Manipulation Under Anesthesia (MUA)
Manipulation is the primary treatment of choice to restore the joint and soft tissue function.
So, why Manipulation Under Anesthesia? Certain patients will not respond favorably or satisfactorily to conservative chiropractic procedures, including manipulation. These indications are listed below.
MUA is designed to stretch or even tear periarticular adhesions that form around the facets of the spine, and joint capsules of the extremities. Adhesions are typically caused by repetitive trauma, post inflammatory responses, or complete lack of joint motion. Adhesions tend to lock the spine in a state of fixation, preventing normal movement and causing pain. This typically causes the paraspinal muscles to splint and further guard at the adhesion site. When this happens, as we as chiropractors know, makes it difficult to adjust the joint, resulting in non-cavitation of that joint. By placing the patient in twilight sedation, a complete relaxation of the paraspinal muscles is achieved allowing the chiropractor to successfully adjust the joint, thus reducing adhesion formation. This is just one example of the benefits of sedation. MUA is a combination of soft tissue stretches, deep tissue massage, and joint manipulation. The benefits of this procedure are numerous including a return to normal spinal movement, the re-establishment of normal structural integrity of the spine, an elimination of symptomatic pain, and an increased range of motion.
If you have more questions please click here for our MUA FAQ.
Post MUA
After the procedure, patients are taken through a rehabilitation process/post-MUA. The purpose of rehabilitation is to strengthen the muscles that have weakened from the decreased range of motion and to prevent the scar tissue from returning in a compressive state by forming it into an elongated state. Post-MUA is extremely important, an estimated 85-95% of patients that are receiving appropriate rehabilitation therapies remain pain free, gaining permanent improvement. [4]
Choosing the Manipulation Under Anesthesia Patient
Choosing the Manipulation Under Anesthesia patient is the most crucial part of the procedure.
The candidate should be under conservative chiropractic care for a minimum period of six to eight weeks and have demonstrated minimal improvement or no relief of their signs of symptoms and /or objective physical findings. This patient should also have tried physical therapy/rehabilitation and or home exercise as well. It is imperative that certain strict documentation and guidelines are followed (including the indications and contraindications for MUA) before a patient should be considered for this procedure.
The overall objective of manipulation is to relieve the patient's pain and disability with a minimum amount of expense and loss of time from his /her work and other activities. In instances of chronic pain when the patient has received regular manipulative treatments over the appropriate period of time to produce results and the patient has demonstrated no improvement either symptomatically or in character of range of articular motion, MUA may be desirable.
Indications for Performing MUA
The following are indications for manipulative procedures under anesthesia, when manipulation is
the therapy of choice:
- Failure to respond to conservative chiropractic care in the office setting after a minimum of six to eight weeks of continuous conservative care
- Chronic or Recurrent pain
- Pain so severe that narcotic analgesic is of little benefit
- Chronic Myositis peripheral, muscular, fibrotic adhesion formation (adhesions and scar tissues will begin to
develop 6-12 hours after an initial injury) - Chronic Fibrositis peripheral, can be muscular or articular: related to fibrotic adhesion buildup over short or long periods of time (i.e.-facet joint encapsulation or encapsulitis with associated restriction of motion)
- Nerve Entrapment . peripheral (i.e-- facet syndrome or inflammation or disc pathology).
- Disc Pathology . Disc protrusions, bulging discs, or herniations less than 3 millimeters in the cervical.spine and 5 millimeters in the lumbar spine (spontaneous or from traumatic origin) documented by CT, MRI or Myelography
- Traumatically induced restriction of range of motion, can be peripheral or radicular (i.e. torticollis)
- Contracture of joint of the cervical, thoracic, lumbar, sacral, sacroiliac, hip, shoulder region. Contractures arise over time (cumulative effect), or neurologic.
- Adhesive Capsulitis
- Chronic production arthritis - spondylosis, spondyloarthritis, and spondyloarthrosis
- Chronic disc changes associated with fibrotic adhesions due to degenerative changes
- Traumatic torticollis peripheral in nature, causing severe muscle splinting and/or contracture, vertebral subluxation due to trauma (intractable pain from hyperflexion/hyperextension injury)
- Failed spinal surgery
- Headaches - non-organic origin
Contraindications for MUA (same for typical in office manipulation):
- Infectious bone disease
- Acute Fractures
- Acute Inflammatory arthritis (i.e- gout or rheumatoid)
- Tuberculosis of the bone
- Gonorrheal spinal arthritis
- Osteoporosis advanced or indicated diagnostically
- "Direct" Manipulation of old compression fractures (however, you can manipulate above or below the fracture site
- Uncontrolled diabetic neuropathy
- Syphilitic articular or periarticular lesions
- Evidence of cord or caudal compression by tumor or disc herniations over 3 millimeters in the cervical spine or 5 millimeters in the lumbar spine
- Widespread staphylococcal or streptococcal infection
- Respiratory infections
- Metastatic bone disease
- Any forms of malignancy or metastasis
- Prior history of stroke
- Discitis
- Osteogenesis imperfecta
- Vertebral artery syndrome
- Abdominal aortic aneurysm
- Clotting disorders
- Pregnancy
- THESE ARE FOR THE CHIROPRACTIC PORTION, NOT THE ANESTHESIA PORTION OF THE PROCEDURE