What Causes Tightness in the Side of the Neck?

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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.

Tight Scalene Muscles

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 in 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.

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Scalenes Compensating for Other 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 your head is too heavy for your body (1).

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

Weak neck muscles can be treated non-surgically 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 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 (2). 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 (3, 4).

The upshot? Your upper trapezius 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!



(1) Elliott JM, Courtney DM, Rademaker A, Pinto D, Sterling MM, Parrish TB. The Rapid and Progressive Degeneration of the Cervical Multifidus in Whiplash: An MRI Study of Fatty Infiltration. Spine (Phila Pa 1976). 2015;40(12):E694-E700. doi:10.1097/BRS.0000000000000891

(2) Arfè A, Scotti L, Varas-Lorenzo C, et al. Non-steroidal anti-inflammatory drugs and risk of heart failure in four European countries: nested case-control study. BMJ. 2016;354:i4857. Published 2016 Sep 28. doi:10.1136/bmj.i4857

(3) Murray RC, DeBowes RM, Gaughan EM, Zhu CF, Athanasiou KA. The effects of intra-articular methylprednisolone and exercise on the mechanical properties of articular cartilage in the horse. Osteoarthritis Cartilage. 1998;6(2):106-114. doi:10.1053/joca.1997.0100

(4) Al-Al-Shaikh M, Michel F, Parratte B, Kastler B, Vidal C, Aubry S. An MRI evaluation of changes in piriformis muscle morphology induced by botulinum toxin injections in the treatment of piriformis syndrome. Diagn Interv Imaging. 2015;96(1):37-43. doi:10.1016/j.diii.2014.02.015

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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. View Profile

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NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.