When Mohammad Shafi, a businessman in his early 30s, complained of chronic fatigue to his barber, while having a haircut, he had no idea what he was in for. The barber, like a good Samaritan and an accomplished professional starting giving him a massage on neck, followed by rapid, sharp turning of his skull in all directions. It ended in five minutes, but in the morning that followed, Shafi could sense something was wrong. While leaving for office, he collapsed at the gate of his house. He was bundled into a car and rushed to hospital where doctors announced that the young man had suffered a stroke – a vessel in his neck had ruptured and was leaking blood. The next one month proved to be a nightmare for the family. Shafi was discharged from hospital with some neural deficiencies and a feeling of being lucky to survive the stroke. With no history of hypertension and no visible injury, doctors taking his history deducted that the neck massage, also called neck cracking, by barbers, and at saloons, was the possible culprit behind his arterial dissection. Arterial dissection is a disorder in which the artery wall develops a tear.
Although, there could be a variety of reasons for the condition, a “pretty preventable” one is avoiding trauma to the neck. Many doctors, who have seen patients with such injuries, said it was not a very rare one. World over, many people had been left paralyzed for life owing to a neck massage or neck cracking horribly gone wrong, they said. Prof Ravouf Parvez Asimi, head department of neurology at Sher-e-Kashmri Institute of Medical Sciences (SKIMS) feels there was a dire need to create awareness about neck manipulation and cracking and its potential health risks. “The injury can be caused by a barber by a sudden movement of the neck, or during massages, or through over stretching of neck during exercise or any other activity that involves twists and turns to the neck,” Prof Asimi said. He said that the practice was quite common in Kashmir and often barbers offer cracking to their clients and that the new age saloons had continued the practice. “Earlier we were not very aware of this cause but in recent times, we have been seeing a lot of young patients with stroke and their history often reveals a tryst with neck manipulation,” he said. The condition has been named “Salon Stroke Syndrome”, first mentioned in The Lancet, in 1992. Doctors believe many patients, who might have suffered arterial damage are not able to establish the link, thus leading to under-reporting of this cause. Nevertheless, in many countries, including India, voices are rising to spread awareness about neck cracking and other practices that could damage arteries and lead to stroke. “Neck is such a delicate area to work on,” the SKIMS neurology head said. The neck manipulation can damage arteries on the backside of the neck and cause extensive damage to brain stem – the hub of vital body functions as a number of arteries and nerves pass through the neck, connecting brain with rest of the body. Noted neurologist and physician and Principal Government Medical College Srinagar, Prof Parvaiz A Shah warned against neck cracking by people with poor understanding of human anatomy. He said that neck manipulation by “inexperienced hands may prove catastrophic” although he termed the occurrence “rare”. “Neck cracking is the popping sound which occurs due to lose joints and ligaments in the neck. Popping sound in the neck results from collection of fluid in these joints,” he said. He added that neck cracking can cause cervical artery dissection which can “increase the risk of stroke”. While detailing the possible symptoms of arterial or neurological manifestations of neck cracking, Prof Shah said a person can have neck pain, dizziness, tinnitus, limb weakness and speech disturbances following a trauma or procedure to neck. “Chiropractic manipulation of neck in trained hands is less likely to cause any harm,” he said. Chiropractor is a trained healthcare professional focusing on diagnosis and treatment of neuromuscular disorder through manual manipulation and exercises. As per some estimates, each year 12,000 to 15,000 people are affected by spontaneous dissection of the carotid arteries in India. While avoiding trauma to artery is the best bet for prevention of these injuries doctors advice timely intervention in case a person feels something has gone wrong. “There often would be symptoms like blurring of vision, slurring of speech, sudden weakness on one side of body,” Prof Shah said. “Don’t give your neck into anyone’s hands, be it a barber, a saloon professional, a friend or family member,” Prof Asimi said. “It can prove fatal,” he cautioned.