Nuchal rigidity refers to neck stiffness caused by serious medical conditions such as bacterial meningitis.
You probably don’t give your neck the credit it deserves. It’s easy to take for granted that such a small, seemingly fragile structure is the only thing supporting the full weight of the head every day.
The uppermost part of the spine is called the cervical spine. Think of it like seven railroad tracks going up into your head, where each track is a bone (vertebra) labeled C1 through C7. The uppermost of these small bones is responsible for supporting your head.
What Are Signs of Nuchal Rigidity?
A person with nuchal rigidity has tightness in the neck and is unable to move the neck muscles or feels pain while trying to do so. In the most serious cases of the condition, “Patients can’t move their neck at all,” says Ann Miller, MD, vice chair of neurology at Hackensack University Medical Center and assistant professor of neurology at Hackensack Meridian School of Medicine in Paramus, New Jersey.
“They won't be able to flex their neck or will have minimal movements laterally.”
Miller compares the condition to a typical stiff neck, where you may have more pain but can still turn your head in any direction.
What Causes Nuchal Rigidity?
Conditions ranging from minor injuries or sprains to potentially life-threatening cancers can cause nuchal rigidity. So, if you’re feeling stiffness in your neck, the best thing to do is to see a doctor to get a proper diagnosis.
Poor posture and repeated physical stress are most likely the cause of your neck pain and stiffness. Without realizing it, you may be causing neck stiffness by hunching your shoulders at work, or even staring at a smartphone or laptop all day. Your neck bones have a tough job, so most of the time it’s simply a case of overuse and overexertion.
But sometimes, more serious issues are to blame.
Nuchal rigidity and arthritis
Your neck bones tend to become coarser and rougher as you grow older. Regular stretching can help slow this down to some extent, but not entirely. As this happens, the soft tissues tasked with holding and cushioning the neck bones can become worn down, potentially leading to a kind of neck arthritis.
If that’s the case, your doctor can diagnose it with an MRI scan of your neck. Other symptoms to watch out for include:
- Instability or weakness in the legs
- Numbness in your arms or legs
- Muscle contractions, especially those stemming from around the neck or upper shoulder area
- Popping sounds when you move your neck
Doctors treat these cases with a combination of physical therapy and neck braces. They treat more serious cases of arthritis in the neck with surgery on the neck bones.
Nuchal rigidity and degenerative disk disease
A more serious form of neck arthritis is degenerative disk disease. Although some wear and tear around the neck bones is natural and expected as you age, they can also start to weaken abnormally.
Usually, your vertebral bones are separated from one another by layers of spongy, water-infused tissue that act as shock absorbers. When they no longer work correctly, your neck bones may compress, stopping you from turning your neck as much as you’d like and often causing a great deal of pain.
If degenerative disk disease is causing your nuchal rigidity, your doctor can diagnose it with an MRI and help you take proper action.
Nuchal rigidity and meningitis
Meningitis is the first thing many think of when they hear about neck stiffness. Inflammation of the tissue encasing the brain and spinal cord causes the condition. The result is “severe irritation, so that any movement is going to stimulate the pain receptors.” Miller says. Neck stiffness is how the body protects itself from feeling pain.
Viral meningitis is the most common type, but it can be caused by bacteria as well. Nuchal rigidity is a main symptom in 70% of people who have bacterial meningitis.
To diagnose meningitis, many doctors rely on tests such as:
Kernig’s sign. You’ll lie down with your legs and knees flexed. If you feel pain while gradually extending your legs outward, it’s a positive sign that could suggest meningitis.
Brudzinski’s sign. You’ll lie flat on your back, but this time, you’ll bend your neck forward toward your chest. If you can’t bend your neck forward without also raising your knees uncontrolled, it’s a sign of meningitis.
But these tests alone aren’t enough. The final test involves taking a sample of cerebrospinal fluid with a spinal tap.
Nuchal Rigidity Treatments
The treatments you need for neck stiffness will depend on its underlying cause. At-home treatments include:
- Taking a break from the activity that caused the stiffness
- Hot and cold compresses
- Over-the-counter medicines, such as acetaminophen or ibuprofen
If arthritis has caused your stiff neck, treatments include at-home therapies, plus stretching and other exercises to build up your neck muscles. To treat meningitis, you’ll usually take medicine to get rid of the infection, along with corticosteroids and IV fluids. Treatments for degenerative disk disease include physical therapy, medicine for inflammation and pain, and steroid shots.
Takeaways
Nuchal rigidity is neck stiffness due to meningitis or other health conditions, such as arthritis, degenerative disk disease, poor posture, or repeated stress. Treatment depends on what’s causing the condition and may include medicine, rest, and physical therapy. The key takeaway is that nuchal rigidity shouldn’t be self-diagnosed at home. It could be minor, but it could also be a serious condition that needs immediate attention. The only way to know for sure is to see a health professional.
Nuchal Rigidity FAQs
What is positive for nuchal rigidity?
When caused by meningitis, a positive test for nuchal rigidity involves lying on your back with your knees flexed. If you have pain while slowly stretching out your legs, this is a sign of the condition. Another test is lying on your back while bending your neck forward toward your chest. If your knees raise on their own, this is also a sign.
What is the triad of nuchal rigidity?
This refers to the three common symptoms of meningitis — nuchal rigidity, fever, and headache.
What is another word for nuchal rigidity?
Another term for nuchal rigidity is neck stiffness, which means you have trouble flexing your neck due to pain or tightness.
What is the difference between nuchal rigidity and torticollis?
Nuchal rigidity and torticollis are both conditions that cause neck stiffness and pain. The difference is that torticollis causes your head to tilt or lean to one side and is a rare condition that you may be born with. An infection, an issue with your brain, spinal cord, or nerves (neurological), or a genetic problem can cause torticollis.
