Sheridan Digby had hoped a 2019 remedial massage appointment would help fix her sore neck.
Instead, she says it caused her to suffer a stroke.
The Geelong mother of four is now preparing to front the Supreme Court of Victoria, where she will claim the masseuse and medical clinic where she received the massage are liable for her injuries.
In a statement of claim lodged with the courts, Ms Digby alleges that the massage therapist said they wanted to "really piss the muscles off" with a deep and forceful massage to the back of her neck.
Her claim alleges the massage caused or contributed to tears to the inner walls of both her vertebral arteries — running up either side of the back of the spine — which then led to a stroke.
"It felt like I'd been hit by a truck," Ms Digby told the ABC.
"It just felt like everything was thrown out of whack. I couldn't concentrate, I lost my balance, I couldn't see, I had no energy, fatigue."
While Ms Digby has now regained some of the vision lost on her left side, she said the constant fatigue has had a lingering impact on her life, particularly as the sole parent of four kids.
"It's like an invisible illness," she said.
"People don't automatically look at you and assume you've had a stroke because you're not paralysed on one side, but it doesn't mean that you don't feel terrible on the inside.
"Having less vision makes everything harder, having fatigue makes everything harder. Every single thing in your life just becomes a little bit more difficult. And people don't notice."
Defence documents show the masseuse denies they did not use reasonable care during the treatment on Ms Digby, and denies the allegation they said they wanted to "really piss the muscles off". The medical clinic has also denied liability for Ms Digby's injuries.
In a statement to the ABC, the masseuse said they held an "excellent long-term record" after decades as a remedial massage therapist.
"I am extremely disappointed that this claim has been made against me and deny the allegations outright," they said.
"I feel for the person making the claim and wish her well, but I will be vigorously defending myself in relation to this claim."
"I am absolutely confident the expert evidence will prove that I did not cause the injuries alleged."
Limited research on link between massage and stroke
While Ms Digby's legal challenge and the subsequent denials may be straightforward, the link between massages and strokes is less so.
There is limited research and medical evidence linking massages with strokes, largely due to the rarity of the injury.
However, a leading expert who spoke to the ABC said they believed it was possible.
Victor Chang Cardiac Research Centre Director and CEO Jason Kovacic said the connection between the two was the creation of an arterial dissection to either the vertebral arteries running along the back of the spine, or carotid arteries on either side of the neck.
An arterial dissection can create a clot at the point of the arterial wall tear, with the clot either blocking blood flow or dislodging and causing a stroke.
Professor Kovacic said while arterial dissections were rare, and those caused by massages even more rare, it did not mean they didn't happen.
"Certainly, a massage is a less common precipitant of a dissection, certainly more forceful and violent things like a severe car whiplash injury would be a more common triggering event for a dissection," Professor Kovacic said.
"But could a massage in theory cause a dissection? I think it could if it was forceful enough.
"Unfortunately, we are limited in the data as to what's available to us to interpret all of this, but nevertheless the link between violent neck movements or extreme neck movements and carotid and vertebral arterial dissection events is quite clear."
Professor Kovacic stressed that he did not oppose massage treatments.
"I would say that I have a lot of patients that derive enormous value from massage, and I think massaging in competent hands can be a wonderfully therapeutic thing and I fully endorse it," he said.
The American Stroke Association (ASA) in 2014 released a statement for healthcare professionals regarding the link between cervical arterial dissections and manipulative therapies on the neck, noting that arterial dissections were an "important cause" of strokes in younger people.
The paper concluded that: "Although current biomechanical evidence is insufficient to establish the claim that Cervical Manipulative Therapy (CMT) causes Cervical Artery Dissections (CD), clinical reports suggest that mechanical forces play a role in a considerable number CDs of and most population controlled studies have found an association between CMT and Vertebral Artery Dissection stroke in young patients"
The paper also suggested practitioners should inform patients of "the statistical association between CD and CMT prior to undergoing manipulation of the cervical spine".
The ABC has contacted the ASA for further comment, while the Australian Stroke Foundation declined to comment.
The Alfred, Austin and Royal Melbourne Hospitals all declined to comment on how often they receive patients suffering arterial dissections or strokes shortly following massage or neck treatments.
Stroke survivor still suffering fatigue, depression six years on
Mornington Peninsula father of two Paul Burns was also found to have suffered an arterial dissection before his 2018 stroke.
He believes that dissection was directly linked to a myotherapy appointment he had received earlier that day.
"I had to teach myself how to walk again, how to eat again, how to swallow food again," Mr Burns said.
Post-stroke fatigue is one of the biggest lingering impacts of stroke Mr Burns faces today, along with "a loss of identity".
"That's still a day-to-day challenge, working out who I am and what I'm doing and why it matters … a lot of depression comes with that," he said.
The impact on Paul's two young children, one of whom was only a baby when he suffered his stroke, is the most painful aspect of his injury.
"My eldest will have a little bit of a grasp on it, but my youngest will never know me at my best," he said.
"He'll never know me pre-injury … and I will always have massive regrets over that."
A self-regulated industry
Victorian massage therapists operate under a negative licensing model, meaning anyone can call themselves a massage therapist in what is a largely self-regulated industry.
The practice is classed as a general health service, with no provision in the Health Act requiring practitioners to be registered.
All Victorian health professionals are nonetheless subject to a range of laws, including the general code of conduct set out in the Health Complaints Act — which leaves massage therapists open to prohibition orders from Victoria's Health Complaints Commissioner (HCC).
Last financial year, the HCC issued 18 prohibition orders against seven different massage therapists.
The Association of Massage Therapists (AMT), a national not-for-profit group aiming to advance the profession, argues the negative licensing model "does not provide adequate protection to members of the public".
In a position statement, the AMT said it supported the creation of a uniform national framework to create credentials for massage therapists, and the protection of the title 'Massage Therapist' to safeguard the public "from rogue or unqualified practitioners".
Slater and Gordon's senior counsel in medical law Shari Liby, who is representing Ms Digby, said the lack of regulation in the industry was a major shortfall for both patients and practitioners.
"If you don't have any oversight you don't have any standards as to what qualifications you even need in order to be able to hang out your shingle and say 'I'm a remedial masseuse'," Ms Liby said.
"So, if you don't have that kind of regulation, you don't have any criteria for education, for training, you don't even have a process for when things go wrong."
"It's difficult to find the numbers of how many people are being injured, whether that's physically or emotionally, whether that's being assaulted, because there's no reporting agency that's really the right place because it's not regulated."
Both Sheridan and Paul share the same advice for people using massage therapists: do some research on the healthcare professionals you're trusting with your body, and don't be afraid to speak up if you feel any treatment is too rough.
"You don't think something like this would happen," Ms Digby said.
"Make sure you research who you're going to go see, make sure you trust them, and if you get the feeling something is not right then listen to that."
