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June 15, 2012
The Hazards of Salon & Massage Work

There’s more to the beauty biz than meets the eye

Beauty is hot. According to Inc. Magazine, nail salons have experienced a 9 percent year-over-year growth rate, with cosmetology and barber schools the fastest growing industry in 2011. Massage businesses, including several national franchise chains, are popping up all over the country.

Salons alone generate more than $60 billion in annual sales in the United States and employ about 1.5 million people. As these industries grow there’s increased attention to the risks for those who maintain Americans’ nails, hair, faces, and bodies.

This Compliance Report focuses on the safety and health of salon and massage workers. Though their job tasks may differ from those of your workers, you’ll recognize familiar hazards like chemical exposure and ergonomics.

Get the latest on efforts to mitigate those hazards, including actions by OSHA and pending federal legislation.

Blowout brouhaha

Beauty product safety made headlines when it was discovered that some hair smoothing/straightening products may contain formaldehyde. These products also may release formaldehyde at levels above OSHA’s permissible limits and may be mislabeled. OSHA says all three put workers at risk.

At the center of the controversy were Brazilian Blowout keratin hair straighteners. In a NIOSH blog post, certified industrial hygienist Dede Montgomery wrote, “Imagining a 10 percent solution of methylene glycol/formaldehyde being applied, dried, and flat-ironed on hair in a salon is enough to make most industrial hygienists cringe.”

Oregon first addressed the issue in a campaign led by Oregon Health and Science University, NIOSH, and Oregon OSHA. The goal was to inform stylists working with Brazilian Blowout and similar products of the risks.

Brazilian Blowout had been advertised as formaldehyde-free and containing no harsh chemicals. Montgomery says the material safety data sheets (MSDSs/SDSs) for the product did not list hazardous ingredients.

However, stylists experienced symptoms similar to those of formaldehyde exposure, including burning eyes, nose, and throat as well as breathing problems.

Regulators get involved

In September 2011 federal OSHA responded with an updated hazard alert on formaldehyde in hair straighteners. The agency refuted claims by the maker of Brazilian Blowout that OSHA air tests showed safe levels of formaldehyde.

By December 2011, OSHA reported that 23 salon owners had been cited and fined for formaldehyde exposure. It published a new Web page dedicated to the topic at

OSHA identified other products that contain formaldehyde or that can expose workers to formaldehyde during use, even though they may not list the chemical on labels or MSDSs. Among these are:

  • Brazilian Blowout Acai Professional Smoothing Solution
  • Professional Brazilian Blowout Solution
  • Cadiveu Brasil Cacau
  • Cadiveu Acai therapy
  • Copomon/Coppola Keratin Complex Smoothing Therapy products
  • Marcia Teixeira products

OSHA recommends that when possible, salon owners, beauty schools, and workers should avoid using products containing formaldehyde, methylene glycol, or other ingredients treated as formaldehyde under OSHA regulations. Employers should check the label or MSDS, as formaldehyde is not always listed.

If such products are used, employers should follow the requirements in the formaldehyde and hazard communication standards. These include testing salon air during treatments, providing adequate ventilation and appropriate personal protective equipment for workers, and training employees on the hazards of formaldehyde.

California has also gotten involved. In early 2012, the state attorney general settled a lawsuit against Brazilian Blowout. The company was ordered to cease deceptive advertising and put caution stickers on products stating that the product releases formaldehyde gas.

Health advocates have urged the U.S. Food and Drug Administration (FDA) to remove keratin hair straighteners from the market.

Nail salon risks

Another area of concern is nail salons. Three industry groups (Professional Beauty Association, Nail Manufacturers Council, and National Cosmetology Association) produced a report titled Nail Salon Workers: Health and Safety, Working Conditions, Compensation, and Demographics.

According to the report, “The ingredients used in nail salon products are safe under normal conditions of use, and the levels of exposure are well below safety limits established by OSHA and the FDA.”

The document addresses three OSHA-regulated ingredients—dibutyl phthalate (DBP), toluene, and formaldehyde. DBP can have adverse reproductive effects and can cause developmental problems in children. Toluene affects the neurological system with symptoms, including headache, dizziness, nausea, short-term memory loss, and can affect a developing fetus.

The authors of the report state that exposure to the chemicals in salons is very low. They add that DBP has been eliminated by leading nail polish brands and credit a European Union ban on the products for the action.

The Campaign for Safe Cosmetics contends that the U.S. ban was the result of a coalition of 160 organizations that organized salon workers and pressured polish makers to remove harmful chemicals. Campaign Director Lisa Archer says that cosmetics requirements in this country have not been significantly updated since they were created in the late 1930s.

A Campaign fact sheet states, “We know little about the actual health impacts because so little research on nail salon workers or customers has been done, but the few preliminary studies that have been conducted indicate a cause for concern.”

Symptoms include decreased attention and processing skills and increases in asthma and other breathing problems.

Even when laws are changed, problems do not disappear. California, for example, has passed a state Safe Cosmetics Act that requires disclosure of ingredients. A recent study by the California Environment Protection Agency’s Department of Toxic Substances Control (DTSC) found that some nail-care products continue to contain high levels of chemicals despite labels that claim otherwise.

One apparent sign of progress is the campaign’s Compact for Safe Cosmetics. Several hundred cosmetics companies have taken a voluntary pledge to avoid chemicals banned by health agencies outside the United States and to fully disclose product ingredients.

Dueling proposals

Congress is currently considering two proposed laws to make safer cosmetics. H.R. 4395, the Cosmetic Safety Amendments Act of 2012, was introduced by Rep. Leonard Lance (R-New Jersey) and has the support of the Professional Beauty Association (PBA) and other industry groups.

According to PBA, the proposed bill “provides the needed improvements to the current laws regarding cosmetic and personal care products, without placing an undue burden on business or compromising safety.”

Supporters say H.R. 4395 would formalize FDA processes for reviewing ingredients, setting safety levels for trace impurities, creating national uniformity for cosmetics regulations, and establishing industrywide good manufacturing processes. It also would establish a means for FDA to review determinations made by a Cosmetic Ingredient Review (CIR) expert panel.

The legislation is opposed by safety and public health groups including the Healthy Nail Salon Alliance. One problem, says Alliance Co-director Jamie Silberberger, is that the CIR panel is not objective because it is made up of cosmetic industry representatives.

Another point of contention is that the bill preempts states’ rights to regulate cosmetics.

Silberberger and other advocates support an alternate bill, H.R. 2359. The Safe Cosmetics Act, introduced by Congresswoman Jan Schakowsky (D-Ill.), would require the following:

  • Phase-out of ingredients linked to cancer, birth defects, and developmental harm,
  • Creation of a safety standard with protections for children, the elderly, workers, and others,
  • Requirement for full ingredient disclosure on labels and company websites,
  • Worker access to information about chemicals in personal care products,
  • Required data-sharing to avoid duplicative testing and encourage alternatives to animal testing, and
  • Adequate funding for the FDA’s Office of Cosmetics and Colors.

Lisa Archer of the Campaign for Safe Cosmetics believes the bill would also give the FDA needed authority to recall dangerous products. Responding to an industry focus on salon ventilation, Archer says workers are better served when hazards are eliminated altogether.

“Unfortunately, a lot of folks in the industry are ignoring the fact that primary avoidance by innovating safe products is the long-term goal. Workers and consumers continue to demand a higher level of safety in the products they use,” says Archer.

Saving hands

Spas are among the fastest growing elements of the beauty business, and massage is offered at many. Lauriann Greene is the co-author of Save Your Hands! The Complete Guide to Injury Prevention and Ergonomics for Manual Therapists. (The book and other information are available on her website at

Greene knows the problems first hand. In 1993, she graduated from massage school but was never able to practice because of injuries sustained during training. Having invested resources and energy into her education, she was eager to put the knowledge to work.

“I realized there was no literature on the subject of repetitive injury—not just among massage workers but among all healthcare workers,” she says. Since the mid-90s Greene has been writing, conducting workshops, and speaking on the subject.

Greene and her co-editor, ergonomist and massage therapist Rick Goggins, have collected data on massage worker health and safety. They questioned 600 respondents and found that 77 percent experienced pain or other musculoskeletal symptoms related to massage work. More than 40 percent reported being diagnosed with an injury, especially overuse syndrome and tendonitis affecting the neck, wrist, and lower back.

“Unfortunately,” concludes Greene, “the massage and spa industries have exploded faster than the increase in knowledge of the risks associated with this type of work.” While she acknowledges that awareness is higher than in the early 1990s when she was training, much work remains to be done.

Awareness and action

Greene and Goggins have developed a train-the-trainer course they call the Certified Injury Prevention Instructor (CIPI) program. Although it’s just getting off the ground, response has been quite positive.

Greene emphasizes principles applicable not only to massage therapists but also to others who use their bodies in their work. For example, she explains that the basic massage stroke is done with a flat palm that moves up and down the back.

“But if you use only that part of the hand, you’re only soliciting certain muscles. If you use other parts of the hand or arm—such as the knuckles, fist, or forearm—you give the original muscles an opportunity to rest and recover.”

She teaches a common ergonomic concept of letting the larger muscles work more than the small ones, which are more easily injured. “So instead of using the small muscles of the hand and arm, you want the power of your stroke to come from the large muscles of the back, the thighs, and the glutes,” she says.

Massage therapists can prevent injury by keeping their bodies in a neutral posture. This is characterized by the head over the shoulders, the shoulders over the hips, hips over the knees, and knees over the ankles.

Keeping the body “stacked” in this way helps maintain the normal curves of the spine, and it ensures that the muscles alone aren’t holding one upright. Bent postures reduce blood flow and oxygen, which results in pain. She advises massage professionals to “work as close to that as possible and return to neutral as many times as you can during the work day.”

Other techniques include keeping the massage table at waist height, not bending constantly to reach items stored underneath, and not working in a space that is so small that it requires awkward postures.

It’s also important for massage therapists to maintain good overall health. That means getting enough sleep, eating well, not smoking, and following a course of exercise and stretching.

The employer’s role

Although some massage therapists enjoy careers spanning 40 years or more, the average career length is only 7 or 8 years, according to Greene. Employers have an important role to play in keeping their personnel injury-free and working longer.

It starts with information. “A lot of employers assume that employees know how to prevent injury, but that’s not at all the case,” says Greene. Though some massage schools teach risk awareness and injury prevention, many do not.

It’s also important to ensure that massage chairs and tables are as adjustable as possible. Make sure employees are not working on an overly hard floor, that they wear proper shoes, and that the workspace is free of trip hazards. Employers should provide carts for transferring heavy linens from place to place.

Greene suggests bringing in an ergonomics consultant to assess the workplace. She says the return on investment is high, noting that workplace ergonomics programs have been shown to reduce injury by 55 percent. Gains in productivity and reductions in absenteeism are also typical.

At what cost beauty?

Getting a massage or going to the hairdresser are pleasant parts of life for many people. But the risks and exposures are potentially serious for the millions of affected workers.

With OSHA and other regulators involved and legislation pending in Congress, stay tuned to learn about efforts to protect employees. These include changes in the law, changes in product formulations, and best practice recommendations from advocates and industry.

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