especially when working at a computer for long hours, perform neck movements to prevent chronic strain.
• Avoid sudden neck twists and lift heavy objects within your capacity.
• Adopt proper sleeping positions, such as lying on your back or side while maintaining normal spinal curvature. Avoid sleeping on your stomach or with your neck curled.