Nuchal Rigidity: Causes, Symptoms, Complications, And Treatment

In layman's terms, Nuchal Rigidity is commonly known as neck stiffness. A sensation of pain due to the tightness and lack of mobility of neck muscles. Depending upon the level of pain and discomfort, neck stiffness can be considered as an individual condition, minor injury, or a surface symptom of a major underlying disease.

One might overlook neck pain as it is quite common these days. People with bad posture and stretched sitting hours can have pain in their neck and shoulder on a daily basis. This happens because the spine's upper part is responsible for supporting the head. If you even have minor pain also, that should be taken seriously as it can be life-threatening, if ignored.

Furthermore, repetitive physical stress on your neck can cause overexertion. This can be easily cured with regular exercise and stretching. Overuse of the cervical spine can cause pain and agitation that can be discomforting in the longer run. Apart from poor lifestyle choices, stiffness in the neck can be a symptom of major underlying diseases like:

• Arthritis:

  The human body tends to wear out as we grow old. The soft tissues responsible for holding and cushioning the neck can become coarser and rougher with poor lifestyle, bad posture, and sometimes regular stretching which can lead to neck arthritis.

• Degenerative Disk Disease:

  Another form of neck arthritis that can be responsible for Nuchal Rigidity is degenerative disc disease. It is more severe than neck arthritis, as it can degenerate abnormally with the simple and natural wear and tear around the neck bones. This is because the layers of sponge or water-infused tissue called intervertebral disc which absorbs and protects the bones from any sudden shock, no longer work correctly as it compresses down because of age and other life factors.

  The compressed intervertebral disc will make your bones more vulnerable to wear and tear hampering your neck movement and making it more painful with time.

• Meningitis:

  It can be described as a viral or bacterial infection that causes inflation in the tissue of the neck. The infection causes swelling of the tissues which can further encase the brain and spinal cord making the locomotion difficult for the patient. 70% of cases of bacterial meningitis have Nuchal Rigidity as their first symptom, making it one of the most common reasons for neck stiffness. Meningitis can be life-threatening if ignored as it spreads to the spinal cord and brain.

Depending upon the root cause of Nuchal Rigidity, symptoms can vary from general stiffness and pain to seizures and mental disorders.

General symptoms of neck stiffness may include the following:

• Pain in the neck region
• Stiffness and lack of mobility in neck muscles
• Inflammation
• Redness
• Swelling
• Fatigue

If a patient is suffering from symptoms other than common ones, it can be associated with more serious underlying illnesses. Look for the symptoms in the following cases:

1. Neck arthritis: Chronic pain and stiffness during neck movement along with:
   • Sudden neck spasms often lead to pain or a loss of movement
   • Popping sound when you move your neck
   • Weakness and numbness in the legs, arms, hands, and fingers
   • Difficulty walking
   • Disturbed sleep
   • Irritability, fatigue, and weakness
   • Kernig’s sign
2. Degenerative Disk Disease: Symptoms, in this case, will not be limited to your neck region. This may include constant and prolonged pain in the lower back, buttocks, and upper thighs which can last up to months. The pain gets worse when you sit, bend, lift, or twist but feels better to lie down, move or walk. A Few cases of Nuchal Rigidity where nerves near your spine get damaged by degenerative disk disease show weakness, numbness, and tingling in your arms and legs.
3. Meningitis: Early symptoms of general Nuchal Rigidity and meningitis will be quite identical, except the symptoms will be followed by illnesses like:
   • Unpredictable high fever
   • Severe headache
   • Vomiting or nausea
   • Difficulty in making a decision and concentrating on a daily routine task
   • Lost the will to eat or drink
   • Seizures
   • Sleepiness
   • Difficulty waking
   • sensitivity to light
   • Skin rash
   • Brudzinski’s sign

Your doctor may start the diagnosis with a routine checkup and medical history, which will include collecting information related to time duration, severity, and your daily routine activity followed by a physical neck examination, by gently moving your neck to check how restrictive your movements are.

If the stiffness is serious and it started to affect your other bodily actions your doctor may prescribe the following tests:

1. Magnetic resonance imaging (MRI): To detect the root cause of your Nuchal Rigidity, your medical professional will advise you to get an MRI. It is mostly recommended in case of neck arthritis.
2. Brudzinski’s sign: It’s a physical examination. During this test, the doctor will ask you to lie down flat on your stomach and bend your neck forward towards your chest. If your keen involuntary rise up while you bend then it is a sign that you might have meningitis. Even though the test is quite effective in diagnosing, it is not completely reliable to confirm the condition.
3. Spinal tap: Or also known as the lumbar puncture is a type of physical examination that is performed to diagnose serious infections such as meningitis or other illnesses associated with the spinal cord, backbone, or brain. This test is performed by inserting needles into vertebrae (Lumbar bones). From the lumbar region in the lower back doctor takes a sample of cerebrospinal fluid.
4. Kernig’s sign: Kernig’s sign is quite identical to Brudzinski’s sign in terms of methodology as both of the physical examinations are external and commonly used in the case of Nuchal Rigidity. Your health care experts will ask you to lie down and flex your legs and knees at a 90˚ angle. In the case of meningitis, your pain will gradually extend as you flex your legs outward.

Neck stiffness is one of the most common conditions these days, so if you are feeling minor pain and stiffness after a long day or a small injury you can go for first aid methods like:

• Over-the-counter medicines, like acetaminophen or ibuprofen.
• Massage therapy.
• Hot and cold compresses.
• Physical therapy‌.
• Neck exercises that will help to relieve the stress.

1. Arthritis: Depending upon the severity of the pain and stiffness, neck arthritis can be dealt with physical therapy, medications, minor medical procedure, or even surgery:
   • Physical exercise may include posture therapy or general physical exercise that will gently stretch strained or weakened muscles. It's a long process that might take 6 to 8 weeks to show its results.
   • A combination of medications like Acetaminophen, Nonsteroidal anti-inflammatory drugs (NSAIDs), Oral corticosteroids, and Muscle relaxants are mostly used to aid the patient to deal with inflammation, pain, and discomfort. At the initial stages of severe cases, steroid-based injections are used as a short-term option to relieve the pain. Also, your doctor will suggest you wear a soft cervical collar followed by ice, heat, or massage therapy.
   • Surgery in the case of Nuchal Rigidity is rare, especially in neck arthritis, it is usually recommended in the case of cervical radiculopathy, cervical spondylotic myelopathy, or patients who have progressive neurologic symptoms.
2. Cervical degenerative disc disease: A combination of surgical or non-surgical methods has been recommended for this condition.
   • Non-surgical treatments: After your physical examination, your doctor will recommend you a series of OTC medications and injections followed by Ice or heat therapy, general physical exercise, and some lifestyle alterations. Your doctor may also advise manual manipulation ( chiropractor). Other non-surgical options may include acupuncture, bracing, electrical stimulation, TENS unit, or massage therapy.
   • Surgical treatments: The surgery is recommended in cases where cervical degenerative disc disease shows neurological symptoms or has chronic pain. Surgery methods like anterior cervical discectomy and fusion (ACDF) and cervical artificial disc replacement are recommended. The surgery may also include widening or removing part of a vertebra and spinal canal in case of spinal cord compression.
3. Meningitis: Once the diagnosis completes, your doctor will suggest the treatment. Here are some options in case of:
   • Bacterial meningitis: The treatment of acute bacterial meningitis may depend on the type of bacteria that is causing the neck pain. If treatment is not done on time, it can lead to some serious complications like seizures and brain swelling. Basic medications like intravenous antibiotics and corticosteroids are advised for instant relief. Other than that a combination of antibiotics is recommended which is strictly related to the root cause of bacterial growth.
   • Viral meningitis: There is no specific course of treatment designed to cure viral meningitis, although your doctor may recommend over-the-counter pain medications like corticosteroids and anticonvulsant medication to reduce the swelling and to control seizures. Only in the case of the herpes virus, antiviral medication is available. The good news is with some bed rest and optimum fluid intake, most of the viral infections recover on their own within a few weeks.
   • Fungal meningitis: In the case of fungus infection, doctors mostly recommend ointments and medications. But since this course of treatment may have serious side effects, it is only applied after the confirmation of the type of infection via laboratory testing.
   • Noninfectious meningitis: This is caused by any existing allergic reaction or autoimmune disease that may be treated before with corticosteroids. In most cases, it wears off without any medical aid.
   • Cancer-related meningitis: Cancer in or around the neck region may cause Nuchal Rigidity. This is rare and depending upon the type and stage of your cancer, therapeutic treatment is advised.
   • Other forms of meningitis: In case the root cause of the meningitis is unknown, your doctor may prescribe a combination treatment of antiviral and antibiotic medications until its detection.

Apart from bad sitting posture and age vulnerability, there are many other reasons why your neck is stiff and makes you feel uncomfortable. To prevent the pain here are some lifestyle alterations that one can adapt to avoid pain and stiffness in the neck.

• Change in sitting position: Posture while working, walking, or even standing is crucial for overall body health. Always keep your shoulder in an upright position in alignment with hips and ears.
• Break the routine: While working or traveling one may be sitting in one stagnant position for long hours can strain your back and neck muscles. Take small frequent breaks to move and stretch to keep the flexibility.
• Adjust your devices: Keep your phone and monitor on eye level. Knees slightly lower than hips and usage of headset or speaker mode instead of pinching the phone between your ear and shoulder can keep your neck and spine straight and healthy.
• Quit smoking: As it can make your immune system weak and more prone to pain and even serious medical conditions like cancer. Carry your heavy material with the help of a supporter and mini trolley, keeping heavy weights on your shoulders can strain your neck.
• Good sleep: The best sleeping position for right alignment is your head should be aligned with your body while sleeping on your back with the thighs elevated on the pillow. This will keep your spine straight and give you a good night's sleep.

Summary: Nuchal Rigidity or neck stiffness can be described as a sensation of pain due to the tightness and lack of mobility of neck muscles. From a serious neck injury to poor lifestyle habits, neck stiffness can happen to anyone at any age or gender.