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Manipulation Under Anesthesia, or MUA, is a highly specialized, non-invasive chiropractic stretching technique for chronic pain patients who are no longer responding to regular conservative care. MUA works by altering adhesions and scar tissues to restore range of motion and mobility while the patient is in a safe, temporary "twilight sleep." As an alternative therapy to surgery and medication, MUA consistently generates life-changing results for carefully selected patients. Certain neck, mid back, low back or other spinal conditions respond poorly to conventional care. The problem is that due to past or present injury, adhesions and scar tissue have built up around spinal joints and within the surrounding muscles causing chronic pain. Patients often undergo various treatments from physical therapy, chiropractic care, epidural injections, back surgery or other treatments that do not address the fibrous adhesions. Some patients feel better temporarily, but their pain returns as the fibrous adhesions have not been removed.
In general, patients selected for MUA are those who have received conservative care for 6 to 8 weeks. If limited or no improvements in symptoms or objective findings has occurred in the character or the quality of these findings then MUA is an appropriate alternative. 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:
" Fibro adhesion buildup
" Chronic disc problems
" Herniated disc without fragmentation
" Chronic myofascitis
" Intractable pain from neuromusculoskeletal conditions
" Torticollis
" Chronic re-injury
" Failed back surgery
" Chiropractic patients who have reached a plateau using traditional therapy also can significantly improve their quality of life using MUA.
How do I begin an MUA treatment plan?
Using standards of care as described by the National Academy of MUA Physicians, the chiropractor selects patients. The typical MUA treatment plan begins with a medical screening process to clear the patient for anesthesia. Medical tests usually will include:
" CBC blood studies
" SMA 6
" Chest X-ray and 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, or magnetic resonance imaging, CT (cat scans), and other diagnostic tests, if needed.
" 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 (and sometimes Fentanyl) - 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 axial traction, forward flexion and lateral flexion movements followed by adjustive procedures. 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 knee-to-chest rolls, as well as lumbar adjustment.
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 15-20 minutes. After recovery, the patient receives fluids and a light snack. The doctor and anesthesiologist also remain in attendance until the patient is discharged. To achieve results in most chronic cases, the MUA procedure is repeated. 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. Post-procedure care is one of the most important parts of the MUA procedure and makes it truly effective. The therapy begins immediately - the same day - after each MUA procedure is completed. At this time, the patient visits the chiropractor's office and undergoes a combination of stretching exercises, cryo-therapy and electrical stimulation to eliminate or reduce soreness. The patient then returns home to rest. Following the last MUA procedure, the patient should follow an intensive therapy program for 7 to 10 days. This post MUA therapy should be the same stretches accomplished during the MUA procedure and adjustments 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. A regimented program of post-MUA therapy will help the patient regain both pre-injury strength and help prevent future pain and disability.
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