What Is Nuchal Rigidity?

Medically Reviewed by Sabrina Felson, MD on May 04, 2023
4 min read

Nuchal rigidity refers to neck stiffness caused by bacterial meningitis and other serious medical conditions. A person with nuchal rigidity has tightness and inability to move the neck muscles — or feels pain while trying to do so.

Nuchal rigidity can range from minor pain to complete inability to extend or turn your neck from side to side. It may be caused by conditions ranging from minor injuries or sprains to potentially life-threatening cancers. That’s why, if you’re feeling stiffness in your neck, the best thing to do is see a health professional to get a proper diagnosis. 

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 comparatively massive 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. 

You may inadvertently be causing neck stiffness with poor posture, hunching your shoulders at work, or even staring at a smartphone or laptop all day. If any of these are the cause, you should notice some relief by stretching more frequently or creating a more ergonomic workspace. 

When you’re feeling minor signs of nuchal rigidity, give these things a try to help your neck get back to normal:

  • Hot and cold compresses
  • Over-the-counter medicines, like ibuprofen or acetaminophen
  • Massage therapy
  • Physical therapy‌

Poor posture and repetitive physical stress are most likely the cause of your neck pain and stiffness. Your neck bones have a tough job, so most of the time it’s simply a case of overuse and overexertion, which can be treated with rest and regular stretching. 

However, sometimes more serious issues are to blame.

Your neck bones tend to become coarser and rougher as you grow older. Regular stretching can mitigate this to some extent, but not entirely. As this happens, the soft tissues tasked with holding and cushioning the neck bones can get worn down, potentially leading to a kind of neck arthritis

If that’s the case, your doctor can diagnose it with a magnetic resonance imaging (MRI) scan of your neck. Additional symptoms to watch out for include: 

  • Instability or weakness in the legs
  • Numbness at the extremities
  • Muscle contractions, especially any emanating from around the neck or upper shoulder area
  • Popping sounds when you move your neck

These cases are treated with a combination of physical therapy and neck braces. More serious cases of arthritis in the neck can be treated with surgery on the neck bones. 

A more severe variation of neck arthritis is degenerative disc disease. Although some wear and tear around the neck bones is indeed natural and expected as you age, they can also start to degenerate abnormally. 

‌Your vertebral bones ordinarily 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 might actually compress down, stopping you from turning your neck as much as you’d like and often causing a great deal of pain. 

If degenerative disc disease is causing your nuchal rigidity, your doctor can diagnose it with an MRI and help you take appropriate action. 

Meningitis is the first thing many think of when they hear about neck stiffness. Meningitis is caused by inflammation of the tissue encasing the brain and spinal cord. Viral meningitis is the most common type, but it can be caused by bacteria as well. Nuchal rigidity is a prominent symptom in 70% of people who have bacterial meningitis. 

To diagnose meningitis, many doctors rely on tests such as: 

  • Kernig’s sign. You’ll be asked to lie down with your legs and knees flexed. If you feel pain while gradually extending your legs outward, it’s considered a positive sign that could indicate meningitis. 
  • Brudzinski’s sign. You’ll be asked to lie down 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 involuntarily, that’s considered a positive indicator for meningitis. 

However, these tests alone aren’t enough. The final confirmation is made by testing the cerebrospinal fluid itself with a spinal tap

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 professional.