What should I do if my neck is locked and difficult to move?

Immediate Management of Acute Neck Stiffness ("Locked Neck")

If your neck has suddenly become locked and difficult to move, you should avoid forcing movement, apply ice for 10-20 minutes, and seek medical evaluation if symptoms persist beyond 24-48 hours, worsen, or are accompanied by neurological symptoms, severe pain, or history of trauma. 1

Initial Assessment and Red Flags

First, determine if this requires emergency evaluation. Seek immediate medical attention (call 911) if you have: 1

• History of significant trauma (motor vehicle collision, fall from height, diving injury, assault) 1
• Age 65 years or older with any trauma 1
• Tingling or numbness in your arms or legs 1
• Muscle weakness in your torso or upper extremities 1
• Difficulty breathing 1
• Not fully alert or intoxicated 1
• Severe headache with neck stiffness (could indicate meningitis or other serious condition) 2

If any of these red flags are present, do not move your neck and remain as still as possible while awaiting emergency medical services. 1, 3 The 2015 American Heart Association guidelines specifically recommend against applying cervical collars in first aid settings, as they can cause more harm than benefit. 1, 3

Non-Traumatic Neck Stiffness Management

For neck stiffness without trauma or red flags (the most common scenario):

Immediate First Aid (First 24-48 Hours)

• Apply cold therapy: Use an ice-water mixture in a plastic bag or damp cloth for 10-20 minutes at a time, with a thin towel barrier between ice and skin 1
• Avoid forcing movement: Do not attempt aggressive stretching or manipulation 1
• Maintain comfortable positioning: Find a position that minimizes pain, typically neutral alignment 1
• Limit activities: Avoid movements that exacerbate symptoms 2

When to Seek Medical Evaluation

You should see a healthcare provider within 24-48 hours if: 2

• Pain is severe or progressively worsening
• Symptoms persist beyond 48 hours without improvement
• You develop new neurological symptoms (numbness, tingling, weakness)
• You have difficulty with daily activities
• You have a history of cancer, unexplained weight loss, or immunosuppression 2

Medical Treatment Options

If you see a provider, evidence-based treatments include: 4, 2

• Muscle relaxants (such as cyclobenzaprine): FDA-approved for acute painful musculoskeletal conditions with muscle spasm, used for 2-3 weeks maximum 4, 2
• Physical therapy and exercise: Most beneficial treatment with strongest evidence for neck pain 2
• Manual therapy: May include mobilization or manipulation by trained professionals, though screening for vascular risk factors is important 5, 6

Common Pitfalls to Avoid

• Do not apply cervical collars: These increase intracranial pressure, cause pressure sores, and provide incomplete immobilization while creating additional complications 3, 7
• Do not apply ice directly to skin: Always use a barrier to prevent cold injury 1
• Do not ignore trauma history: Even seemingly minor trauma in older adults or from motor vehicle collisions requires evaluation, as neck symptoms following high-energy mechanisms are associated with prolonged recovery 1, 8
• Do not delay evaluation if red flags present: Serious conditions like myelopathy, atlantoaxial subluxation, or metastases require urgent diagnosis 2

Special Considerations

For trauma-related neck stiffness: The risk of cervical spine injury after blunt trauma requiring imaging is approximately 2%, tripled in patients with craniofacial injury 1. If trauma occurred, remain still and activate emergency services rather than attempting self-treatment. 1

For non-traumatic "mechanical" neck pain: This represents 43% of neck pain cases in clinical trials and generally responds to conservative management 5. Most acute episodes resolve with or without treatment, though 50% of individuals experience some degree of ongoing symptoms 2.