Manipulation Under Anesthesia (MUA)

What is MUA?

The practice of Manipulation Under Anesthesia as performed by Chiropractors and Medical doctors has grown popular over the past decades due to its effectiveness in the field of pain management.  After medical clearance, a patient is lightly anesthetized to achieve total relaxation, then joint manipulation as well as muscle, ligament and tendon stretching movements – which would normally be too painful to even consider, are easily,  painlessly and quickly accomplished.

MUA, combined with consistent, but simple post-procedure treatment and exercise, can eliminate or greatly reduce pain and restore or greatly improve range of motion. Plus, MUA procedures are cost-effective…thousands of dollars less than traditional surgery and other more invasive treatments – and usually qualify for insurance coverage. In addition, recovery is much faster, allowing MUA patients to get back to work and the pleasure of living much sooner than expected. Chiropractors and MD’s work together as a team approach to this treatment modality.

Is MUA new or experimental?

MUA is neither new nor experimental. It’s actually been practiced since the late 1930s and used by osteopathic physicians and orthopedic surgeons for many years as a proven form of treatment. During the past eight years, interest in MUA has greatly increased thanks to tremendous advances in anesthesiology. Today, MUA is a multi-disciplinary outpatient procedure that takes place in a controlled hospital or ambulatory surgical setting, usually over the course of one to three days. Using specialized chiropractic techniques, supported by the expertise of MDs, RNs and anesthesiologists, MUA achieves maximum results for qualified patients. Countless recent case studies and medical research continue to show that MUA is widely regarded as safe and effective and is gaining acceptance by the medical community at large. Qualified patients are those who are not responding to traditional conservative treatments for musculo-skeletal problems, yet are not surgical candidates. There is little left for these patients besides manipulation under anesthesia.

Who can benefit from MUA?

MUA can be a valuable procedure for people with chronic neck, back and joint problems conditions caused by long-term disabilities, accidents, and injuries that have not been responsive to conventional treatment – but MUA is not for everybody. Common, general indications that MUA could be effective include:

  • Fibromyalgia
  • Torticollis
  • Muscular fibrous adhesion
  • Failed Back Surgery
  • Chronic disc problems
  • Post-surgical scar tissue formation
  • Herniated disc without fragmentation
  • Chronic re-injury

Chiropractic patients who have reached a plateau using traditional therapy also can significantly improve their quality of life using MUA.

Why does MUA work?

MUA achieves results where other treatments fail because it allows your caregivers to adjust the joints and stretch muscles without the usual resistance. “Twilight” sedation allows you to be responsive, but not apprehensive. Manipulations are completed in a GENTLER manner than when fully awake and engaged.  Fibrotic adhesions, which limit range of motion and contribute to pain, are altered, muscles are stretched and collagen fibers are remodeled to eliminate or reduce restriction thus pain and discomfort are decreased. The adjustments received using MUA are the same as those the patient experiences during regular chiropractic visits, but require less force simply because of the relaxed state.

How do I begin an MUA treatment plan?

Using the standards of care as described by the National Academy of MUA Physicians, the doctor would select patients. The typical MUA treatment plan begins with a medical screening process to clear the patient for anesthesia. Medical tests usually may include:

  • Blood studies
  • Chest X-ray
  • EKG, or electrocardiogram for patients age 50 and older
  • A pregnancy test for female patients

Your chiropractor may also order additional tests, such as an MRI, CT scan and other diagnostic tests, if not already performed and are necessary to complete the diagnosis. After receiving medical clearance, the patient is scheduled at the facility where the MUA will be performed.

What’s the MUA procedure like?

On the day of the MUA, the patient must be accompanied by a friend or family member to drive the patient home after the procedure. No patient will be allowed to drive following this procedure. The patient then confers with the anesthesiologist, is gowned and the sedative – usually Diprivan and/or Versed is administered to achieve the comfortable “twilight” sleep that makes treatment possible.

If the full spinal procedure is performed, MUA begins with specialized techniques that first methodically start in the cervical spine with gentle traction, forward flexion and lateral flexion movements followed by spinal manipulation. The doctor then moves on to the thoracic spine, using mild stretching techniques and adjustment and finally into the lumbar spinal regions using flexion and traction techniques, plus stretching, targeted massage and typical lumbar adjustment.  If the hips are involved, procedures to increase range of motion of the hip will be employed: stretching, traction and soft tissue massage techniques.  To achieve results in most chronic cases, the MUA procedure is repeated.  Although not typical, treatments sometimes repeat up to 3 days in a row. The doctor may adjust only the area of abnormality plus the adjacent area, the adjacent area only, or all three areas, depending on the doctor’s assessment of the condition.

What happens after the procedure?

After the procedure is completed, the patient is repositioned and awakened then taken to recovery, where he or she is carefully monitored by the O.R. nurse. Recovery time is generally up to 20 minutes. After recovery, the patient receives fluids and a light snack. The doctor and anesthesiologist also remain in attendance until the patient is discharged.  Post-procedure care is one of the most important parts of the MUA procedure and makes it truly effective. The therapy begins immediately the day each MUA procedure is completed.  At this time, the patient visits the chiropractor’s office and undergoes a combination of stretching exercises, ice/heat and usually electrical stimulation (if applicable) to eliminate or reduce soreness.

Following the last MUA procedure, the patient should follow an intensive therapy program for up to 7 days.  This post MUA therapy consists of the same stretches and adjustments accomplished during the MUA procedure but now are made in the doctor’s office.  This is followed by rehabilitation for the next two to three weeks, including stretching, flexibility and strengthening exercises, plus periodic adjustments as required by the doctor.  This could be done with the help of a physical therapist.  A regimented program of post-MUA therapy will help the patient gain the most from the procedure and help prevent future pain and disability.