Manipulation Under Anesthesia (MUA)

After medical clearance, the patient is lightly anesthetized to achieve total relaxation. Then adjustments and stretching movements that would normally be too painful to even consider are easily, painlessly, and quickly accomplished. This procedure is a non-invasive procedure increasingly offered for chronic conditions that have not responded to traditional forms of physical medicine. The treatment is performed in a hospital or surgery center by licensed physicians with specialized training and certification, specifically for the procedure. A team approach is required to have a safe and successful outcome, and utilizes the expertise of anesthesiologists, medical doctors, chiropractors and nurse practitioners.

Manipulation Under Anesthesia is very similar to what takes place in the chiropractor's office, with the added assistance of anesthesia. An intravenous catheter is inserted into the patient's arm and a small amount of anesthesia is administered by a qualified anesthesiologist. The procedure lasts less than 20 minutes. While the patient is asleep, the muscles affecting spinal dysfunction are stretched and the spinal joints that are "locked" and painful are manipulated. The patient wakes up quickly thereafter and is monitored by the nursing staff. The procedure is performed on three consecutive days and occasionally four.

Post Procedure care is one of the most important parts of the MUA procedures and makes it truly effective. The therapy begins immediately - the same day. At this time, the patient visits the chiropractor's office and undergoes a combination of stretching exercises, cryotherapy and electrical stimulation to eliminate soreness and promote healing. The patient then returns home to rest. After the last MUA procedure, the patient should follow an intensive therapy program for several weeks consisting of the same stretches and manipulations accomplished during the procedure. Rehabilitation will be required for the next several weeks, which includes stretching, flexibility training, and strengthening exercises. There will be periodic manipulations as required by the doctor. This regimented post- MUA therapy will help the patient regain pre-injury strength and help prevent future pain and disability.

M.U.A. can be a valuable procedure for people with chronic neck, back, and joint problems. There are conditions caused by long-term disabilities, accidents, and injuries that have not been responsive to traditional treatment. Additionally, chiropractic patients who have reached a plateau using traditional therapy can also significantly improve their quality of life using M.U.A.

Which patients should be considered for manipulation under anesthesia?

Certain neck, mid back, low back, or other spinal conditions respond poorly to conventional care. One proposed theory for this is that as a result of past or present injury, adhesions and scar tissue have built up around spinal joints and within the surrounding muscles and causes chronic pain.

Patients often undergo various treatments, such as physical therapy, chiropractic care, epidural injections, back surgery, or other treatments that do not address fibrous adhesions. Some patients feel temporarily better with these treatments, but their pain often returns.

In general, patients selected for manipulation under anesthesia are those who have received conservative care for six to eight weeks. If limited or no improvements in symptoms or objective findings have occurred, then manipulation under anesthesia may be an appropriate alternative.

Prior to treatment, protocols of diagnostic testing should document the nature of the diagnosis, support the need for treatment and eliminate questions of psychosocial factors that can influence pain responses. In addition to X-ray, MRI scan or CT scan, a musculoskeletal sonogram or nerve conduction velocity test may be ordered.

Common, general indications that M.U.A. could be effective include: