The vast majority of straightforward neck stiffness can be put into two categories. Neck or shoulder driven neck pain. A very simple test that I’ve used to distinguish the two with a high degree of accuracy is simple neck rotation.
Scenario #1: Shoulder/Scapular Driven
If rotation towards the same side of increased stiffness or pain increases, then it is highly likely to be caused by weakness of muscles that pull your shoulders down away from your ears. (ie. right rotation increases stiffness or pinching on the right)
Scenario #2: Neck Driven
If rotation increases stiffness or pain on the opposite side of the neck, then it is most likely caused by a weakness in the neck flexors involved with rotation in that direction.
Shoulder Driven Neck Pain / Stiffness
There can be many causes of shoulder driven neck pain/stiffness, but a very common one is poor, hunched over posture. In athletes, you’ll see poor movement patterns with pulling activities like rows and deadlifts. One simple fix is to avoid using your upper traps during those movements.
Personally, I prefer to use manual therapy to address the specific weakness typically found in the lower/middle trap, serratus anterior, rhomboid, and/or latissimus dorsi. Alternatively, you can use exercises to help correct the issue as well.
Supine KB Hold with Head Rotations
1. Hold the KB (~15lbs) in the hand (only the side of complaint) as if setting up for a bench press. Keep a tight back depressing your shoulder down into your hip pocket and toward your spine.
2. Rotating toward that (same) side should now be pain free in this position or significantly better. You may even notice the stiffness has moved to the other side. This indicates you also have a neck driven issue lying underneath this. Clear this and move on to the neck after.
3. Try 5-10 head rotations, lead with your eyes and follow with your head. Set the weight down, and recheck rotation to insure improvement.
Neck Driven Neck Pain / Stiffness
Neck driven issues also stem from poor posture or poor movement patterns. Most commonly, we are spending way too much time with our heads far in front of our shoulders.
While I still prefer manual therapy to address these issues, the neck is a bit too complicated to let someone inexperienced to attempt it. In short trigger points in the opposite SCM and same sided scalene muscles are common findings.
The most textbook exercise for this pattern is the simple chin tuck. You can build on top of it, but for the purpose of this article start here.
Simple Supine Chin Tuck
1. With 50% effort press the back of your head into the ground.
2. While maintaining that position, tuck your chin to your chest. (Do not lift your head up!)
3. Hold for 5 seconds, relax for 5 seconds. Try 5 rounds.
You should find that rotation has improved after this.
Things to Consider
If it is worse at the end of the day, then it probably is something you’re doing throughout the day.
– To prevent this from coming back, avoid bad posture throughout the day.
– Do not initiate movements by shrugging!
If it is worse in the morning, then consider your sleeping posture.
– Back sleepers should have a small pillow.
– Side sleepers should have a larger pillow that occupies the space your shoulders create.
– Belly sleepers, stop it! Its pretty hard to maintain a neutral spine here unless you cut a whole for your head in the bed.
If the pain or stiffness does not resolve quickly, then further evalutation by a qualified professional might be necessary. These are the doctors that do what I do.