There is more than a 90 per cent chance that this will get better without surgery," I told Nilesh, a 46-year-old gym instructor who had come to me with severe neck and left arm pain. He wore a tight black tee that delineated the curves of his torso. I've always wondered why people who pump iron go everywhere dressed as though they are still at the gym.

The pain had started a few days before he came to see me when he had lifted weights that were heavier than usual. It was now at a point where he could not lift his arm up, an act that unleashed an intense, undesirable pain.