A neck rotation or neck extension is widely sold as best relaxation technique and to make neck muscles tight. But neck massage or shampooing at the salon can cause an injury and even result in paralysis.

Massage is generally accepted safe and is used widely for various ailments. One cannot resist the complimentary neck or head massage post a haircut to soothe our nerves.

The massage therapy is widespread in several countries with various cultural backgrounds, usually given to relieve the musculoskeletal and neurogenic pain, improvement of blood circulation, and that of lymphatic circulation. However, several complications of massage therapy have been reported, such as vascular injury, stroke and paralysis among others by unprofessional salon and parlour services.

A similar situation arises during hair wash in washbasins at salons with uneven positions for head rest and prolonged head hanging for hair wash. Also a neck crack – usually performed by holding the chin and tilting the neck sharply to the left and right by barber – can damage phrenic nerves that control the diaphragm, which in turn controls breathing.

Hairdresser-related ischemic cerebrovascular cases are associated with compression of vertebral arteries or cervical artery dissections that occur during neck massage or shampooing at the salons.

The term “beauty parlour syndrome” has been used to describe this type of injury, which is rare. In 1993, Michael I. Weintraub described Beauty Parlour Stroke Syndrome, when a person, leaning back on a basin to have their hair washed, resulted in compressed arteries in the neck, leading to damage that could result in a stroke.

In 1997, a study published in The Lancet also reported the cases of beauty parlour stroke syndrome caused by shampooing in a beauty parlour within a day of the shampoo.

“Beauty parlour stroke occurs due to the overstretching of the neck during the hair wash, or vigorous neck massage, unfortunately, the reason often goes undetected,” says Dr Debanjan Banerjee, Senior Resident at National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India.

In 2018, the Department of Neurosurgery, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India reported a case of a 30-year-old male suffering from vertebral artery dissection, a flap-like tear of the inner lining of the vertebral artery, which is located in the neck and supplies blood to the brain. The complication started after he took a neck massage from an untrained professional at a hair salon.

“It happens more after the mid-life or elderly or in people with additional vulnerabilities such as hypertension, diabetes, deranged lipid profile, heart attack and previous strokes in whom the walls of the blood vessels are already weakened due to tear and cholesterol deposits,” says Dr Banerjee. “Similar positions or neck manipulation can also injure the phrenic and vagus nerves leading to difficulty in breathing or paralysis. Though rare, this is a medical emergency and can be potentially life-threatening and dangerous.”

The doctors recommend that hairdressers should use a cushion to make sure that the neck is not overextended and that one should avoid hyperextension or hanging of neck for long periods, if uncomfortable with the position.

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