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  • Dr. James Fonner

Nuchal Rigidity: Why It Might Signal Meningitis

Meningitis is a very serious condition that happens when the meninges (protective membranes that cover the spinal cord and brain) become inflamed and infected. The early symptoms can actually be similar to the flu. Typically the person feels like they have a stiff neck and can't flex fully, which is nuchal rigidity. They may also run a fever. Since it is severe, the person should be checked out by a medical physician.

There are multiple meningitis types, but the two most common options are bacterial and viral. When someone contracts meningitis of a bacterial nature, immediate medical attention is necessary or permanent disability or death can occur. Getting the right information about this condition is the first step.

Common meningitis symptoms

Common Meningitis Signs

Meningitis often starts suddenly. People can have early symptoms, such as these:

  • Fever - When the immune system is compromised, the body runs a fever to kill off the infection. Fevers can run up to 103 degrees with meningitis.

  • Headache - Typically, a meningitis headache is unrelenting and extreme. They don't go away when you take an aspirin.

  • Nuchal Rigidity - Often, nuchal rigidity means that a person can't flex their neck forward. The physician might call it a stiff neck, but it's the same thing. Depending on how severe the nuchal rigidity is, the neck muscles might only flex half of what they could before or may not flex at all.

Other symptoms can develop, including sensitivity to light, vomiting, nausea, and cognitive problems.

It's important to get the right information so that it can be treated quickly. Adults and children can both get meningitis, and their health can suffer significantly. When the neck doesn't flex correctly, testing is essential. Both bacterial and viral meningitis are contagious. It's important to know the signs and what to do if someone in the household is positive.

Diagnosis of Meningitis

There's important information about spinal meningitis and how it can cause inflammation in the neck muscles. When this condition is suspected, tests must be done to determine if that is the cause. One thing medical doctors often ask is the overall health of the person and whether or not they can move the neck forward like they used to.

In the search for information, it's important that people understand that meningitis requires the help of a medical professional. Online resources and data aren't enough to protect a person. Though the primary features are easy to spot, the illness can cause death and permanent disability. The right diagnosis is essential and can only happen by a medical physician. This is an emergency situation, so do not delay when seeking treatment.

The physician is going to focus on the patient's history, and a physical exam is performed. Diagnostic tests are also completed. Often, these are the ones used, and it's important to have the right information about them:

  • Spinal Tap - The spinal tap is often referred to as a lumbar puncture. It requires a needle to be inserted into the spinal canal within the lower back. This is a safe distance from the spinal cord. From that, a sample is drawn of cerebrospinal fluid. Lab tests can be run on this fluid to measure protein, glucose, red/white blood cells, and to find out which bacteria or virus is present. This spinal tap and the other testing options are critical. Medical doctors can get a lot of information to provide the right diagnosis.

  • Blood Test - Blood tests can also be used before the spinal tap to quickly analyze the inflammatory markers that suggest an infection or illness. Sometimes, it can indicate meningitis is unlikely. When that happens, the patient must have the invasive spinal tap to determine a positive or negative result.

  • Imaging Study - Information is critical, and time is of the essence. Therefore, the next option is an MRI or CT scan, which can be done before the spinal tap, as well. If the symptoms show a neurological deficit (light sensitivity or confusion), this is often the first step by health providers. Imaging studies can also show brain swelling and give more data that the medical professional needs.


The patient needs to have the right information, which shows them that they need to go to a health professional. However, minutes matter when treating bacterial meningitis. Medical doctors can't wait days or hours to find out if a lab comes back positive or that the virus or bacteria is present. If a medical professional believes that meningitis is the culprit, the health of the patient is at risk. Therefore, medical doctors are going to start treatment immediately while other diagnostic tests are run.

When more information is presented, the official diagnosis is rendered. Rest, fluids, and good nutrition are important for viral meningitis, and there's plenty of information out there about how to protect a person's health. However, people with bacterial meningitis require an antibiotic that specifically targets that bacteria.

What are meninges?

Meninges - What They Are and How it Relates to Nuchal Rigidity

Most people have stiff neck muscles periodically, and this can happen for many reasons. The health of the person is often not to blame. For example, a strenuous workout could cause stiffness. This nuchal rigidity is going to go away with time. Forward flexion is important. Adults should focus extensively on their health and pay close attention to data out there.

The meninges are the protective layers that cover the spinal cord and brain. They can also direct more blood flow to the brain or skull while transporting cerebrospinal fluid. This gets formed in a person's brain and can flow freely throughout the cranial meninges into the spinal bones.

Clinical Tests Might Not Help for Meningeal Inflammation

It's important to have the right information and understanding of nuchal rigidity and meningitis. The meninges cover the person's spinal cord and brain. A person's spinal cord runs through the neck and torso and stops right before the low back. The neck is the most mobile here. If those meninges get inflamed and are painful with movement, it's most noticed in the neck muscles.

If a patient has suspicions for meningitis, they may complain of a headache, nuchal rigidity, and more. They should focus solely on their health and get to a medical professional for diagnosis and important information. Clinical tests could be performed by a medical doctor, and these include:

  • Nuchal Rigidity - Nuchal rigidity happens when a patient can't move their neck forward all the way. This can occur when the neck stiffens to avoid any painful movement. Nuchal rigidity can occur in other conditions, so it isn't the only indicator.

  • Brudzinski's Sign - Brudzinski's Sign is the next testing option. The person lies on the back with the head lifted upward. When the knees and hips flex, the Brudzinski's sign is positive. In theory, when the neck moves upward, the inflamed meninges have to stretch. That means the hips and knees move reflexively to reduce tension. This health concern is serious, but the Kernig's Sign might also be used.

  • Kernig's Sign - When the person lies on their back, one knee is lifted so that the leg gradually extends for the Kernig's sign test. If the results are painful and there's resistance to straightening the leg, the Kernig's sign is positive. Kernig's sign testing is often done in conjunction with others. They're quick to perform by a medical doctor. Since the person's health is at stake, this is a good thing.

Most clinical studies show that these tests aren't great for diagnosing meningitis. However, positive results for Kernig's sign paired with a headache and fever can indicate the likelihood that it's present.


People must pay attention to their health and go to a doctor when an issue arises. Typically, nuchal rigidity can occur with many conditions and neck decompression can usually help. A stiff neck is all it really indicates. If there aren't any other problems, such as neck crepitus, other tests must be completed. It could be a slipped disk in the neck or elsewhere in the body.

Most health professionals and chiropractors realize that a stiff neck can happen when someone coughs a lot or has a tension headache. However, without the right information and treatment, people can die.

There is plenty of information about meningitis, and it's important not to take a person's health for granted. Therefore, take any complaints about a neck flex issue seriously.

Without the right treatment, death or permanent disability can occur. It's important to get the head and neck checked out thoroughly. Ultimately, chest x-rays aren't necessary, but a doctor might choose to include them for different reasons. Typically, the tests are done with the person lying on their back. One knee or both might also be tested.

It's important to include similar testing and check for other issues. Though one of the features of meningitis is nuchal rigidity, search for others. Remember, this is an emergency situation, so the right resources are required.

Ultimately, the chest and back are checked, but neck stiffness is also considered. During the search for answers, time is of the essence. Meningitis is an emergency and can cause significant problems now and in the future.

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