Manipulation Under Anesthesia
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.
Indication For Manipulation Under Anesthesia
Spinal manipulation under anesthesia is a procedure that is intended for patients that suffer from sometimes acute, but mostly chronic musculoskeletal disorders in conjunction with biomechanical aberrancies. These individuals have also been unresponsive to previous conservative therapy. Etiology of their pain can be disc bulge/herniation, chronic sprain/strain, failed back surgery, myofacial pain syndromes in conjunction with those listed below. The procedure is extremely beneficial for the patient that has muscle spasm accompanied with pain and terminal joint range of motion loss. These types of patients typically respond well to manipulation/physical therapy/exercise, but their relief may only be temporary (days to weeks). To ensure good results with a procedure of this type, one of the most important considerations is patient selection.
MUA Procedure and Post-Follow Up Care
Manipulation under anesthesia (MUA) is performed using conscious sedation usually using Diprivan (Propofol), and Versed as the anesthesia. The patient is taken through passive cervical/thoracic and lumbar ranges of motion in flexion, lateral flexion and rotation. Specific spinal manipulation is performed when the elastic barrier of resistance and segmental end range of motion is achieved. Then stretching of the paraspinal and surrounding supportive musculature is performed to promote cervical, thoracic, lumbar and lumbopelvic flexibility in conjunction with attempting to restore proper kinetic motion.
The patient is then awakened from the anesthesia, which usually occurs minutes after the diprivan is stopped. They are taken to recovery and monitored until full recovery has occurred. This varies but is usually accomplished within a very short period of time. The patient is then discharged to rest until post-MUA therapy is begun later the same day.
Post-MUA therapy is a vital part of the MUA procedure and is accomplished the same day as the procedure to help continue the alteration of adhesions in the joints, joint capsules, and surrounding holding elements. Post MUA therapy consists of warming up the involved areas with passive stretching as was accomplished in the MUA procedure, followed by interferential stimulation and cryotherapy. The patient is then sent home to rest.
This exact procedure is repeated serially in most cases by having the patient return to the facility the next day and the following day(s). The average number of days for the MUA procedure to accomplish the desired outcome has been shown to be between 2-4 days. Consecutive day procedures have been shown to alter adhesion formation and joint dysfunction in a manner that single procedures do not accomplish. The concept is that a little more movement each day in incremental movements accomplishes the desired increase in range of movement and decrease pain far better than trying to spend great amounts of time on one day to accomplish the same movement.
This also has a dramatic effect on decreasing the post-MUA therapy time. This protocol for post-MUA therapy is repeated 7-10 days straight after the final MUA followed by pre-rehabilitation and then formal rehabilitation for 3-6 weeks. Additional assistance with the reduction of soreness and mild edema with an increase in range of motion, has been noted when small, portable, multi-modality interferential/NMES/HVPC devices are applied in the OR directly after the MUA procedures are accomplished and the patients are sent home with these units prior to receiving post-MUA therapy.
The rehabilitation program continues for 3-6 weeks following the MUA procedure to give the patient time to recover to pre-injury status. It gives the patient confidence that they have achieved recovery, and in most cases, the patient's return to work and daily lifestyle with a renewed feeling of confidence in their ability to accomplish everyday tasks that they have previously been unable to accomplish due to pain and reduced movement. Marked improvement (80-97%) has been the general rule when the properly selected cases have received this procedure. Strict adherence to standards and protocols should be the rule of thumb when considering the MUA procedure and only certified MUA practitioners taught through accredited institutions should be allowed to practice this technique - reimbursement should also reflect that proper educational standards have been achieved.
