What Can Cause Upper Neck Stiffness?

Upper neck tightness is unfortunately a very common symptom. In a study by Hoy et al. they determined that the prevalence of people with neck pain at any time is up to 86.8%. In any given year, studies show that an average of 25.8% of people will experience neck pain. These are staggering numbers when you look at them.

Fortunately, most neck pain resolves on its own within a few weeks. However, the study showed that relapses of neck pain are common in those that have suffered from it before. Usually, most people take the approach of resting their neck, taking some medication, and gradually getting back to normal. This can be helpful, because most neck pain will resolve on its own, but it is not addressing the root cause of the pain.

Pain is the primary motivator for people when it comes to their body. This makes sense, as pain can be very debilitating and cause significant stress. Because of this, many people will consider their neck to be “healed” if pain is no longer present. This is the wrong way to look at our bodies. While resolving pain is crucial, a return to full function is paramount. Our necks are the most flexible parts of our spine to allow us to look around easily. If we get rid of pain, but our neck mobility is compromised, is that truly a success?

Our bodies are very adaptive to their environment. Due to this fact, if we do not use something, then we will lose it. Imagine not ever turning to your left. Your neck muscles and joints would get tight over time because they were not used to performing a motion. Now, imagine the discomfort if you tried to turn left. You would be limited and probably in pain. You could never turn to your left again and not suffer from pain, but this is unrealistic and it creates additional problems. Maybe you hurt your back from compensating when you need to look to your left? Maybe you can’t reach your left arm over your head because the muscles that connect your neck and shoulder are too tight? The absence of pain is not a successful treatment of a musculoskeletal condition. We often forget this fact in traditional healthcare, and our bodies slowly have less mobility or strength because we simply neglect areas to avoid pain. This is not a long term solution.

Anatomical Causes of Upper Neck Stiffness

Before we go any further, it is important to understand the anatomy involved in your upper neck. The top two vertebrae at the base of your skull are known as the atlas (C1) and axis (C2). The image (courtesy of spineuniverse.com) shows the unique structure of the vertebrae. Our cervical spine is responsible for about 90 degrees of rotation. Half of that rotation comes from C1 and C2. You can see the structure is essentially a ring on a pole (the Dens). C1 rotates around the Dens without much restriction, allowing you to turn your head. As I mentioned before, our neck provides the most mobility of our entire spine, and this segment is responsible for half of that motion.

There are several muscles that insert into the upper cervical region, but the group of suboccipital muscles are some of the most important. This image shows the four muscles on either side of the spine, meaning that there are 8 in total that connect the skull, C1, and C2. These muscles are significantly involved with rotation, as they have multiple attachments in the upper cervical spine. Unfortunately, this means that restrictions or tightness in these muscles can limit rotation by not allowing smooth movement of the bones.

Anatomography, CC BY-SA 2.1 JP <https://creativecommons.org/licenses/by-sa/2.1/jp/deed.en>, via Wikimedia Commons

Posture is a complicated topic that we can discuss more in depth in a later post. Basically, research shows that it is not as predictive of pain as we might think. However, it can create mobility limitations that can decrease function and lead to pain in certain individuals. Below is an image from innovativespinewellness.ca that shows “poor posture”. This is not necessarily a guarantee of pain and tightness, but it can be a cause. Notice how extended the upper cervical spine must become if we are leaned forward. The goal of our neck is to keep our eyes level with the ground, and this can gradually lead to compression in the back of the upper cervical spine. Think about the suboccipital muscles I showed before and how tight they will become if stuck in this position. Try to mimic the posture in the right picture and then rotate your neck. It is very limited because of the muscle and joint positions. If you are unable to move out of this posture, then how do you expect to have full rotation of your neck?

How to test yourself for upper neck tightness

The first test that you can perform to look at your upper neck mobility is simply rotating side to side. As I mentioned before, about half of your motion comes from your upper cervical spine, so limitations can often be a result of tightness in that area. The goal is 90 degrees of motion, but I realistically hope that clients can get their chin over their clavicle without discomfort or strain. Another key point is to compare side to side. Figure out how far over your clavicle or shoulder you can go on one side and test it on the other side. Both sides will never be exactly the same, but they should be close. Also, pay attention to any tightness or discomfort that you feel.

Another simple test is simple neck flexion. If your upper cervical spine is restricted, you will have difficulty bringing your chin to your chest. You should be able to touch your chin to your chest with your mouth relaxed and without much stretching or discomfort. Limitations with this stretch are often due to the suboccipital muscles limiting you.

A final test that I like to use combines these two motions. First, bring your chin to your chest and try to let it relax. Then, turn your head to one side and then the other. Flexing your head all the way forward should limit movement at segments other than C1-C2, so you should have about 45 degrees of motion to either side. I would not worry about your exact range of motion, rather I would feel for a difference or discomfort when comparing sides.

There are other tests for looking at mobility in the upper neck, but these are a great starting point and should point out if you have any limitations.

How to get upper neck stiffness relief

If you found that you had some limitations with the previous tests, then here are a couple of options to get the suboccipital muscles to relax:

A lacrosse ball or similar mobility ball can be very effective in this region. If you noticed discomfort or tightness on one side in particular, you can lie on your back with the ball under you. The ball should be right at the base of your skull. You may feel some discomfort, but there should be no sharp pain. Some people prefer to put one ball on each side of their spine as pressure is more evenly distributed. Play around with a comfortable position for you. You can also place the ball in a sensitive position and perform gentle chin tucks (I will discuss these more down below). My word of advice would be to watch out for hair with this, because it can get caught on the lacrosse ball and that is not a fun experience.

Another strategy to relax the muscles is to vary your posture. There is no perfect posture, but your best posture is your next posture. Movement is good for your entire body, so set a timer if you work at a computer. Every 20-30 minutes, try to get up and move. Perform some light exercises that I describe below, but above all else, move. This can counteract the tightness and stiffness that you accumulate from working all day!

Some simple upper neck stiffness exercises

There are a million variations of exercises that you can do for your upper neck, but they rely on you having a solid starting position. Chin tucks should allow for this. Simply lie in a relaxed position, on your back, and tuck your chin down as if you are giving yourself a double chin. You do not want your head to come off the ground, and you should not feel too much strain while performing this exercise. You may feel a slight stretch in the back of your upper neck and this is a good thing. Holding a chin tuck can provide a stretch of the suboccipital area while also teaching you a neutral position for other exercises.

Once you have mastered the chin tuck, sit up in a comfortable position. Tuck your chin and try to retract your head as far backwards as you can. The goal with this exercise is to keep looking straight ahead, while pushing your head backwards as far as you are able. Once again, some stretching in the suboccipital area is normal as we are trying to mobilize it. The movement is subtle, so don’t worry if you do not have much motion in the beginning. Practicing this movement while sitting at your desk should make you an expert in no time.

Finally, if you want to make the previous retraction exercise a little more challenging. Put your hand behind your head. You should perform the retraction movement with slight resistance from your hand. You should feel your suboccipital muscles engage. These muscles are small, so you do not want to push too aggressively, as you will end up using other muscles to compensate.

If you want to learn more about your upper neck and how to assess and treat it, we have a free course that you can access here. This course includes 10 videos including some of the assessments and treatments that we mentioned with sets and repetition recommendations so that you can perform them at home.

As always, if you are suffering from pain, nerve symptoms (numbness, tingling, or weakness), or anything else significant, please see a healthcare provider. This blog is meant to be educational and is not a substitute for medical advice.

Hopefully you learned something about your neck and how it works. Maybe you learned how to get some more mobility from your upper cervical spine, or maybe you learned that you already have great mobility! If you found this blog helpful, please share it with someone. We hope to continue to grow and help people better understand how our bodies move and work. If you are suffering from neck pain and are in the Sterling, Virginia area then reach out for a physical therapy evaluation at Eclipse Wellness! If you have any questions email me at danny@eclipsewellnessnova.com or follow me on Instagram or Twitter @drdannydpt.