Neck Pain - Stiff Neck, Cracking

For the last few weeks I’ve noticed that my neck has been extremely stiff, and usually once a day or sometimes twice I’ll tilt my neck as far as I can to the left and something will crack/shift. It doesn’t crack when I tilt it to the right. Also, for the last few weeks I’ve been getting migranes off and on - I never used to get migranes, and I’ve probably had five or six in the last month.

This stiffness/cracking can’t be a good thing. What can I do to fix it?

I’ve always been a library brat, so my neck is used to tilting to the right to read book spines, and last year I had a free consult with a chiropractor who measured the angles my neck could bend, and my neck could bend much farther to the right than it could to the left.

Um, random info that might be useful: I work 3rd shift and go to school full time, so I average around 5 hrs of sleep a day during the week, slightly more on the weekends. The building where I work is always cold - I often have to wear a jacket despite being indoors and occasionally even grab a blanket and sit wrapped in it.

I’m 22 yrs old. I’m very obese (375lbs) which is probably adding to the strain, but I’m on Optifast to lose the weight.

Another random thing I can’t explain: for a couple years now, I’ve noticed that whenever I’m particularly stressed or tired, my head will suddenly jerk to the right: I’ll be looking straight ahead and feel a little twitch in my neck, and the next thing I know I’m looking to the right. This isn’t painful, just strange and worrying. Is this a symptom of a more major problem?

An update: Work hasn’t been as cold as it was back in October, and I’ve noticed that I’m not getting the migranes anymore, so I’m reasonably certian those were linked. My neck still cracks approx. once a day when I tilt/stretch my head to the left. It’s not really painful, but there’s always a loud crack and the feeling of something shifting. Every once in a while it won’t crack one day, and then the next day I’ll tilt my head to the left and there’ll be either two or three swift cracking sounds “CRACRACRACK”. One time my neck did a triple-crack and my roommate heard it on the other side of the living room. The stiffness is gone for a little while after it cracks, but then it starts building up again. The doctor at Optifast said that it might be arthritis and suggested that I see my primary physician, but my schedual is hectic and I haven’t had a chance to go in yet. Do you have any advice?

Dr. Joshua’s Answer:

You’ll have to ask your own doctor to evaluate this problem. I can only offer some ideas based on what you’ve written, and without the benefit of a physical examination, I can’t say for sure what’s causing these symptoms.

Keeping the above in mind, it sounds like you may have a tension neck problem. Your neck muscles are under a lot of strain, and this may result in an imbalance of the forces exerted by those muscles on your cervical spine. This in turn may lead to a slight shifting and improper positioning of the small joints that connect the vertebrae, resulting in a situation where the joints become locked into a slightly wrong position, and cracking realigns the joints. This is one possibility anyway. Of course, I can’t say this for sure in your specific case, but generally speaking this may be a possible mechanism behind symptoms such as yours. Headaches are often also related to neck muscle tension.

Congratulations on your decision to lose weight. Take this very seriously, and don’t give up. Spine problems as well as other muscle and bone problems are often related to obesity, and as I’m sure you know, these are some of the least dangerous complications of obesity. Keep up the good work!

Some measures, in addition to weight loss, you can take to prevent this neck problem: Exercise. Ask your doctor or someone with expertise in this area about exercises you can do to strenghten and loosen your neck mucles. Specific neck exercises are not necessarily the key - just generally being active and avoiding sitting or lying down in a fixed position will help. Go for walks out of doors. Work / study ergonomics are important, try not to bend your neck when browsing the books, see if you can utilize a computerized search, and also don’t sit in front of the computer for more than an hour at a time, take 10 minutes to stretch out and mobilize your neck for each hour. Make sure your desktop ergonomy is good, and so on.

I realize that I’m not able to offer a magic trick to make this problem go away, but musculoskeletal problems usually need a long-term solution and are related to lifestyle and ergonomics.

Before you take any of the above advice, visit your doctor to see if he/she agrees on all that, to make sure. Keep us posted!