Manipulation Under Anesthesia

What is MUA?
Manipulation under anesthesia (MUA) is a non-invasive procedure increasingly offered for acute and chronic conditions, including neck pain, back pain, joint pain, muscle spasm, shortened muscles, fibrous adhesions, and long term pain syndromes. It is generally considered safe and is utilized to treat pain arising from the cervical, thoracic and lumbar spine as well as the sacroiliac and pelvic regions.

Manipulation under anesthesia uses a combination of specific short lever manipulations, passive stretches and specific articular and postural kinesthetic maneuvers in order to break up fibrous adhesions and scar tissue around the spine and surrounding tissue. These particular adhesions tend to lock the spine in a state of fixation, preventing normal movement and causing pain. The paraspinal muscles cause a splinting or guarding at the adhesion site, which makes traditional manipulation less effective. By administering anesthesia, complete relaxation is achieved, allowing the provider to directly influence particular adhesions by diminishing the postural musculature. The team includes the anesthesiologist, the primary surgeon/chiropractor who performs the manipulations, and a co-surgeon/chiropractor, also certified in manipulation under anesthesia. This combination of manipulation and anesthesia is not new, as this treatment has been part of the manual medical arena for more than 70 years.

Who is a candidate for mua?
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 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 response. In addition to X-ray, MRI scan or CT scan, a musculoskeletal sonogram or nerve conduction velocity test may be ordered.

What are the proposed effects of MUA?
The proposed effects of manipulation under anesthesia therapy include the following: Breaking up scar tissue (adhesions) both in and around the spinal joints, commonly caused by multiple injuries or failed back surgery Decreasing chronic muscle spasm Overcoming hyper-sensitivity of injured areas that makes the patient unable to cooperate for effective treatment Stretching persistent shortened muscles, ligaments and tendons Relieving pain and radiating symptoms from damaged intervertebral discs