Most people have back and neck pain from time to time. Some people have ongoing pain that affect their daily activities. Find out how our spine specialist can treat, manage, and avoid back and neck pain.

Medical Tests for Back & Neck Pain

Back & Neck Pain Specialist

Dr Mathew Tung Neurosurgeon

Dr Mathew Tung

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Tensing your muscles is a normal response to stress and heightened emotions, such as anger, nerves, or frustration. You may also get into the habit of holding certain sets of muscles in a tense, fixed position when performing basic everyday actions, such as moving around or sitting on your desk. This tension, however, is a major cause of neck and back pain.

Trapezius Muscle

Causes to Muscular Tension

Poor posture, injury, overexertion, differences in leg length, and conditions such as scoliosis can all cause you to tense specific sets of muscles, as the muscle compensate for any difficulties these problems create. Stress and emotional pressures are the main triggers for over-tense muscles, but difficulty sleeping or poor nutrition can also cause an increase in muscular tension. Holding your muscles for any length of time in a tense, contracted position limits blood flow to your muscles and restricts the supplies of nutrients and oxygen that they need to work properly.

All this can lead to pain and muscle spasms, which in turn put strain on the joints and ligaments so that they too become tender and sore.

Symptoms and Diagnosis

Pain from excess muscle tension may start with dull ache, but can become extremely painful. Muscles that are regularly held in a contracted and tense position for extended periods of time may also develops “knots”, or “trigger points”. These are particularly tender areas that are easily irritated, sending waves of pain out to other, often distant, parts of your body. Your doctor will make a diagnosis by performing a physical examination.

Risks and Recovery

You should always check that the pain is due solely to chronic muscular tension, rather than any illness or physical problem. If you hold your muscles in a tight, tense state for a very long time, they can become permanent shortened and stop functioning properly.

Treatments for Muscular Tension

Muscular Tension Specialist

Dr Mathew Tung

Dr Mathew Tung Neurosurgeon

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If you have suffered from a neck problem for three months or more, your pain will be described as “chronic”. The pain may be severe or mild, constant or intermittent; these factors will determine the degree to which it affects your life.

Neck Pain
Neck Pain

Causes of Chronic Neck and Nerve Root Pain

Precise causes of chronic neck pain are often difficult to determine. In more than 50% of sufferers, it stems from the facet joints as a result of osteoarthritis, spondylosis, or a previous trauma such as a whiplash injury. If you have nerve-root pain, the most probable cause is a prolapsed disc. Less common causes of chronic neck pain include myofascial pain.

Symptoms of Chronic Neck and Nerve Root Pain

The symptoms of chronic of  neck pain are similar to  those of acute neck. Older people with degenerative changes in their neck may experience grinding or grating when moving, causing stiffness and aching. Recurrent episodes of more disabling pain can be triggered by trivial movements such as rotating your neck suddenly, jolting or jarring, and extending your neck or bending forwards for sustained periods of time. Numbness, pins and needles, and weakness in your hands may be a sign of cervical myelopathy – when the spinal cord in the neck is squeezed by degenerative changes in the bones and discs, leading to impairment of the nerves, affecting the arms and sometimes the legs – or spinal cord compression. Advanced cervical myelopathy may affect walking and gait. Chronic nerve-root pain may cause neuropathic features – when a nerve or nerves are damaged over a long period, leading to abnormal processing of pain – such as burning sensations. Mood and sleep patterns may become disturbed; the impact of the pain on your life can cause frustration and sometimes depression.

Risks and Complications for Chronic Neck and Nerve Root Pain

The physical risks of chronic neck pain are associated with the more serious conditions of major disc prolapse or cervical myelopathy leading to spinal cord compression. Other significant complications of chronic pain relate to its effect on your life, work, relationships, mood, and fitness.

Treatment for Facet Joint Pain

  • If your pain has been diagnosed as being caused by a facet joint problem, you should
    • take painkillers
    • start physiotherapy
  • If your pain is moderate to severe,and you have not improved with physiotherapy, you should see a specialist. The specialist may:
    • perform MRI and injections to the neck.
  • If the specialist decides that injections are not appropriate or are not working, he may:
    • suggest a functional rehabilitation programme
    • suggest an operation
  • If a more specific diagnosis leading to effective treatment has not been made
    • use medication wisely and appropriately.

Treatment for Myofascial Pain Syndrome

  • If your pain has been diagnosed as being caused by a myofascial problem, you should:
    • take painkillers
    • start physiotherapy
  • If you are still in pain, your doctor may refer you to a specialist, who may:
    • consider giving you a low dose of an antidepressant to relax your muscles and improve sleep quality.
    • identify trigger points. If these are found, he may use trigger-point injections.
  • If after several months you are still in pain, your specialist may:
    • suggest a functional rehabilitation programme.

Treatment for Disc-Related Pain

  • If your pain has been diagnosed as disc-related, you should:
    • take painkillers
    • start physiotherapy
  • If your pain is moderate or severe and it has not improved with physiotherapy, then you should see a specialist. He may:
    • perform MRI.
    • offer further treatment, such as prolotherapy.
  • If your spine has degenerated of the disc is badly damaged, your specialist may:
    • suggest surgery
  • If your specialist feels that treatment is not working,
    • a functional rehabilitation programme to improve the range of motion.
    • suggest surgery
  • If treatment has improved your symptoms, you should:
    • continue to practice good neck care

Chronic Neck and Nerve Root Pain Specialist

Dr Mathew Tung

Dr Mathew Tung Neurosurgeon

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Minor neck injuries may result from tripping, falling a short distance, or excessive twisting of the spine. Severe neck injuries may result from whiplash in a car accident, or sports-related injuries.

“Burners” and “Stingers”

If you’ve played contact sports and suffered a burner or a stinger, you remember it. The pain shoots from the shoulder to the hand “like an electric shock or lightning bolt down the arm”. A burner or stinger is an injury to the nerve supply to the upper arm, either at the neck or shoulder, often following a fall onto the head – for example, following a tackle in football.

What Happens?

When the head is forced sideways and downward, it bends the neck and pinches the surrounding nerves. As a result, you may feel numbness or weakness in the arm and possibly a feeling of warmth.

Usually the symptoms subside quickly – within seconds or minutes – but in up to 10 percent of cases, the unpleasant sensations can last hours, days, or longer.

What Should be Done?

You should immediately get checked by a doctor. An examination will confirm the type of injury. If the symptoms pass, you will probably need no treatment. But you may need further medical attention if you experience weakness lasting more than a few days, neck pain, symptoms in both arms, or if you have a history of recurrent stingers or burners. Having a narrow spinal canal – spinal stenosis – may make you more prone to burners and stingers.


When your head is jerked violently and unexpectedly backward or forward – typically in a car accident or during contact sports – the resulting injury is known as whiplash. It can also be called cervical sprain (or strain) or hyperextension injury.

Whiplash Injury
Whiplash Injury

What Happens in a Whiplash Injury?

The pain is caused by the soft tissues (muscles, tendons, and ligaments) of the neck being forced to the very limit of their range of motion. If the ligaments are torn, there will be internal bleeding bleeding between them and the vertebrae. You may start to feel pain and experience stiffness in the neck within minutes or it make take several hours for symptoms to be felt. Further symptoms that result from whiplash may include neck spasms, dizziness, and headache.

What Should be Done?

It’s important to seek medical help as soon as possible. Modern surgical treatment with internal fixation (screws, plates, rods) has eliminated the need for cast treatment in all but the most unusual circumstances. A plastic collar may be used for a short period.

Subject to your doctor’s advice, anti-inflammatories and physiotherapy may help relieve discomfort in the early stages the recovery process.

You can expect a full recovery within a couple of weeks, although some people have problems for longer.

Neck Injury Specialist

Dr Mathew Tung

Dr Mathew Tung Neurosurgeon

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Sprain and Strain

Cervical sprains and strains involve an overstretching or tearing in the supporting tissues of the neck. A sprain results from injury to the ligaments and a strain from injury to the muscles or muscle tendon. Sprained or strained tissue becomes tender to the touch, and results in stiffness, swelling and reduced range of motion in the neck. Other associated symptoms can include headache, dizziness, numbness, tingling, pain or weakness in the arms.

Cervical sprains and strains typically occur together and are usually a result of one of two common causes: long-term or excessive physical activity or sudden trauma. These types of injuries frequently occur in people whose occupation requires excessive or repetitive use of their arms or awkward head positions, such as working on an assembly line, in car repair, and even working in an office at a computer with poor ergonomics. Sudden trauma, such as an car accident, fall or sports injury, can also cause cervical sprains and strains.

Whiplash is a common cause of a sprain / strain injury. It is also the most common type of injury resulting from a motor vehicle accident. The force at impact causes sudden, excessive extension (backward motion) and then rapid flexion (forward motion) of the neck. A more severe ligament injury can even cause instability of the spine. This can be detected in routine x-rays. Whiplash motion can also cause trauma to the facet joints. Other, more serious injuries to the vertebrae or intervertebral discs are possible but less likely.

Whiplash Injury
Whiplash Injury

People usually report pain from whiplash shortly after an accident, but sometimes the pain doesn’t begin until several days later. After the injury, the muscles surrounding the neck and head stiffen up. Over time, this stiffness may spread from the neck to the upper back muscles. Associated symptoms can occur, including headaches, dizziness, and arm pain or tingling.

Most of the time, your body heals from whiplash, with minimal treatment, over the course of several weeks. Treatment includes heat application, oral  anti-inflammatory medications or muscle relaxants and physical therapy.


Arthritis is inflammation and stiffness of a joint that may result in swelling and restricted motion. Arthritic disorders can complicate neck pain in many people.

Osteoarthritis is a degenerative joint disease that occurs in everyone as they age and tends to worsen over time. In fact, osteoarthritis occurs in everyone as they age and tends to worsen over time. In fact, osteoarthritis occurs in more than half the population over age 50. That said, only some of these people suffer chronic pain. Osteoarthritis in the neck can be precipitated by an earlier trauma or degenerative disc disease. Increased friction, inflammation, and bone formation occur because of a mechanical breakdown in the cartilage lining the joint.

Over time, as a response to everyday stressors, our bones thicken to stabilise the spine. When excessive thickening occurs, the extra bone (called bone spurs, or spondylosis) can causes pain by compressing or irritating the exiting the spinal nerve roots (spinal stenosis) or small nerves that supply the facet joints. Excessive bone formation can also extend into the spinal canal, compressing  the spinal cord.

Several factors can increase the likelihood of developing severe osteoarthritis. Age is the primary and most predictable reason for osteoarthritis, often starting at around age 30. Work or sports related repetitive motion, or poor body mechanics, can set the stage for arthritis, particularly if you are overweight, because excess pounds place more stress on your joints. Genetic predisposition. poor circulation, or disease – such as diabetes – can also promote the onset and development of osteoarthritis.

Stiffness and pain are common features of osteoarthritis. These symptoms are typically at their worst first thing in the morning, lessening slightly as you become more active after rising. The pain can even awaken a person during the night. Many people with osteoarthritis experience a steady aching pain that is worsened by neck motion. Some people note that this pain becomes most acute during times of major weather changes. This is thought to be related to fluctuations in the barometric pressure and the heavier air that a low-pressure weather front brings.

Much less common types of arthritis include rheumatoid arthritis, psoriatic arthritis, gout, and ankylosing spondylitis.

Disc Disease

The number one question that people with neck or upper back pain ask their doctors is if a slipped disc is the cause of their pain. Although it is probably the most common concern, it is not the most common cause of neck pain. Surprisingly, many people with a disc problem do not experience neck pain.

When disc disease is the cause of pain, it typically results in compression or chemical irritation of a spinal nerve root. The fibrous outer shell of the disc (annulus fibrosis) can become torn or cracked by an acute injury or by chronic wear. The back (posterior) of the disc is most susceptible to this type of damage, which can also lead to herniation of the inner nucleus pulposus. Small tears in the disc can heal over time, but recurrent or large tears can result in bulging disc (an intervertebral disc that extends beyond its normal boundary) or a herniated disc (when the inner nucleus pulposus extrudes through the outer annulus).

Herniated Disc

Large disc herniation in the cervical spine can cause narrowing of the central canal and, as a result, compression of the spinal cord. This compression can cause weakness and numbness not only in the arms but also in the legs. This is not an unusual scenario, yet most people – understandably- fail to attribute leg symptoms to neck problems. More commonly, disc herniation causes narrowing of the spinal foramina, resulting in irritation or compression of a spinal nerve root. The location of the irritation or compression determines where symptoms are experienced in the body. These symptoms can include pain, numbness, tingling, or even weakness and can be present in the neck, upper trunk, or arms. For example, compression of C8 nerve root (at the base of the neck) may result in numbness and tingling in the hand, while irritation of the C5 nerve root (at the middle of the neck) can cause symptoms in the shoulder region. Although some herniated discs require surgical repair, many patients respond to nonsurgical interventions, preventing or delaying a need for surgery. Nonsurgical options are described in the rest of this book.

Radiculopathy and Neuralgia

Radiculopathy is disease of a spinal nerve root. Typically, this disorder results from the compression or physical irritation of a spinal nerve root as it exits the neural foramen. The foraminal space can become narrowed by a disc herniation or by vertebral bone thickening (spurs), causing compression. Or the fluids ordinarily contained within a disc may leak out because of a tear, causing irritation and inflammation in a nearby nerve root. Less commonly, diseases such as shingles or diabetes similar affect the spinal nerve roots by inflaming them. Any one of the eight cervical nerve roots can be involved in a radiculopathy, but the sixth and seventh nerves are the most commonly affected. Cervical radiculopathy can cause not only neck pain but also pain, numbness, and weakness down one or both arms.

Spondylolisthesis and Spondylolysis

Spondylolisthesis is a slipping of one vertebra over another. The most common cause of such slippage is spondylolysis, or a crack in the posterior portion of the vertebra that connects the spinous process to the facet joint. This defect can occur on one or both sides of the vertebra, and it is typically a result of chronic repetitive motion or trauma such as that experienced by professional athletes or industrial workers. Although spondylolisthesis usually occurs in the lower back, it can occur in the neck, especially in people who wear heavy head gear while working, such as welders.

Diagnostic Testing

Your doctor will use diagnostic tests to aid in the evaluation of your chronic neck pain. Each test is designed to look for specific types of abnormalities in the anatomy or function of the cervical spine.

X-ray (radiography) is the most commonly performed diagnostic test for patients with neck pain. The bones of the neck are best visualised with this technique when looking for fractures or other changes to the bones.

Magnetic resonance imaging (MRI), unlike an x-ray, does not expose the body to any radiation. MRIs are more frequently ordered to evaluate possible disc pathology.

Neck and Upper Back Pain Specialist

Dr Mathew Tung

Dr Mathew Tung Neurosurgeon

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