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Gravidanza e post parto

Stiff Neck and Shoulders After Childbirth: Why It Happens

Team Ri-Hub15 min lettura

Revisione clinica: Daniele Carretto, Fisioterapista (Albo 2019) · Pubblicato il 16 luglio 2026

Una madre e un figlio che praticano yoga insieme a casa in una giornata di sole, promuovendo il benessere e la connessione.
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It is five past five. The baby has just fallen back asleep on your arm, you try to turn your head to see the time and you cannot. The back of your neck is one solid block, the right shoulder blade burns, and to look round you have to turn your whole body as if you were wearing a collar.

You have not done anything. You have not fallen, caught a chill or lifted anything heavy. You have only spent the last three nights in the same position, in the dark, with three and a half kilos resting on your forearm.

Two answers straight away. The first: it is the norm, not a failure on your part. In the studies of women who breastfeed, neck and shoulder pain affects between 48% and 73% of the sample.

The second, the one that changes something: it is not your posture that is wrong, it is the height of the baby. The postural gap between people with neck pain and those without is a few degrees, less than what separates adults up to 50 from those over 50. What shifts the load is more mundane: how high the baby comes up, and how many supports you have under your arms.

How common it really is

The figures come from different countries and different questions and should not be added together: wherever it has been looked at, a lot has been found.

Study What it found
Japan, 308 women at the first-month visit 73.1% with neck and shoulder pain
Poland, 395 breastfeeding women, online survey 48% with neck pain at least once a week
Nigeria, 310 mothers at postnatal clinics 51.7% with neck pain linked to breastfeeding

The Japanese study contains the detail that matters most to you: of that 73.1%, in a quarter of cases the pain had appeared after the birth. It is not an old problem coming back, it is new. And the most affected area was the upper trapezius, where you put your hand when you say "here".

Why it happens right now

Nothing traumatic happened. Everything came together, through repetition.

Hours in the same position. The load does not come from weight, it comes from time. In the Polish survey, women with back pain (there the comparison is on spinal pain, not on the neck alone) spent more time on each feed (p < 0.05) and had a higher total daily time (p < 0.01) than those without; among the 471 Arabic-speaking mothers, longer and more frequent feeds were associated with more breastfeeding-related musculoskeletal pain (p < 0.05). These are cross-sectional studies: they do not prove that time causes the pain, it could be the other way round.

Night feeding, in the dark, with no support. During the day, somehow, you adjust: the cushion, the armrest, the foot under you. At three in the morning you do not. You lean forward to check the latch and hold the neck flexed and rotated for twenty minutes or more, with one shoulder carrying everything, two or three times a night. In the Nigerian study, 94% of women used the cradle hold and 55.2% fed at least ten times a day; 60% of those with pain felt it during the feed.

The first month is the peak. In a Japanese cohort of 2,709 women followed from hospital discharge up to six months, the frequency of stiffness in the shoulders, back pain and wrist pain increased significantly from discharge to the first month in first-time mothers aged 35 and over. The worst moment is now, and it is the moment when you have the least time to deal with it. If the wrist is the part that hurts most, the picture is in wrist pain after childbirth.

Una donna esegue la posizione del ponte yoga su un tappetino in casa, dimostrando flessibilità e forza.

Broken sleep does not just make you tired: it makes you feel more pain

This part deserves to be taken seriously, because it has been measured. A systematic review with meta-analysis in Sleep Medicine Reviews gathered 31 studies in which sleep was manipulated in the laboratory, involving 699 healthy people:

  • total sleep deprivation lowered the pain threshold and tolerance (effect sizes 0.74 to 0.95, limited evidence);
  • partial deprivation increased the intensity of spontaneous pain (0.30, moderate evidence);
  • fragmented sleep increased peripheral and central sensitisation (0.42 to 0.79, from very limited to moderate evidence).

The last line is yours. You are not having one sleepless night: you are having seventy nights broken into three pieces, and fragmentation is the pattern that raises sensitisation, meaning how much the nervous system amplifies a signal it previously ignored. A second review, of 38 studies, found that in women disturbed sleep amplifies pain more than in men, with an effect that the authors themselves describe as small.

The limitation, stated clearly. These are laboratory studies on healthy volunteers: applying them to your nights is a plausible reasoning, not direct proof. And the largest review on sleep after childbirth, 60 studies and 20,684 women, from 2025, also looked at back pain among its outcomes, but the only solid result it reports concerns mood: sleep interventions reduced depressive symptoms, with a small effect.

So I am not telling you to sleep more: it does not depend on you. I am telling you that the pain you feel in the morning is partly amplified, and that the most useful thing to ask the people around you is not "hold him for half an hour", but "hold him from six to eight while I sleep".

The "correct posture" is not the answer

You have been told to sit up straight. It is the most common advice and one of the least supported by data. Two meta-analyses have measured how much head posture distinguishes people with neck pain from those without.

The first included 15 cross-sectional studies; in the 10 that directly compared symptomatic and asymptomatic people, adults with pain had more forward head posture, with a mean difference of 4.84: significant, but with an interval that nearly touches zero at one end and reaches almost 10 at the other (95% CI 0.14 to 9.54). In adolescents there was no difference.

The second, of 26 studies, is sharper. The craniovertebral angle differed by 2.93 degrees between people with and without pain (95% CI -4.95 to -0.91), while in the same review the difference in that angle linked to age was 2.36 degrees and the one linked to sex was 2.57 degrees.

Read them together: the postural gap between people who suffer and those who do not is as large as the gap that, in the same review, separates adults up to 50 from those over 50. And all these are cross-sectional studies: they capture a single moment, and cannot say whether posture caused the pain or the other way round. So no, you do not have a damaged neck because you hunch, and "sit up straight" is in any case not an instruction you can carry out at three in the morning with a newborn latched on.

What really changes: the height, not the back

The gesture that takes the load off is a different one: bring the baby up towards you, instead of going down towards him. Cushions, an armrest, a stool under your feet, a towel under your elbow. The aim is to be able to let your shoulders relax while the baby is latched on, instead of holding him up in your arms for twenty minutes.

The data point in this direction. In the Polish survey, neck pain was less intense in women who breastfed lying down than in those who breastfed sitting on a chair or in an armchair (p < 0.05); among the 471 Arabic-speaking mothers, the use of an ergonomic support was associated with lower musculoskeletal pain (p = 0.01).

But the opposite also needs saying, because it exists. In the Nigerian study of 310 women, no maternal characteristic and no feeding profile was significantly associated with neck pain (p > 0.05): the authors' recommendation to change position is not supported by their own test.

The most consistent reading is that it is not which position you choose that matters, it is whether you are supported in that position: the perfect cradle hold with free arms for half an hour loads more than any hold with three cushions underneath. On how to choose it, the picture is in breastfeeding positions; if the pain also affects the lower back, it is in back and neck pain during breastfeeding.

Exercises that fit into two minutes

A randomised study published in Pain divided 198 adults (174 women) with frequent neck and shoulder pain into three groups: a band for 2 minutes a day, a band for 12 minutes a day (both five days a week for 10 weeks), or weekly health information. After ten weeks, compared with the control group:

  • 2-minute group: pain down 1.4 points out of 10 (95% CI -2.0 to -0.7; p < 0.0001), muscle tenderness down 4.2 points out of 32;
  • 12-minute group: pain down 1.9 points (95% CI -2.5 to -1.2), tenderness down 4.4 points.

The big jump is between zero and two minutes, not between two and twelve. In a secondary analysis of the same study, headache frequency dropped by 0.64 days a week in the 2-minute group (95% CI 0.23 to 1.0), a 43% reduction, while the intensity and duration of the remaining headaches did not change. They were not women after childbirth, and the dose was five days a week for ten weeks: it is not the exercise, it is the repetition.

What type of movement? The Cochrane review on exercise for mechanical neck disorders, covering 27 studies and 2,485 participants analysed, gives moderate-quality evidence for strengthening the cervico-scapulothoracic region and the upper limb in chronic pain (standardised mean difference -0.71; 95% CI -1.33 to -0.10). With two qualifications: for acute pain it found no evidence, and with stretching alone no benefit should be expected.

In practice the two minutes look more like pulling than stretching:

  • shoulder blades back and down: shoulders down, shoulder blades towards the spine, three seconds, release. Ten times;
  • band row (or a light shopping bag): elbows close to the body, pull back, ten times;
  • external rotation: elbows at your sides, forearms opening outwards against light resistance, ten times;
  • slow neck rotations through the full range available, five per side: here the aim is to move, not to stretch.

Do not do them while you are feeding: do them while the kettle boils or while the baby is in the bouncer. It is the only way they will reach five days out of seven.

If you are thinking of an anti-inflammatory: in a network meta-analysis of 119 randomised studies and 12,496 patients with chronic neck pain, anti-inflammatories did not reduce pain, either alone or added to other treatment. The German guideline of 2025 puts activation at the centre (effects up to d > 1.0) and advises against imaging in acute pain without signs of a structural cause.

This section is the most important one, and it is not about physiotherapy. In the weeks after childbirth a severe headache that is different from usual is not neck-related until preeclampsia has been ruled out. It is not excessive caution: it is the correct sequence.

Postpartum preeclampsia is defined as new-onset hypertension between 48 hours and 6 weeks after birth. Most late-onset cases appear within the first 7 to 10 days, more often with neurological symptoms and typically with headache. It can also occur in women who had never had high blood pressure during pregnancy; worldwide, preeclampsia complicates 2% to 8% of pregnancies.

The serious point is that you cannot tell it apart yourself. In a prospective study of 900 women followed for the first month after birth, 26.8% had at least one episode of headache, almost always primary headaches and therefore benign; in another cohort of 985 women, 39% reported headache or neck and shoulder pain (the two were counted together there), and over three quarters were primary headaches. But among 207 women with headache of gradual onset, three met the criteria for preeclampsia, and for thunderclap headache, 34 women or 3.8%, the authors write that no recorded variable allowed a distinction between those who had it and those who did not.

Almost always it is nothing. And for exactly that reason the rule cannot be "I'll see how it goes".

Go to the emergency department, straight away:

  • a severe headache, new or different from usual, in the first six weeks after childbirth: your blood pressure needs measuring, today;
  • a headache that reaches maximum intensity in less than a minute (thunderclap);
  • vision disturbances: flashing lights, dark spots, blurred or double vision;
  • severe pain under the right ribs or in the pit of the stomach;
  • sudden swelling of the face and hands, or breathlessness at rest;
  • fever with a stiff neck, confusion, unusual drowsiness;
  • seizures.

Call your doctor within a few hours, do not wait:

  • a headache that gets worse when you stand up and eases when you lie down, after an epidural or spinal: it is a post-dural puncture headache, and it is treatable;
  • weakness, persistent tingling or loss of strength in an arm or a hand;
  • neck pain that appeared after a trauma, or that stops you sleeping;
  • a stiff neck that does not improve at all in two weeks.

ACOG has a dedicated guideline on headaches in pregnancy and the postpartum period, precisely because the assessment here follows different criteria from usual; and in a separate document on postpartum care it recommends a first contact with your care team within the first three weeks. The forty-day check is not the deadline after which to stop asking questions.

What we can do, and what we cannot

Let us set the limits before the promises. We do not measure blood pressure through a screen and we do not diagnose: if your account suggests a headache that a doctor needs to look at, we will say so straight away, rather than let you lose two weeks on exercises.

The rest we do. We look at how you actually are during a feed, not the ideal position from the manual: yours, at nine in the evening, with the cushions you have at home, and we take the load off wherever possible: height, supports, the elbow that holds, the foot that touches the floor. Then we build the two minutes, in a repeatable dose, five days out of seven, with a newborn at home.

The video call has one plain advantage here: the real obstacle is leaving the house, and the risk is putting it off until the worst month has already passed. With the Ri-Hub Mamma pathway you can start with a free 20-minute introductory consultation: you tell us about your day and we say whether it makes sense to work on it together or whether a medical check comes first. Follow-up sessions cost 29,90 €.

One thing, however, you can change tonight without waiting for anyone: before latching the baby on, lift him up. One more cushion under the arm, one under the elbow, the back supported. You do not have to sit up straight: he has to come up.

Sources

Last source check: September 2026.

Domande frequenti

How many women have a stiff neck and shoulders after childbirth?

Many, and the figures show it in every country where it has been asked. In a study of 308 Japanese women seen one month after birth, 73.1% reported pain in the neck and shoulders, and in a quarter of cases it had appeared after the birth; the most affected area was the upper trapezius. In an online survey of 395 Polish women who were breastfeeding, 48% had neck pain at least once a week. In a study of 310 mothers in Nigeria, 51.7% reported neck pain linked to breastfeeding. The figures vary because the questions and samples vary, but the direction is always the same: it is the rule, not the exception.

Why now, when I have not done anything strenuous?

Because the load is not a strain, it is repetition. You spend hours in the same position with your head bent forward, at night and often in the dark, with no support. In the Polish survey, women with back pain (there the comparison is made on spinal pain as a whole, not on the neck alone) spent significantly more time on each single feed (p < 0.05) and more total time per day (p < 0.01) than those without. In a study of 471 mothers from Arabic-speaking countries, older age, longer and more frequent feeds were associated with more breastfeeding-related musculoskeletal pain (p < 0.05). And in a Japanese cohort of 2,709 women followed from hospital discharge up to six months, in first-time mothers aged 35 and over, stiffness in the shoulders, back pain and wrist pain increased significantly from discharge to the first month: the peak is right at the beginning.

Does broken sleep really cause pain?

Yes, and it is not a gentle way of saying you are tired. A systematic review with meta-analysis of 31 experimental studies, 699 healthy people and 47 people with chronic pain, measured that in healthy subjects total sleep deprivation lowered the pain threshold and tolerance (effect sizes 0.74 to 0.95, limited evidence), partial deprivation increased the intensity of spontaneous pain (0.30, moderate evidence), and fragmented sleep increased peripheral and central sensitisation (0.42 to 0.79). Fragmented sleep is exactly yours. One limitation needs stating: these are laboratory studies on healthy volunteers, not on women after childbirth.

Is it my bad posture?

Less than you have been led to believe. A systematic review with meta-analysis of 26 studies found that the craniovertebral angle differs by 2.93 degrees between people with neck pain and those without (95% CI -4.95 to -0.91), while the difference linked to age was 2.36 degrees and the difference linked to sex was 2.57 degrees. In other words, the postural gap between people who suffer and those who do not is as large as the gap that, in the same review, separates adults up to 50 from those over 50. In the same review, other measures of forward head position showed no significant differences. All these studies are cross-sectional: they capture an association, they do not prove that posture causes the pain.

So what does change?

The height of the baby relative to your breast, and the number of supports you have under your arms. You should not bend down towards the baby: the baby should come up towards you. In the Polish survey, neck pain was significantly less intense in women who preferred to breastfeed lying down than in those who breastfed sitting on a chair or in an armchair (p < 0.05), and in the study of 471 Arabic-speaking mothers, the use of an ergonomic support during feeding was associated with lower musculoskeletal pain scores (p = 0.01). Note, however, that in the Nigerian study of 310 women no feeding profile was significantly associated with neck pain. The point is probably not which position you choose, but whether you are supported in that position.

How many minutes of exercise are needed?

Two, if you do them almost every day. A randomised trial published in Pain, with 198 adults with frequent neck and shoulder pain (174 women), compared 2 minutes a day of exercise with a resistance band, 12 minutes a day, and a control group that received only health information, five days a week for 10 weeks. In the 2-minute group pain fell by 1.4 points out of 10 (95% CI -2.0 to -0.7) and muscle tenderness by 4.2 points out of 32; in the 12-minute group by 1.9 and 4.4. The real jump is between zero and two minutes, not between two and twelve. They were not women after childbirth, and what matters is consistency for ten weeks, not a single session.

When is a headache not neck-related?

When it is severe and different from usual in the first six weeks after childbirth. In that window, the first thing to rule out is preeclampsia, not neck pain: postpartum preeclampsia is defined as new-onset hypertension between 48 hours and 6 weeks after birth, and most late-onset cases appear within the first 7 to 10 days, more often with neurological symptoms and in particular with headache. Your blood pressure needs to be measured, now, not left until the forty-day check. Go to urgent care also for a headache that reaches its maximum in less than a minute, for vision disturbances, for sudden swelling of the face and hands, for severe pain under the right ribs, or for fever with a stiff neck.

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