Stroke Caused by Neck Massage

The blogger received the following report about “Singapore banker becomes half-paralysed after neck massage in China” from an e-buddy Leo Nathan. He then sought comment/advice from Dr JB Lim on the suggestion of another e-buddy David Chen. The response from Dr Lim is reproduced below the report.

SINGAPORE - After a particularly painful neck massage, a 40-year-old banker from Singapore suffered a stroke and became a paraplegic consequentially.

Mr Lin claims that his doctors suspect that the excessive force used in the massage broke a blood vessel and resulted in a stroke.

He is now deaf in one ear and is undergoing therapy to regain movement in the left half of his body, Chinese Daily Lianhe Wan bao reported.

According to the paper, Mr Lin is an assistant director of a department in a bank, and was in China recently to visit some friends.

There, he visited a massage parlour to get a foot massage. Upon the therapist's recommendation, he decided to try a neck massage instead.

After the massage, he felt okay. But three days later, he suddenly felt a sharp pain in the left side of his head, and woke up to find that his left ear was deaf.

He also couldn't move the left side of his body, and was unsteady in his gait.

He recalled: "I felt very afraid. It all happened so fast, it was really like a bolt from the blue."

As he was not in condition to be moved, he could not return home immediately for treatment. Mr Lin was sent to a hospital in Hong Kong and hospitalised for about two weeks until doctors deemed him fit for a flight home.

Mr Lin told the Chinese Daily that his doctors suspect that when he underwent the neck massage, the massage therapist tore the vascular wall of an artery accidentally by using too much force.

The damage resulted in the blockage of the artery passage, causing the blood flow to be disrupted.

Recovery

According to his doctors, Mr Lin suffered vertebral artery dissection, which is a flap-like tear of the inner lining of the vertebral artery - a blood vessel that is located in the neck and supplies blood to the brain.

After the tear, blood enters the arterial wall and forms a blood clot, thickening the artery wall and often impeding blood flow. This can result in intermittent or permanent stroke symptoms such as difficulty speaking, impaired coordination and even vision loss.

According to medical resources, it can be caused by physical trauma to the neck, such as a car accident.

Currently, Mr Lin is undergoing treatment at Tan Tock Seng Hospital's rehabilitation ward.

Last month, he began a "walking" rehabilitation treatment, where he is assisted in walking back and forth along a set path. Doctors said this will help speed up the recovery process.

On August 24, Mr Lin was discharged from hospital. Although he is still easily fatigued, he is now able to walk without the need for crutches.

-Your Health, Asia One

Sunday, 23 September, 2012 9:01 PM

From: lim juboo

I really cannot comment on this as I have not come across such a case before, nor have read this in the literature.

I am not sure if excessive force used in the massage can even tear an internal blood vessel and cause a blood clot? Blood vessels are quite elastic and rubbery and are not easily torn even by hard rubbing especially from outside the body.

A blood vessel usually can only be ruptured by some sharp objects such as a knife or torn apart say in a motor vehicle accident. The vessels are quite well protected inside, and are not easily torn even hard rubbing. At best, any hard pressure applied from outside may temporarily impede the flow of blood to the brain.

This may cause a person to faint provided all the vertebral vessels to the brain including both the carotid arteries on both sides of the neck are all blocked off at the same time.

But this cannot cause a CVA (cerebral vascular accident – stroke). How is it possible to break a vertebral vessel by just massaging the neck? There is no evidence in the literature on this possibility.

This case is an isolated one, and should be classified under ‘case study’ rather than an accepted epidemiological norm. You need very large scale studies over very long periods – longitudinal cohort studies to prove what the patient believes or what his doctor’s suspect. You need to apply the Null Hypothesis in the study to prove this. There is no evidence that neck massage causes stroke? This is the first time I heard about this.

Even if the vessel was torn by excessive pressure during a massage, the blood may not necessary form a clot. Internal bleeding may be possible, especially under the skin causing bruising and purpura (purple marks due to subcutaneous bleeding) by hard banging with a blunt object.

Moreover, the victim felt okay after the massage, but it was only 3 days later when he woke up to find his left ear deaf.

A blood clot normally takes place within 5 – 8 minutes of a vascular injury, and not 3 days later. This is clearly not consistent with what we know. Even if you have a small cut on your finger, bleeding will automatically stop within 8 -10 minutes at most as the clotting mechanisms come into play unless you have a bleeding disorder (example: hemophilia). Exactly how long it takes to form a blood clot depends on the prothrombin time and platelet activation to form a fibrinogen which is around 10 – 15 seconds, and not 3 days.

Tens of thousands of people go for massages everyday throughout the world without incidence of strokes occurring.

Healthcare providers must remember the vast majority of cerebral vascular accidents (CVA) or strokes are due to more realistic causes such as hypertension, diabetes mellitus, obesity, over-eating, the lack of exercise, sedentary lifestyle, stress, free radical damage from food and medication, smoking, and aging.

These are the recognized and well-established root causes on why people get a stroke or cardiovascular events rather than blaming it on traditional massages which do far more good in relaxing a stressed out body, and a sense of well-being.

Healthcare providers should educate the public on more recognized causative factors than single out isolated cases for which there is no definitive evidence. A stroke caused by a body or neck massage would be more an academic interest to a clinician than an accepted norm as a significant wide-spread public health problem.

Doctors must also look at the statistical probability that this patient was already going to get a stroke in 3 days time anyway, whether or not he went for the massage. It probably was already imminent for him, and this would have no bearing with his massage.

In short, a lot of people suffer from stroke these days because of bad lifestyles, and not because they went for a neck or body massage. The aetiologies for CVA from these other factors have already been mentioned. They may not even go for any massage in their entire life.

If people are afraid, then do not go for massage at all, or tell the masseur not to massage the neck, or just message it lightly.

Dr. JB Lim