Neck Stiffness & Hypomobility

Treatment by Physical Therapy

By Mahnoush Rodriguez
Videos by Dr. Saeed Monterrey, PT, DPT, OCS

Neck hypomobility is an excessive stiffness within the cervical joints and one of the causes of neck pain. Neck stiffness can limit the normal movement and range of motion in the neck and cause pain.

People with stiff neck often find it difficult and painful to turn their head to the side. And they may feel an overall discomfort with their daily activities such as reading, lifting and sleeping.

Important Note

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Neck Structure

First, let’s take a look at the neck structure and become familiar with parts of it that affect neck mobility.

Cervical Spine

The upper part of the spine is called the cervical spine. It houses bones, nerves, muscles, joints, ligaments, tendons and other connective tissues. The connective tissues enable the neck to function correctly and be flexible and mobile.


Cervical Vertebrae

The cervical spine is comprised of seven bones often referred to as C1 to C7 that protect the spinal cord. Also known as Atlas, C1 connects to the base of the skull while C7 connects to the top of the thoracic spine in the upper back. The rest of the cervical vertebrae, C2-C6 are located in between these two.

Cervical Discs

There are six intervertebral discs in the cervical spine, one between each vertebra, except between C1 and C2 – also known as Axis. These discs, made of a spongy material, give a shock absorption quality and limited flexibility to the cervical vertebrae.

Facet Joints

At the back of each vertebra, there are two sets of joints called facet joints. The surface of the facet joint is covered by a rubbery material called articular cartilage. The cartilage lets the bones to move against each other and glide smoothly. Each joint has a capsule filled with synovial fluid that adds lubrication to the joint. This structure allows for increased joint mobility.

Except for C1, each vertebra has two facet joints on each side. The facet joints on the top, facing upward, connect with the top vertebra and the joints facing downward connect with the below vertebra. The facet joints along with the intervertebral discs create support and stability. They permit the neck to move in different directions and provide flexibility and mobility in the cervical spine.

Neck Stiffness and Joint Hypomobility

VIDEO: Neck Pain and Stiffness due to Hypomobility

Watch the full video by Dr. Saeed Monterrey, PT, DPT, OCS

Hypomobility is an excessive stiffness in the joints which causes resistant to movement and reduces the expected range of motion. If the facet joints become restricted in their movement due to degeneration, arthritis, history of trauma or bone spurs, it can lead to pain or instability in the neck.

When neck hypomobility happens in one part of the neck, for example between C5 and C6, it reduces the joint mobility in that area. To compensate for the loss of motion, when the neck needs to move, it shifts the movement to the other parts of the neck that is more flexible, for example to C3 and C4.

The shift of movement from the damaged sections of the neck to the healthy ones puts more stress on the healthy joints which are the joints in the middle part of the neck in this example. It may also lead to more stiffness and pain in the damaged area over time that is the lower neck in this case.

If hypomobility sneaks in due to degeneration, arthritis, history of trauma or bone spurs, it can lead to stiffness in one of these joints.

Dr. Saeed Monterrey, PT, DPT, OCS

Cycle of Pain

When the neck pain is left unresolved, a cycle of pain can happen. The pain can cause the muscles in the damaged site to go into spasm to protect the joint and guard it against further injury. The pain can also prevent the normal movement in the joint which can lead to a cycle of more contractions and more pain.

Pinched Nerve in The Neck

The stiffness in the neck can cause a pinched nerve. If a nerve is pinched, it can cause headaches, shoulder pain or pain in the arm and even fingers. The pain may appear as radiating pain, numbness or a tingling sensation.

Stiff Neck Headache

If the stiff neck occurs in the upper part of the neck, it can cause a headache that starts in the back of the head and moves forward by the eyes in a ram horn pattern.

Neck and Shoulder Pain

If the stiff neck occurs at the bottom of the neck, it can cause pain that emanates down into the shoulder blade or even all the way down to the arm and fingers which may be accompanied by numbness and tingling in those areas.

Treatment with Physical Therapy

Despite the relatively high prevalence of cervical spine pain, there are not many high-quality clinical studies that measure and support the efficacy of different techniques used to treat this type of neck condition.

Some studies suggest that a multi-dimensional approach including joint mobilization, joint manipulation, and therapeutic exercise could be used to treat neck pain effectively.

Joint Mobilization


Joint mobilization is a treatment used to target the joint to restore or to enhance its function. It is like a massage for the joint performed by a skilled physical therapist. With repeated stretching, slow movement and gentle pressure to the joint, this technique helps the neck muscles to relax. Joint mobilization can also lead to increased lubrication on the joint surface and can allow the tissue around the joint to remodel.

Joint Manipulation

Joint manipulation is another technique for joint mobility improvement and pain reduction.

It is a quick impulse in mid-range with proper mechanics to help free up the joint.

Many patients might hear a pop or a click during the treatment followed by decreased pressure in the neck and improved mobility.

Therapeutic Exercise

Therapeutic exercises usually added to treatment after above techniques have improved the neck mobility and pain. These exercises are neck movement patterns aimed to improve function and decrease neck pain and stiffness.

Neck Structure Image Credit: [Sebastian Kaulitzki] ©
Header Image Credit: [Antonio Guillem] ©

Share Your Thoughts

I hope you found this article helpful.

Now it’s your turn!

Have you ever had a stiff neck and pain? What was your experience like? 

How did it impact your daily activities? Did you seek treatment? How was it? Could it completely resolve your neck stiffness and pain?

Please share your thoughts below.



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Please note that the information compiled in this article is from a variety of sources and it may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. Always seek the advice of a doctor or other qualified health providers with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. Learn more

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