What To Do For a Stiff Neck

Physical Therapy Techniques To Improve Neck Mobility

by Michael Curtis

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You know you have a stiff neck when you literally have to turn your whole body to look at the
person sitting right next to you. A stiff neck is not an easy problem to hide and not an easy
problem to live with – even simple daily tasks become painful and difficult. Driving, for
instance, presents a whole new challenge, requiring a strategic use of mirrors just to change lanes
safely.

For many, a stiff neck can last a day or two, while it can be a persistent issue in others. The good
news is: there are steps you can take to improve your mobility and function to overcome your
stiff neck…

Stiff Neck Presentation

So what does a typical person who has a stiff neck (neck pain with mobility deficits) look
like1,2,3,4?

 Younger than 50 years old

 Acute neck pain lasting less than 12 weeks
 Symptoms are only in the neck (referred pain may or may not be present)
 Restricted neck range of motion
 Limited mobility of the cervical (neck) and thoracic (mid-upper back) spine

If you see a Physical Therapist for your neck pain, they would determine you have a mobility
deficit5 based on your:

 Limited ability to move your cervical and thoracic spine in different directions (active
range of motion)
 Limited mobility of one or more segments of your cervical and thoracic spine from a
manual evaluation

Treatment for a Stiff Neck

It should go without saying, but I’ll say it anyways – evidence shows the treatment that targets a
specific classification of neck pain (mobility deficits, headaches, sprain, etc.) has better outcomes
than just general treatment for neck pain6.

So, what are these specific treatments for a stiff neck?

1. Manipulation/Mobilization of the Cervical or Thoracic Spine

When it comes to the neck, I’m more comfortable with mobilization techniques rather
than thrust manipulation techniques – the neck is a vulnerable area. Plus, a 2010 study
found that a cervical thrust manipulation versus mobilization techniques are equally as
effective in terms of outcomes for people with neck pain – with no difference between
the two7.

A great mobilization technique for the neck you can do is a cervical SNAG:
  To mobilize a stiff segment on the left side of your neck:
o Use the edge of a towel or pillow case to get a good purchase on the specific stiff
segments at the left side of your neck
o Using the left hand, reach across to your right side and pull the towel straight
down to anchor it
o With your right hand, reach over the top of your left arm and pull the towel across
your chin to your right as you turn your head in the same direction
o Hold this position for 3-5 seconds, rest, and repeat 10 or more times

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How about thoracic spine mobilizations? How does this affect a stiff neck?

Limitations in thoracic joint mobility can contribute to musculoskeletal disorders in the

neck8,9.

Multiple studies have shown that thoracic spine manipulation or mobilization can
improve neck pain and function10.

Here’s one of my favorites:

 Thoracic Extension Mobilization on a Foam Roller:

o Lie face-up with the foam roller horizontally across your mid back
o Keep your butt down, knees bent, and feet flat on the floor
o Put your hands behind your head for support
o Breathe out and depress your ribs toward your naval
 Maintain this rib position by bracing your abdominals
o Slowly extend your mid back over the roller
o Hold 5 seconds
o Relax, repeat
o Inch by inch, make your way from your mid to your upper back
o Do not perform on the lower back

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2. Coordination, Strengthening and Endurance

Although mobilization for neck pain is beneficial, for even better outcomes, mobilization
treatments should be combined with exercise11,12,13.

The Deep Neck Flexor Muscles are very important to help support the neck. By strengthening
and increasing the endurance of these muscles, they can assist in more coordinated movement of
the neck – offsetting some of the stress on stiff joints.

3. Stretching

When comparing 2 groups of research participants: a manual therapy

(mobilization/manipulation) group and a stretching group, both groups’ neck stiffness improved
– the manual therapy group only slightly more14.

Therefore, in addition to mobilization, I recommend you include stretching exercises as part of

your treatment for a stiff neck.

What kind of stretches?

People with neck pain often present with a lack of flexibility in key muscles in the lower cervical
and upper thoracic area15:

 Scalenes Stretch:
o Sit straight up in a chair
o To stretch the left Scalenes muscles, reach your left hand down and anchor it at
the bottom or leg of the chair
o Gently side-bend your neck toward the right until a stretch is felt
o Gently rotate your head toward the left
o Gently extend the neck back
o Hold stretch at least 30 seconds

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 Upper Trapezius Stretch:

o Sit up straight in a chair
o To stretch the left Upper Trap, reach your left hand down and anchor it at the
bottom or leg of the chair
o Rotate your head to the left
o With your right hand, reach over the top of your head, placing your hand on the
left side of the back of your head
o Gently pull down and to the right (toward your right knee)
 o Hold stretch at least 30 seconds

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 Levator Scapulae Stretch:

o Sit up straight in a chair
o To stretch the left Levator, reach your left hand down and anchor it at the bottom
or leg of the chair
o Rotate your head to the right
o With your right hand, reach over the top of your head, placing your hand on the
left side of the back of your head
o Gently pull down and to the right (guiding your nose in the direction of your right
armpit (insert deodorant joke) until a stretch is felt
o Hold stretch at least 30 seconds

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 Pec Major Stretch:

o Stand in a doorway
o To stretch the left pec major, place your left forearm against the left doorjamb at a
90-degree angle
o Stagger your stance with your left foot slightly forward
o Gently advance your weight forward
o Gently rotate your shoulders to the right until a stretch is felt
o Hold stretch at least 30 seconds
o Repeat this same stretch, this time with the angle of the arm at 120 degrees (up
higher in the doorjamb) to stretch a different aspect of the Pec Major muscle

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  Pec Minor Stretch:
o To stretch the Right Pec Minor
o Stand in a doorway
o Place a small towel between the front of your Right shoulder and the doorjamb
o Keep your arm Right arm down at your side and lean your Right shoulder against
the doorjamb
o Continue leaning forward until you feel a stretch
o Hold stretch at least 30 seconds

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Question: What other exercise techniques have you found to be helpful for a stiff neck? You can
leave a comment by clicking here.

1. Cleland JA, et al. Development of a clinical prediction rule for guiding treatment of a
subgroup of patients with neck pain: use of thoracic spine manipulation, exercise, and
patient education. Phys Ther. 2007;87:9-23. ↩︎
2. Fritz JM, Brennan GP. Preliminary examination of a proposed treatment based
classification system for patients receiving physical therapy interventions for neck pain.
Phys Ther. 2007;87:513-524. ↩︎
3. Hoving J> et al. Manual Therapy, physical therapy, or continued care by a general
practitioner for patients with neck pain. Spine. 2001;26:196-205. ↩︎
4. Tseng YL, et al. Predictors for the immediate responders to cervical manipulation in
patients with neck pain. Man Ther. 2006;11:306-315. ↩︎
5. Childs J, et al. Neck Pain: Clinical Practice Guidelines Linked to the International
Classification of Functioning, Disability, and Health From the Orthopaedic Section of the
American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38(9):A1-A34.
↩︎
6. Fritz JM, Brennan GP. Preliminary examination of a proposed treatment-based
classification system for patients receving physical therapy interventions for neck pain.
Phys Ther. 2007;87(5):513-24. ↩︎
7. Leaver AM, et al. A Randomized Controlled Trial Comparing Manipulation With
Mobilization For Recent Onset Neck Pain. Arch Phys Med Rehabil. 2010;91:1313-1318.
↩︎
8. Johansson H, Sojka P. Pathophysiological mechanisms involved in genesis and spread of
muscular tension in occupational muscle pain in chronic musculoskeletal pain
syndromes: a hypothesis. Med Hypotheses. 1991;35:196-203. ↩︎
9. Knutson GA. Significant changes in systolic blood pressure post vectored upper cervical
adjustment vs resting control groups: a possible effect of the cervicosympathetic and/or
pressor reflex. J Manipulative Physiol Ther. 2001;24:101-109. ↩︎
10. Adams G, Sim J. A survey of UK manual therapists’ practice of and attitudes towards
manipulation and its complications. Physiother Res Int. 1998;3:206-227. ↩︎
11. Gross AR, et al. A Cochrane review of manipulation and mobilization for mechanical
neck disorders. Spine. 2004;29:1541-1548. ↩︎
12. Walker M, et al. The Effectiveness of Manual Physical Therapy and Exercise for
Mechanical Neck Pain. SPINE. 2008;33(22):2371-2378. ↩︎
13. Cleland J, et al. Examination of a clinical prediction rule to identify patients with neck
pain likely to benefit from thoracic spine thrust manipulation and a general cervical range
of motion exercise: Multi-center randomized clinical trial. Phys Ther. 2010;90(9):1239-
1250. ↩︎
14. Cleland J, et al. Examination of a clinical prediction rule to identify patients with neck
pain likely to benefit from thoracic spine thrust manipulation and a general cervical range
of motion exercise: Multi-center randomized clinical trial. Phys Ther. 2010;90(9):1239-
1250. ↩︎
15. Childs J, et al. Neck Pain: Clinical Practice Guidelines Linked to the International
Classification of Functioning, Disability, and Health From the Orthopaedic Section of the
American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38(9):A1-A34.
↩︎