Scooping up an armful of exercise books and sitting at his desk for long hours was all in a day's work for 35-year-old Jason Wang, a secondary school language teacher. Day after day, he would pick up or hand out assignments while balancing a heavy load in his other arm. When he was not teaching, Wang (name changed for patient confidentiality reasons) would be hunched at his desk for hours on end, grading stacks of assignments and tests. While the hardworking Wang gave little thought to these habits, they were creating undue stress on his neck muscles, cartilage and bone. After more than a decade of repeated neck strain, Wang developed a persistent neck pain. To relieve the discomfort, he turned to massage, physiotherapy, acupuncture, moxibustion and other forms of therapy. However, not only did the pain not go away despite his efforts, it spread to his left shoulder and shot down his arm to his fingertips. After two years searching for a remedy, the pain suddenly intensified. It was so severe Wang could not sleep. He also experienced weakness in his left arm. Wang bore the severe pain for two months before he finally sought medical attention from Dr Mak Kan-hing, a specialist in orthopaedics and traumatology at the Hong Kong Sanatorium and Hospital. Magnetic resonance imaging and X-ray scans showed that the bones in Wang's neck (collectively known as the cervical spine) were degenerating in a condition called cervical spondylosis or arthritis of the neck. Wang's decade-long poor posture and bad work habits strained his neck muscles. As these muscles grew fatigued from the prolonged stress, the pressure then transferred to the bones, says Mak. The cervical spine is made of seven pieces of bone called vertebrae that are stacked on top of one another. In between the vertebrae are shock-absorbing cushions called the intervertebral discs. These discs also give some elasticity and flexibility between the vertebrae. The spinal cord, which is composed of millions of nerve fibres, runs through a hollow within the vertebrae. In Wang's case, the pressure that transferred to the vertebrae affected the proper circulation of nutrients around the intervertebral discs. This essentially starved some of the discs to the point that they started to degenerate early and desiccate. As the discs dry out, they lose height and the space between the vertebrae starts to narrow, resulting in extra stress and friction between the bones. This also causes the cartilage that protects the bones to wear out. The excessive stress causes pulling on the 'skin' or surface of the bone, says Mak. In response to the excessive movement, the vertebrae start to grow new bone called osteophytes, or bone spurs. The additional bone formation encroach on the space occupied by the nerves and can impinge on the nerves themselves. In Wang's case, the discs between his fifth and sixth vertebrae, and between his sixth and seventh vertebrae, were badly degenerated. Mak proposed surgery to remove what was left of the two desiccated intervertebral discs and fuse the fifth and sixth bones, and the sixth and seventh cervical bones. This way, there would be no movement between those two pairs of vertebrae, thereby removing the cause of osteophyte growth. The offending bone spurs that were now impinging on Wang's nerves and causing him such distress could also be removed. The surgery only involved a small incision to the left side of Wang's neck. As Wang had tried every other form of conservative therapy and failed to find relief, he agreed to the surgery. The surgery proceeded smoothly and six months later, a follow-up X-ray showed that Wang's fifth and sixth bones, as well as the sixth and seventh vertebrae, had fused beautifully. Most of Wang's range of neck movements had been retained, while the pain that had plagued him for years was finally gone. In comparison to the debilitating pain of the past, the little numbness that now remains in Wang's finger barely registers in his consciousness. Mak says that people who work at jobs that keep their necks in a fixed and strained position are most at risk for cervical spondylosis. Taxi drivers and office workers in particular should give themselves short breaks every hour to relax and stretch their neck muscles.