Waking up with a stiff neck can be one of the most aggravating types of pain that most people experience at some point in their lives. I’m sure most of us have been there before, you wake up after a good night’s sleep, and just as you begin to raise your head off of the pillow you feel a sharp pain in the muscles at the side of your neck. You try to cautiously turn your head in either direction and it just feels…tight…stiff…PAINFUL!
This type of morning neck pain and stiffness is all too common. Some refer to it as a “crick in the neck” or even “my neck is locked up.” However, they are all typically describing a painful cervical condition where the neck muscles have developed sudden tightness and trigger points. By understanding the common causes of morning neck pain, you will be able to effectively treat and prevent this condition with the exercises and stretches that we will discuss today.
- Purchase for Easy, Convenient Access Anytime
- Download for Use on Any Mobile Device or Print at Home
- Includes Additional Exercises for Comprehensive Rehab Program
- Custom Designed by Dr. Tim, PT, DPT, OCS
Purchase for Easy, Convenient Access Anytime
Download for Use on Any Device or Print at Home
Includes Additional Exercises for Comprehensive Rehab Program
Custom-Designed by Dr. Tim, PT, DPT, OCS
Table of Contents
What Causes a Stiff Neck When You Wake Up in the Morning?
Sleeping Position:
I would argue that the neck sleeping position throughout the night is the #1 reason that someone would wake up with morning neck pain, stiffness, and tightness. Lying with the neck rotated, side bent, or excessively flexed forward can all be contributors to morning neck pain, stiffness, and tightness as these positions can strain the neck muscles.
Everyone has a preferred sleeping position. However, lying prone on your belly is one of the worst positions as it is a frequent aggravator of both neck pain and low back pain. Try sleeping on your side or on your back instead with your neck in a neutral (straight) position.
Pillow Selection:
Research has found that it is important to have a soft, yet supportive pillow to prevent increased neck pain when sleeping. You should look for a pillow that can provide sufficient support to help maintain the natural curvature of the cervical spine without causing compensations.
Your head and neck spend several hours in static positions throughout the night while you sleep. It is important to have a pillow that helps to support the neck properly during this time. Otherwise, it is likely that you will wake frequently or have neck pain in the morning.
There are specifically designed memory foam pillows that have been created and marketed to “cradle” the neck. While these pillows are beneficial for some, they are not a “cure-all.” There have been several times in my career where I have had success reducing a patient’s morning neck pain by advising them to return to a standard pillow rather than using a memory foam pillow.
You should try using two or three different types of pillows for a few nights each to see which one supports your style of sleeping (side-sleeper or lying on your back) and feels best on your neck. No matter which pillow type you choose, be sure to pull the pillow in to fill the space on either the side or the back part of your neck. If properly done, your head and neck should feel cradled and fully supported without any rotations or side bends.
Whiplash Injury:
If you happen to have unfortunately experienced a motor vehicle accident recently or a sudden impact injury, the neck muscles will have succumbed to a very sudden stretch force. This quick stress will cause micro-tearing and inflammation within the muscle fibers. Muscle tightness and pain will gradually build up within these muscles causing neck pain throughout the day including when you sleep.
Cervical Spine Osteoarthritis:
Cervical spine osteoarthritis occurs naturally over time with aging. It can occur in one or more joints in the neck resulting in generalized neck stiffness and pain. Typically osteoarthritis causes symptoms that include:
- Generalized cervical spine stiffness
- Morning joint stiffness and pain
- Stiffness gradually loosens up with movement throughout the day
Cervical Facet Joint Syndrome:
Cervical Facet Joint Syndrome, also known as neck facet joint syndrome, occurs when there is an injury or strain at a facet joint in the cervical spine. Facet joints are synovial joints located between each cervical vertebrae.
The cervical facet joints (also known as zygapophyseal, apophyseal, or Z-joints) are allowed to slide against one another as they guide and restrict general neck movements.
Sometimes quick or awkward neck movements cause a strain of these facet joints resulting in a “locked neck” or pinching sensation at the side of the cervical spine.
Certain conditions increase your risk of having Cervical Facet Joint Syndrome. These include:
- Cervical Osteoarthritis
- History of Whiplash or other neck injuries
- Rheumatoid Arthritis
Other causes of waking up with a stiff neck:
In addition to the previous conditions, there can also be other causes of waking up with a stiff neck. These include:
- Poor posture (especially a forward head position)
- Poor ergonomics at work (i.e. improper seating position at work desk)
- Straining neck while exercising (i.e. performing overhead press with heavy weights)
- Cervical Radiculopathy (herniated disc with nerve impingement)
Anatomy of Neck Muscles and Bone Structures
There are several muscles located on all sides of the neck. These muscles are tasked with moving and stabilizing the neck. The muscles that most commonly cause you to wake up with a stiff and painful neck are located on the backside of the neck. These muscles are the cervical paravertebral muscles (semispinalis capitis, splenius capitis), suboccipital muscles, levator scapulae, and the upper trapezius.
However, if there is one muscle that is MOST responsible for morning neck stiffness, it is the levator scapulae. This muscle can cause sharp, intense pain on either side of your neck. You’ll also notice a tugging sensation on the same side of the muscle when trying to look down or to the side.
What to Do if You Wake Up With a Stiff Neck
If you wake up with a stiff neck, there are several things that you can do to help relieve the neck pain, stiffness, and/or tightness.
- Use a heating pad on the neck or take a hot shower
- Heat is better than ice because it helps to reduce muscle tightness and joint stiffness.
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- Gently massage the painful, tight muscles
- I know they are tight and tender to touch, but gentle, firm pressure will help reduce the muscle tension and relieve pain gradually.
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- Consider taking over-the-counter anti-inflammatory medications
- Oral medications such as naproxen (Aleve), ibuprofen (Advil), or acetaminophen (Tylenol) reduce pain and inflammation. Check with your doctor first to make sure they are safe for you to take!
- Perform therapeutic neck pain relief exercises as described below!
Morning Neck Pain Prevention
There are several precautionary steps that you can take to prevent morning neck pain and stiffness. These include:
- Find a supportive pillow that promotes a neutral neck position
- If you sleep with a traditional pillow, try a memory foam one. If you already sleep with a memory foam contour pillow, try switching to a supportive, traditional-style pillow. Find and use whichever pillow supports your neck the best without causing increased neck pain or tightness throughout the night.
- CUSHION LAB DEEP SLEEP PILLOW
- DESIGNED FOR BACK & SIDE SLEEPERS
- ZERO PRESSURE CLOUD SUPPORT
- ANTI-AGING FRESHFACE PILLOWCASE
- SLEEP DEEPER
- CUSHION LAB CERVICAL CONTOURED PILLOW
- THERAPEUTIC NECK RELIEF
- HEAD & NECK SUPPORT
- HYPOALLERGENIC
- MADE WITH HYPERFOAM
- Sleep on your side or on your back
- Sleeping on your belly WILL set you up for failure. Try using a contoured knee pillow that will help support your back as well!
- CUSHION LAB WEDGE PILLOW
- PERFECT FOR SIDE SLEEPERS
- PROMOTES NEUTRAL HIP ALIGNMENT
- IMPROVES CIRCULATION
- DECREASE SCIATICA, BACK, & HIP PAIN
- BREATHABLE & EASY TO CLEAN COVER
- Stretch your neck muscles before you go to sleep and when you wake up in the morning
- Avoid using a pillow that is too stiff or too soft
- Avoid using a mattress that is too old or soft as it can cause compensations in your thoracic spine and cervical spine
- Improve your awareness throughout the day to use good posture when working, playing video games, reading, etc.
- Exercise regularly
- Exercising will keep muscles strong and improve joint mobility overall
When to See a Doctor
Usually, when you wake up in the morning with neck pain, stiffness, or tightness it is NOT a serious condition that requires seeing a doctor. However, there are certain times when you should seek the care of a medical provider for care with neck pain.
You should seek medical care if you experience any of the following:
- Lack of improvement of neck pain after 2-4 weeks of performing daily therapeutic exercises and stretches
- Sudden progression of severe neck pain that cannot be attributed to a specific cause
- Persistent sensation of numbness and tingling into the hand/s
- Noticeable lump newly located in your neck
- Fever or swollen glands in the neck
- Sudden difficulty gripping or writing
- Difficulty with swallowing
The BEST Neck Pain Relief Exercises When Waking Up with a Stiff Neck!
- Purchase for Easy, Convenient Access Anytime
- Download for Use on Any Mobile Device or Print at Home
- Includes Additional Exercises for Comprehensive Rehab Program
- Custom Designed by Dr. Tim, PT, DPT, OCS
Purchase for Easy, Convenient Access Anytime
Download for Use on Any Device or Print at Home
Includes Additional Exercises for Comprehensive Rehab Program
Custom-Designed by Dr. Tim, PT, DPT, OCS
Massage with Neck Rotation
- Find the painful, tight muscle with your fingertips
- Press firmly against the tight muscle while simultaneously slowly rotating your head towards the same side
- Perform: 3-5 minutes on the painful side (1-2x/day)
Sub-Maximal Isometrics with Neck Rotation
- Sub-maximal isometrics work effectively to improve the neck range of motion after waking with a stiff neck
- Find the direction of rotation that elicits neck pain
- Turn the head in that direction until the pain is felt on the same side of the neck
- Press against the temple of the forehead as if you were trying to turn your head in the opposite direction
- BUT do not allow your head to move, this will cause the muscles that are eliciting pain to contract slightly (pain will increase slightly, but that’s okay)
- Perform: 5 sec holds x 5 reps (30% maximum force), then look the opposite direction to prevent too much neck stiffness. Then, perform a 2nd set of 5 reps in the same direction (as needed throughout the day)
- Goal: the purpose of this exercise is to reduce the amount of neck pain with rotation and to improve the rotation range of motion
Neck Rotation Stretch with Towel Stretch
- Use a towel or pillow case
- Hold one end against the chest and wrap the towel around the back of the neck and across the temple of the forehead
- Gently rotate into the restricted direction of rotation
- Perform: 10 sec holds x 10 reps each direction (trying to gently pull slightly further into rotation with each repetition) 1-2x/day
- Goal: restore rotation range of motion and relax the painful neck muscles
Supine Chin Tucks Exercise
- Lie on your back with the neck in a neutral position
- Close your lips, breathe through the nose, and allow the tongue to rest on the roof of your mouth
- Gently draw your chin down and in as if you were trying to make a “double chin”
- Perform: 10 sec holds x 10 reps (2-3 sets) 1-2x/day
- Goal: We’re trying to ISOLATE the deep neck flexor muscles that help stabilize the cervical spine. They are located on the front side of the neck but behind the esophagus. These are the core muscles of the neck.
Seated Shoulder Blade Squeeze
- Sit upright in a “military posture” position with both hands resting on your thighs
- Draw both shoulders and shoulder blades down and back as if you were trying to squeeze a pencil between your shoulder blades
- Do not allow your hands to move from your thighs
- Perform: 10 sec holds x 10 reps (3 sets) 3-4x/day
Upper Trapezius Stretch
- Look straight ahead, use one hand to grasp the opposite side of the head
- Gently pull the opposite ear down towards the shoulder until a stretch is felt on the side of the neck
- Perform: 3 reps x 30 sec holds (1-2x/day)
Levator Scapulae Stretch
- Place on hand on the back of your neck (if you cannot do this because of shoulder pain, then hold the bottom edge of a chair that you’re sitting on)
- Rotate the head to the opposite direction trying to get your nose even with the front side of your shoulder
- Place the other hand on top of the head and gently pull the nose directly down towards the armpit until a stretch is felt on the back of the neck
- Perform: 3 reps x 30 sec holds (1-2x/day)
