Physical Exam

Nuchal Rigidity

🎬

Video coming September 2026

How to Perform

With the patient supine, support the head and gently flex the neck, bringing the chin toward the chest. Nuchal rigidity is present when there is involuntary resistance to passive neck flexion, while side-to-side rotation remains relatively preserved.

How to Interpret

Meningitis

Neck stiffness

Rule in

Not helpfulDerived CI

Rule out

Not helpfulDerived CI

Evidence:Limited

Stroke

Hemorrhagic Stroke

Neck stiffness

Rule in

Helpful

Rule out

Not helpful

Evidence:Strong

References

Thomas KE, Hasbun R, Jekel J, Quagliarello VJ. The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis. Clin Infect Dis. 2002;35(1):46-52. doi:10.1086/340979. PubMed: 12060874
Runchey S, McGee S. Does this patient have a hemorrhagic stroke? Clinical findings distinguishing hemorrhagic stroke from ischemic stroke. JAMA. 2010;303(22):2280-2286. doi:10.1001/jama.2010.754. PMID: 20530782.
Backes D, Rinkel GJE, Sturkenboom AJJ, Vergouwen MDI. Time-dependent test characteristics of neck stiffness in patients suspected of nontraumatic subarachnoid haemorrhage. J Neurol Sci. 2015;355(1-2):186-188. doi:10.1016/j.jns.2015.06.016. PMID: 26115913
McGee S. Evidence-Based Physical Diagnosis. 6th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 9, 2026.