How a massage can cause a stroke

It happened to Elizabeth. Here she warns of a danger even beauty therapists don’t know about

EVERYONE loves a pampering spa day: the chance to unwind in peace and comfort. So imagine Elizabeth Hughes’ disappointment when a stress-relieving facial began to feel anything but.

When she questioned the sudden pain in her neck, the beauty therapist put it down to Elizabeth being ‘ tense’ and continued the massage.

But annoyance turned to abject horror when a week later the 51-year-old found herself in hospital having suffered a stroke. And when her consultant revealed the likely cause, she could barely believe it.

Elizabeth explains: ‘ The consultant asked me if I’d been in a road traffic accident but I said no. Then he asked — half jokingly — if I’d been in a rugby scrum and I said of course not.

‘He told me my carotid artery — the main artery which runs down either side of the neck — had split and a blood clot had leaked out and taken a week to get to my brain. I mentioned the painful massage and he said, “That’s it.”

‘It was a very sobering moment. I realised I could have died.’

Can a beauty treatment really cause something as life-threatening as a stroke? As unlikely as it sounds, the answer is yes, albeit very rarely. It even has a name, ‘ salon stroke syndrome’, which was first mentioned in the medical journal, The Lancet, in 1992.

The article described how a person, leaning back on a basin to have their hair washed, can’t help but compress arteries in the neck, potentially leading to damage which could cause a stroke.

There have been a handful of known cases in this country although it’s thought many stroke patients fail to realise the link. Worryingly, since Elizabeth’s case, it has emerged that beauty therapists are not trained to avoid this sensitive area in the neck.

‘This type of injury has been reported previously in the U.S. and there have been similar incidents of negligence during physiotherapy and sports massages but until now there are no reported incidents in the UK,’ says Ciaran McCabe, partner at Moore Blatch solicitors, who represented Elizabeth in her subsequent legal case.

‘We’re calling for changes in the beauty training curriculum as a result of this case. At present, when a therapist undertakes training, they are told where the carotid artery is but are not taught that force can lead to severance of that artery. Physiotherapists and sports masseurs are taught this, but not beauty therapists. It’s a big omission.’

As a nurse in a busy clinic, Elizabeth, from Gosport, Hampshire, took time off to treat a friend to a spa break in 2010.

ELIzABETHsays: ‘ She had taken me to the same spa for her birthday some years earlier. We’d enjoyed it so much I promised I would repay her one day,’ she says. ‘At Christmas, I booked us in for a “stress eliminator day”. Work had been incredibly busy so I was looking forward to it.’

The friends arrived in the morning and — like all spa clients — were given health questionnaires to fill out. As a non- smoker and modest drinker, Elizabeth had no previous problems apart from mild asthma and being overweight. But her day was about to become painful.

‘Our first treatment was a facial,’ she says. ‘I’d never had one before, but the beauty therapist was very nice and I lay on the couch while she put ointment on my face. Then she started rubbing my neck but I found the pressure too hard and it hurt on my right hand side, like a bad muscular pain.

‘I mentioned it but she said I was tense and continued. I thought she must know what she was doing and it would ease off, but it didn’t. I endured it for around another ten minutes until she moved on to other areas of my face.

‘When she’d finished 45 minutes later I was still in pain. My friend had the same treatment with a different therapist and she didn’t complain of any pain.

‘But for me, it hurt for the rest of the day. When I got home, I had to take painkillers.’

The next weekend, Elizabeth and her husband Andrew, 51, a prison officer, went to North Wales for a short break. Elizabeth’s neck remained sore and she was starting to feel physically unwell.

‘On the Saturday — a week after the spa treatment — I was so tired that I slept all afternoon and later I vomited,’ she says. ‘I thought I must be coming down with a bug.

‘A couple of times in the night, I got up to go to the toilet and realised my balance was going. Then I looked in the mirror and saw that my face had drooped a bit. As a nurse, my first thought was, “I’m having a stroke” but I dismissed the idea. I was only 46. I thought my mind must be playing tricks so I went back to bed.’

Four hours later, she woke and her speech was slurred. Her husband agreed her face had drooped. This time, Elizabeth knew for sure she was having a stroke.

‘I asked him to ring for an ambulance and by this point I was very scared,’ she says. ‘The paramedics arrived and gave me oxygen but I knew something bad was happening to me. I’ve nursed lots of stroke patients in the past and as I was rushed to the local hospital, I did wonder if I was going to die.’

Sure enough, hospital doctors confirmed Elizabeth’s worst fears — she had suffered a stroke. She was taken to a medical assessment unit to be observed and stayed there for a week before being moved to a hospital closer to her home. An MRI scan confirmed that her stroke was linked to her facial. ‘I still can’t believe that I went off for what was supposed to be a nice day at a spa and it’s changed my life for ever,’ says Elizabeth.

‘It’s all about training. As a nurse, I was culpable for anything I did to my patients but it seems beauty therapists aren’t even told the neck is such a delicate area to treat.

‘I tell anyone going for a beauty treatment to be aware of the pressure being put on their neck, and at hairdressers I always stand with my head tipped forward over the bowl to have my hair washed.’ Elizabeth remained in hospital for six weeks, staying in a rehab ward where she was given medication and extensive physiotherapy to help improve her movement.

‘I have got better gradually and I can open my hand a little bit,’ she says. ‘But I’ll never be able to use it properly again. I found it difficult to swallow for a while but that’s got better. My family have been wonderful. My daughter Isabel, who is 25, was terrified for me at first.

‘When she came to the hospital and saw me, she was so scared.’

In Elizabeth’s case, the medical experts representing both parties agreed that the stroke occurred as a result of a dissection to the carotid artery and that it was probably caused when cream was massaged on to the sides of Elizabeth’s neck by the beauty therapist.

The issue of whether the beauty therapist was negligent or had applied an excessive degree of force was still in contention.

However, the case was settled before a High Court trial, with no admission of liability and Elizabeth secured compensation.

Kerry Lawlor, a beauty therapist for more than 30 years who runs the International Beauty And Holistic Academy for trainees in Gloucestershire, agrees that the industry needs stricter regulation to avoid this kind of injury.

‘As a therapist myself, I always thought you would have to really over-work that part of the neck to do damage to the artery but having read the reports of this case, I realise how easy it is and I’ve integrated it into training of my therapists,’ she says.

‘There is a real need for the beauty industry to be regulated. There are a lot of excellent therapists out there but anyone can set up as a beauty therapist without any real qualifications which is very worrying.’

BUThow worried should we be? The chances of suffering a stroke or transient ischaemic attack (often called a mini stroke) while having a beauty treatment are thankfully rare.

‘Each year for people under 45, between seven and 15 out of every 100,000 will have a stroke and one in four of those will be due to a carotid dissection,’ says Caroline Watkins, professor of Stroke Care at the University of Central Lancashire. ‘Many of these are spontaneous, with a few being due to minor trauma so it’s not common in the truest sense of the word.

‘People shouldn’t be frightened of having their hair washed at the hairdressers or going for a massage, but I would recommend gently easing back the head in the hairdressers.’ For Elizabeth, her spa day has had life-changing consequences. ‘I feel as if I’m 86 when I’m only 51,’ she says. ‘I have a slight droop in my face and eye and I get tired very easily. Sometimes when I’m tired, I slur my speech and my balance goes so people assume I’m drunk, which is very embarrassing.

‘I’m registered disabled and had to take medical retirement. I can no longer drive. I was unable to nurse my father, who died the following year — it’s been a very difficult time.’

Elizabeth is filled with regret and is speaking out to warn other women. ‘ When I hear of people going for facials, I warn them to be careful and to speak up if something doesn’t feel quite right.

‘Most of all I want rules in the beauty industry to change. The neck is a very delicate area and anyone who is massaging it should be taught about how sensitive it is.

‘All I did was go off for a spa day, and it changed my life irrevocably.’