"A 45 years old man has hit the headlines in England after having a stroke said to be triggered after his hair salon visit"
In 1992, Weintraub introduced the term “Beauty Parlour Syndrome” to describe five patients who suffered stroke or stroke-like syndromes as a result of sustained extension and/or rotational movements of their neck during their hair washing sessions in their beauty parlours.
Vertebral artery continues its flow to the basilar artery at the atlanto-occipital junction. Due to the sharp turning of the vertebral artery at the atlanto-occipital junction, it is vulnerable to mechanical injury. Sustained extension and/or rotation of the neck can lead to compression of the vertebral artery at the atlanto-occipital junction and results in reduced blood flow to the brain. The medical term to describe this is “Vertebral-basilar Insufficiency” (VBI).
Besides beauty parlour syndrome, scenarios that can potentially lead to VBI are activities that involved sustained extension and/or rotation of the neck, for example yoga, neck stretches, massage session, and so on. Vertebral-basilar insufficiency (VBI) should not be confused or used interchangeably with Beauty Parlour Syndrome. VBI is an umbrella medical term which describes any conditions that lead to reduced blood supply to the vertebral-basilar distribution.
About 25% of strokes or transient ischemic attack (TIA) occur in the vertebral-basilar distribution (LR Caplan et al. 2005). However, it is very rare that these are caused by the movements involved hyperextension and/or rotation of the neck (Lima Neto AC et al. 2017).
Despite the rare occurrence of VBI due to sustained extension and/or rotation of the neck, the consequences can be fatal or cause long-term disability. Hence, it is very important for those who often engaged with these risk activities, for example exercise trainer, yoga instructor, and massage therapist to familiarize themselves with VBI. This allows them to minimize the risk of VBI in their daily routine, either for their clients or themselves.
VBI tends to have higher occurrence rate in those who are/have (Lima Neto AC et al. 2017)
(iv) high-cholesterol levels
Small group of people who have structural limitation, for example, sharper turn at the at lanto-occipital junction, cervical spondylosis, bone spur at the cervical area, hypoplastic vertebral artery (congenital vertebral artery defect with smaller blood vessel lumen) are more prone to VBI as well. It is difficult to identify these group of people until they present with the syndromes. The best way is to look out for the common symptoms of VBI, especially for new clients or during a new movement routine.
Example of joint degeneration may lead to VBI is demonstrated in the picture.
The most common symptoms of VBI are (Lima Neto AC et al. 2017)
(ii) vertigo / spinning sensation
(v) diplopia / double vision
(vi) blindness / loss of vision / blurring of vision
(vii) ataxia / loss of coordination
The recommendation for suspected cases is to refer for proper medical review.
However, the worrying part is that the symptoms are being overlooked or dismissed as something minor. This can lead to unwanted consequences which can be prevented if it is being picked up early.
If you are a personal trainer, exercise trainer, yoga instructor, massage therapist, or someone who encounter a lot of activities involve sustained extension and/or rotation of the neck, you can consider to
For those who are at high risk,
(i) keep sustained extension and/or rotation of the neck the most 10 seconds;
If sustained extension and/or rotation of the neck is essential for whatever reason,
(ii) Break up the sustained movement into short bouts of 10 seconds, for example 5 sets of 10 seconds neck extension with 10s to 20s rest in-betweens sets
If sustained extension and/or rotation of the neck is unavoidable
(iii) Closely monitor them by talking to them and ask for feedback. Stop immediately if there is any sign and symptoms which were mentioned above.
For those who are not at high risk but are new to the movement / exercise,
(i) closely monitor them by talking to them and ask for feedback. Stop immediately if there are any sign and symptoms which were mentioned above.