A guide from Dr Beate Helgers’ private orthopaedic practice in Steinfurt.
Suddenly, your head is tilted slightly to one side, your shoulder is raised, and turning to the right or left is uncomfortable – or your neck has felt stiff and immobile for days. Many patients simply describe this as a ‘crooked’ or ‘stiff’ neck.
Medically speaking, there can be a wide variety of underlying causes. Often, the muscles and joints in the cervical and upper thoracic spine are involved. Sometimes posture plays a part, sometimes an unusual strain, and sometimes an irritated nerve. Rarely is there an underlying issue that needs to be investigated urgently.
For Dr Beate Helgers, therefore, the crucial question is not whether a neck looks ‘stiff’. What is more important is: how long has the poor posture been present? Which movements are restricted? Does the pain radiate? Is there any tingling, numbness or loss of strength? And what happens when the patient moves?
Key points at a glance
A stiff or crooked neck is often caused by muscular or functional factors, but cannot be assessed on the basis of its external appearance alone.
For uncomplicated neck pain, movement is usually more beneficial than prolonged rest.
Heat, gentle movement and suitable exercises can help with simple muscle tension. They are no substitute for a medical examination if symptoms persist or worsen.
X-rays or MRI scans are not automatically necessary for new-onset, non-specific neck pain.
Tingling, numbness, loss of strength, problems with fine motor skills or balance should be investigated by a doctor.
Following an accident, or in cases of severe neck stiffness, fever or neurological deficits, an appointment with a specialist in orthopaedics should be made immediately.
What exactly is meant by a ‘crooked neck’?
‘Crooked neck’ is not a medical term. Some people use it to describe a head that is pushed forwards and shoulders that are hunched up. Others suddenly find they can only hold their head in one direction. Still others describe a posture that has changed over a period of months.
These differences are important. A head that is acutely tilted to one side after sleeping or following a sudden movement is different from a long-term posture with the head pulled forwards. And both need to be assessed differently if pain radiates into the arm or hand.
That is why effective treatment does not begin with an attempt to ‘straighten’ the neck as quickly as possible. First, it should be clarified why the body is adopting this posture.
Why does the neck become so stiff?
The cervical spine must, on the one hand, be very flexible and, on the other, support the head stably. Small joints, intervertebral discs, muscles, fasciae and the shoulder girdle all work closely together to achieve this.
Typical triggers for a tense neck can include:
sitting for long periods in front of a screen or working in a static position
unfamiliar strain or intensive exercise
an awkward sleeping position
shoulders held high for prolonged periods
muscle imbalances or shortened tissues
restricted mobility of the cervical or thoracic spine
Stress and persistently increased muscle tension
Often , there is no single cause. Particularly in the case of recurring symptoms, several factors come into play.
Is posture to blame?
Many people look at themselves in a full-length mirror and are alarmed to see their head jutting forwards. This quickly leads to the assumption: ‘My posture is wrong – that’s why my neck hurts.’
The connection isn’t quite that simple. There is no single ‘perfect’ posture that everyone has to maintain all day long. Problems can arise, in particular, when the body hardly changes position over long periods or when certain movements are no longer easily possible.
In practice, therefore, it matters less whether a patient is standing perfectly straight in a photograph. What is more important is whether their posture can be adjusted, how the cervical spine, thoracic spine and shoulder girdle move, and whether certain stresses reliably trigger symptoms.
When the head is suddenly tilted
A head that is suddenly held at an angle is often colloquially referred to as ‘wry neck’. This may be caused by painful muscular protective tension. The body then seeks a position in which the affected area hurts less.
This does not automatically mean that a vertebra is ‘dislocated’. Particularly in the case of acute symptoms, it is important not to use force to counteract this protective tension.
If a tilted neck occurs following an accident and is accompanied by severe headaches, a fever, pronounced neck stiffness or neurological symptoms, the cause should be investigated by a doctor as soon as possible.
A stiff neck: what can you do yourself?
According to Dr Beate Helgers from Steinfurt, simple measures may be helpful initially for mild, newly developed symptoms without any warning signs.
1. Keep moving
The urge to avoid moving your head as much as possible is understandable. However, in cases of uncomplicated neck pain, prolonged rest is usually not helpful. Small, pain-free movements spread throughout the day are often more beneficial than keeping the neck completely still.
2. Try applying heat
Many patients find heat soothing for muscular tension. Whether it’s a heat pad, a warm shower or a short walk with your neck well protected – the key is whether it actually makes you feel better.
3. Design your workspace to be not just ‘ergonomic’ but also flexible
Even the best sitting position loses its value if you remain in it for four hours. Changing position frequently, taking short walking breaks and alternating between sitting and standing are often more important in everyday life than searching for a single ‘perfect’ posture.
4. Don’t approach exercises with the ‘more is better’ mindset
Gentle flexibility or strengthening exercises can be beneficial. However, an exercise programme should be tailored to your specific symptoms. If a movement repeatedly triggers pain in your arm or hand, increases numbness or causes significant dizziness, you should not simply carry on doing it.
What should you avoid doing?
Forcibly ‘pop’ your neck back into place yourself
A cracking sound is no proof that a joint has been put back in the right place. Furthermore, abrupt self-manipulation does not address the underlying cause of the symptoms.
Wearing a neck brace for days on end
A neck brace may be medically necessary in specific situations. However, for ordinary muscle tension, prolonged immobilisation is not usually the solution.
Avoiding any movement
Adopting a protective posture may provide short-term relief. If this becomes a permanent habit, mobility often continues to decline.
Wanting to explain every instance of neck pain immediately with an MRI scan
Imaging can be important if certain warning signs are present or symptoms persist. However, in cases of non-specific neck pain, X-rays or MRI scans often reveal changes that are not clearly related to the current symptoms.
When is an orthopaedic examination advisable?
An appointment, for example at the private orthopaedic practice in Steinfurt, is advisable if the symptoms do not improve significantly within a few days, recur repeatedly or mobility remains noticeably restricted.
The following situations also warrant a targeted examination:
Pain radiates into the shoulder, arm or hand.
Tingling or numbness occurs repeatedly.
The head remains visibly tilted for a prolonged period.
The hand becomes less dexterous or strength in the arm decreases.
Neck pain keeps returning whenever the same strain is applied.
The symptoms persist for several weeks despite the patient’s own efforts to alleviate them.
Neck and shoulder problems are accompanied by recurring headaches.
How does Dr Beate Helgers in Steinfurt examine a tense neck?
At her private practice in Steinfurt, the examination begins with a simple question: What exactly are you currently unable to do as you normally would because of your symptoms?
After that, it is not just the painful area that is examined. Depending on the symptoms, the following points, amongst others, may be assessed:
Mobility of the cervical spine
Mobility of the upper thoracic spine
Shoulder and shoulder blade function
Muscle tension and possible shortening
Reflexes, strength and sensation in the arms and hands
Posture and movement patterns
The relationship between daily life, work, sport and symptoms
This reflects the practice’s guiding principle: understand first, then treat. Particularly in the case of long-standing symptoms, it is important to know what has already been investigated and which measures have actually helped.
Do you need an X-ray or an MRI scan for this?
Not necessarily. In cases of acute neck pain with no evidence of a structural condition, routine imaging is not recommended. If symptoms persist or worsen over several weeks despite appropriate treatment, or if neurological abnormalities are present, the need for further diagnostic tests may be reassessed.
When deciding on a course of treatment, it is therefore not only important what is visible on an image, but also whether the findings, the examination and the symptoms are consistent with one another.
What treatment options are available?
Treatment depends on the findings. Not every case of a stiff neck requires the same treatment.
Dr Beate Helgers’ treatment approach in Steinfurt is based on three steps: first, alleviating symptoms to the extent that movement is possible again; treating functional causes and the structures involved; and finally, improving resilience and stability.
Manual medicine and chiropractic therapy
In cases of functional movement restrictions, mobilisation techniques from manual medicine may be considered. However, it should first be clarified whether the symptoms are actually suitable for such treatment.
Not every restriction of movement can be effectively ‘mobilised away’. Shortened muscle or tendon structures, for example, require a different approach and, where necessary, supplementary exercises.
Exercises and active stabilisation
If neck complaints recur repeatedly, short-term relief is often insufficient. In such cases, it may be beneficial to specifically develop strength and coordination in the neck, shoulder blades and trunk.
Depending on the findings, postural and movement analyses, as well as medical exercise therapy, can also be incorporated into the treatment plan at the practice.
Further treatments
Depending on the cause and findings, additional treatments such as acupuncture, electrotherapy, neuromuscular electrical stimulation or other pain management measures may be considered in Steinfurt. What matters is not the number of treatments, but whether they are suitable for the specific issue at hand.
What works – and what doesn’t?
What may be beneficial
What cannot be reliably promised
Carefully examining symptoms and movement patterns
Deriving a diagnosis from posture alone
Gentle exercise and activities suitable for everyday life
Eliminating all neck pain through rest
Tailoring treatment to the cause and findings
‘Straighten everything’ permanently with a single movement
Actively stabilise the area in the event of recurring symptoms
Automatically identify the cause of pain from signs of wear and tear visible on MRI scans
Take warning signs seriously and investigate them thoroughly
Present a specific treatment as the right choice for each patient
When should you not wait to seek treatment for neck pain?
Most neck complaints are not a medical emergency. However, there are symptoms where prompt medical attention is important.
Neck pain following an accident
severe stiffness of the neck, particularly when accompanied by a fever or a severe feeling of being unwell
new-onset symptoms of paralysis or a marked loss of strength
Persistent numbness or increasing problems with the arm, hand or fingers
Problems with balance or gait
Severe headaches accompanied by nausea, vomiting, dizziness or sensitivity to light
Constant severe pain at rest and when moving
unexplained weight loss, fever or chills
If you experience any of these symptoms, you should not wait for a routine appointment.
Get your neck pain checked out in Steinfurt
If your neck is repeatedly tense, visibly misaligned or has limited range of movement, it is worth having it examined thoroughly. The aim is not to achieve a supposedly ‘perfect’ posture. What matters is to restore movement that is resilient and as pain-free as possible, and to identify the factors that repeatedly trigger the symptoms.
Dr Beate Helgers’ Private Orthopaedic Practice Wippert 8A · 48565 Steinfurt
Frequently Asked Questions – to complement the guide
Can the wrong pillow cause neck pain?
A pillow can affect the position of your neck whilst you sleep. If you regularly experience discomfort after sleeping, it is worth taking a look at your sleeping position, mattress and pillow height. However, persistent neck tension can rarely be explained by simply changing your pillow.
Can teeth grinding make neck tension worse?
The muscles of the jaw, neck and shoulders influence one another. If you suffer from night-time teeth grinding, jaw problems or morning stiffness, we also include the jaw area in our assessment at our practice in Steinfurt.
When is a posture or movement analysis advisable?
It may be useful if symptoms recur, consistently worsen during certain activities, or if there is a suspicion that several parts of the body are involved.
Can I do sport if I have a stiff neck?
In cases of mild discomfort with no warning signs, it is often possible to adjust one’s activity level accordingly. Exercises that significantly increase pain or trigger discomfort in the arm and hand should be avoided for the time being. Following an injury or in the event of neurological symptoms, it is advisable to seek medical advice first.
Is a standing desk automatically better for your neck?
Not necessarily. Even when standing, you can remain in a rigid position for a long time. The key is to vary your posture: sit, stand, walk and move your upper body regularly.
Why does my neck crack even though I’m not in any pain?
Joint noises can occur without any underlying medical condition and are not, in themselves, a reason for treatment. They become particularly relevant when accompanied by pain, a sensation of the joint being locked, neurological symptoms or a significant restriction in movement.
Can dizziness be caused by the neck?
Dizziness can have many possible causes. As it may be caused by conditions outside the field of orthopaedics, recurring or newly occurring dizziness should not be hastily attributed to the neck. To assess this, if you are experiencing dizziness, you should book an appointment at our practice in Dorsten-Lembeck, Ahaus, Gescher or Steinfurt as soon as possible.
Is your neck constantly stiff?
If you’ve lost mobility, are experiencing recurring pain or find yourself constantly tilting your head to one side, the cause should be investigated more closely. At our private orthopaedic practice in Steinfurt, we take the time to carry out a functional and orthopaedic assessment of your symptoms.
Dr Beate Helgers studied medicine at Ruhr University Bochum. Her medical training took her, amongst other places, to the University Orthopaedic Clinic at St Josef’s Hospital in Bochum, the Department of General and Trauma Surgery at Marienkrankenhaus Schwerte, the University Orthopaedic Clinic at RWTH Aachen University, and the Paracelsus Clinic in Marl.
In 1996, she obtained her PhD in orthopaedics, and in 1998 she was recognised as a specialist in orthopaedics. In 2011, she established her own private practice in Dorsten-Lembeck; since 2020, she has also had a branch in Ahaus. Today, Steinfurt and Gescher are also part of the practice network.
Her treatment approach combines orthopaedic diagnostics and pain management with an analysis of functional relationships and – where medically appropriate – active stabilisation and exercise therapy.
