What Causes Tightness in the Side of the Neck?

by Chris Centeno, MD /

I’ve already told you about my left upper trap; now meet my left scalene. When I lift too much, these muscles, which live on the side of the neck, get tight. Why?

The Scalene Muscle

The scalene muscles make up a large-muscle group that lives on either side of the neck, connecting the neck to the ribs. You can experience tightness in these muscles while lifting weights (e.g., benching or deadlifting) or doing work above your head or even just with driving or using your arms in a way that works the scalene muscles. If you have a consistent forward-head type of posture, these muscles can be chronically tight, and on the video, I provide a stretch that can help you open up your chest and hips if this is an issue for you. Scoliosis, meaning a side-bent spine, can also make one side of the neck tight because it’s literally being pulled away from the ribs.

If stretching the scalene muscle out doesn’t seem to hold and the tightness in the side of the neck continues, this big muscle may be doing work it wasn’t meant to do, and you may have a bigger problem that needs to be addressed before more damage is done.

Your Large Scalene Muscle May Be Compensating for Small Weak Muscles

The spinal column consists of bones that sit one on top of the other called vertebrae, and the neck segment of the spine is called the cervical spine. Between each cervical vertebra are small multifidus neck muscles (e.g., semispinalis capitis, splenius cervicis, etc.), and these deep muscles actually function to stabilize one neck bone on the other every time you turn or bend you head or neck. Watch the video above for a moving image showing cervical vertebrae functioning properly with a stabilizing multifidus muscle.

If these small muscles atrophy (shrink) and become weak, this can cause excessive motion between the vertebrae, and the big scalene muscle (or other large muscles, such as the trapezius and levator scapula) may be recruited to step in and do their job, a function is was never intended to do. Tightness in the side of the neck can then be the result of an overworked scalene muscle.

What could cause a multifidus muscle to atrophy? Typically this would be a nerve injury, such as a pinched nerve, or neck injury. Even an older long-forgotten, or even unknown, injury can cause a gradual decline of the small neck muscles. You may just experience tightness in the side of the neck but otherwise feel strong, or you may have accompanying neck pain and headaches or even a feeling that your head is just too heavy for your body.

Watch the video to see an image of normal neck muscles providing stability and protecting the structures of the neck compared to an image of atrophied neck muscles resulting in unstable movement and painful joints, discs, and nerves.

Ways to Treat Tightness in the Side of the Neck and Weak and Other Neck-Muscle Issues

Weak neck muscles can be treated nonsurgically to help relieve the scalene muscle from its extra duties and relax the tightness in the side of the neck. Some ways to treat these muscles that cause tightness in the side of the neck include the following:

  • Slow neck range-of-motion exercises (arms at sides), twice a day. This is where you slowly look up, down, right, and left. This will stimulate those small muscles.
  • Physical therapy from an expert provider
  • Platelet-rich plasma (PRP) into the neck joints into the affected-muscle levels
  • PRP or stem cell injections to tighten up loose ligaments in the neck

People often turn to nonsteroidal anti-inflammatories (NSAIDs) for pain relief, but due to the dangerous side effects we don’t recommend these drugs. Likewise, it’s best to avoid steroid injections as these destroy cartilage and carry other risks or Botox injections, which may cause more muscle damage.

The upshot? Your upper trap and scalenes are both muscles that compensate for weak neck stabilizing muscles. So just continuing to blindly stretch these tight muscles day after day without asking why the tension keeps coming back may be one of the definitions of insanity, You know the one, where you keep doing the same thing to get the same poor result!

Category: Neck/Cervical

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14 thoughts on “What Causes Tightness in the Side of the Neck?

  1. Colette Scott

    Thank you for your informative article at last I know what my neck problem is.

    Something really odd happened a week ago, my son’s girlfriend gave me a big hug, she had her one arm around my neck and i was thinking…….oh my gosh my neck is SO SORE!
    Well as she let go there was an almighty cracking sound that she even heard and we looked at each other in horror and I was to scared to move…..but the wonderful thing was that I felt so much better, the pain is still there but the awful stiffness has gone.

  2. Tina

    Very informative article. I have nit received any of this information from any of my doctors or PT’s about this possibly being a cause of scalene and trapezius tightness that will not release.
    How would Is one diagnosed with weakness in the smaller neck muscles?

    1. Regenexx Team Post author

      Tina,
      Symptoms give us a very good idea, but to treat both an MRI and extensive exam completes the diagnostic process.

      1. Tina

        I’ve had an MRI of my cervical spine in February. It showed mild degeneration at C6 and mild stenosis at C4. My first rib is elevated. Is an MRI needed for the neck muscles or is the one in the cervical spine enough? My Scalene, trapezius, levator, splenius, SCM, rhomboids are all tight. Im having difficulty maneuvering testing for thoracic outlet syndrome. The EMG only showed ulnar nerve entrapment and the hand surgeon wants to do a transposition surgery on both elbows, which will still leave me with some symptoms and not help anything above the elbow. I didn’t see ulnar nerve listed as one of the procedures done by the Seattle doctor. Is there a doctor in the NW that treats the elbow and could do an extensive exam on the neck muscles?

        1. Regenexx Team Post author

          Tina,

          Please see above.

      2. Tina

        I had a cervical MRI last February. I have symptoms of thoracic outlet syndrome, but the EMG only showed ulnar nerve entrapment at the elbow and am told transposition surgery on both elbows is my only option for improvement. I would still have symptoms. Ive had PT, OT, chiropractic care and massage and no one can get my scalene, traps, lavatory or SCM to release. Any relief is very temporary. I didn’t see that this procedure or a procedure for the elbow is done in the Seattle area. Is there a Regenexx doctor in the NW that does these exams and procedures?

        1. Regenexx Team Post author

          Tina,
          It’s very unlikely that that surgery is needed or would help. Please see: https://regenexx.com/blog/nerve-regeneration/ and https://regenexx.com/blog/hands-numb-while-sleeping/ Dr. Attaman in Seattle would be able to do the Candidacy Evaluation and exam to determine what’s actually wrong. He treats both Spinal and elbow issues. Please see: https://orthoregenerative.com/

          1. Tina

            Fantastic! Thank you for the informative.

  3. Steve Trivoli

    Yes
    for over 15 years and counting I have a had the issue on the left side of my neck. It radiates down to and through the inside of my shoulder blade. I have always had a mild case of scoliosis which I’m sure contribute to the issue. My question is, what is the % of success with the PRP procedure?

    1. Regenexx Team Post author

      Steve,
      We use several different types of Platelet procedures. To answer the your question, we’d need to diagnose your particular problem and based on that diagnosis, determine the right procedure to address it. Overall, patients generally experience significant improvement in pain and function.

  4. Bryan Oneill

    Is there any evidence this is the cause of the muscle tightness or is this just your theory ?

    1. Regenexx Team Post author

      Bryan,

      It’s well documented. Please see: https://regenexx.com/blog/how-to-recover-from-neck-pain/

  5. Stacy

    During certain seasons (pollen, the flu or even stress) causes my neck muscles on both sides to become so tight. Then I lose my voice for weeks. I have been to vocal cord specialist years ago which this came info out when they sent me to a speech therapist. Anyway – I got the flu in January and since then my voice is gone. The Pollen count is so high which makes it worse. Today I noticed a huge relief in my neck muscles and my voice coming back a little more. Have you heard of this at all? It’s something I’ve really been noticing for years but don’t know how to stop the tightening of my neck muscles. Please help.

    1. Regenexx Team Post author

      Stacy,
      As we have found out, it is unfortunately quite difficult to get to the bottom of these types of issues in today’s medical system. Please see: https://regenexx.com/blog/the-least-common-denominator-paradox/ and https://regenexx.com/blog/steady-decline-good-doctoring/ Have you looked into what may be causing inflammation? We could rule in or out neck related issues.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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