MUA is a beneficial procedure for chronic neck, back and joint problems. It is especially effective for people with conditions caused by long term disabilities due to accidents or injuries that are not relieved through conservative treatment. MUA can be an alternative for patients facing invasive surgery.
Studies prove when compared to surgery and other procedures, MUA patients return to work faster, have higher activity rates, and longer lasting results. Some conditions benefiting from MUA are fibroadhesion build up; chronic disc problems; herniated discs; chronic re-injury; myofascial pain syndrome; fibromyalgia; failed back surgery; frozen shoulder; headaches/migraines; sciatica; acute and chronic muscle spasm and decreased spinal range of motion. More detailed information about MUA is available upon request.
Since the 1930’s Manipulation Under Anesthesia has been changing the lives of chronic pain sufferers and improving their quality of life (refer to chronic pain page). Documentation regarding the success and value of MUA has been recorded in the Osteopathic literature since 1948, when Clybourne reported in the Journal of American Osteopath Association a success rate of 80-90% which has been maintained to this day. MUA is a non-invasive procedure increasingly offered for acute and chronic neck pain, back pain, joint pain, and migraines. It is performed on only those Patients that have little or no response to any other treatment and meet all the requirements to be considered a candidate for the procedure. Unfortunately, not every patient is a candidate for this procedure, but if you are, the results and overall improvement are incredible.
The combination of manipulation and anesthesia is not new, as it has been a part of the manual medical arena for over 60 years. The overall objective of manipulation is to relieve the patient’s pain and disability with a minimum of expense to the patient and loss time from work and other activities of daily living. Anesthesia allows for complete muscle relaxation so patients’ muscles can be stretched beyond the point of consciously tolerable pain. The Manipulation Under Anesthesia procedure uses the combination of manipulation and anesthesia to perform short lever manipulations, passive stretches, specific articular joint manipulations, and postural kinesthetic maneuvers in order to break up fibrous adhesions and scar tissue around the spine, extremities and surrounding soft tissue. The fibrous adhesions and scar tissue that surround the spine and soft tissue are directly responsible for the chronic pain.
Four very important principles must be carefully followed if manipulation under anesthesia is to be successful.
1. Careful selection of cases, not everybody will be a candidate.
2. Careful application of the technique by a skilled MUA physician.
3. Well-planned post-manipulation care and rehabilitation.
4. Patient education provides a clear understanding of the requirements that lead to a proven, positive outcomes.
Who is a candidate for manipulation under anesthesia?
Manipulation under anesthesia is intended for patients that suffer from sometimes acute, but mostly chronic neck, mid-back, lowback, hips, shoulders, headaches and other spine disorders causing chronic pain. These patients have also been unresponsive to conventional care such as chiropractic manipulation, physical therapy, chronic care, epidurals and back surgery. Before the patient can be considered a candidate they need to receive a minimum of 6 weeks of conservative care (physical therapy and chiropractic care). The reason some spinal syndromes respond poorly to conservative, conventional care is because they do not address the underlying cause. Whether it is a disc injury, old injury to the spine or headaches it is the adhesions and scar tissue that have built up around the spinal joints and within the surrounding muscles causing the chronic pain.
Patient evaluation and screening:
One of the most important aspects to assure that the MUA procedure will be a success is patient selection. Not everybody is a candidate for this procedure. Candidates are selected for MUA after taking a thorough and adequate history, thorough examination and appropriate diagnostic imaging and laboratory procedures necessary for an accurate diagnosis of the underlying condition.
· History
· Physical
· Labratory
· X-ray
· MRI
· Musculoskeletal Ultrasound
· Nerve Conduction Velocity
· JTech- Computerized Range of Motion and Muscle Testing
· Motion and Static Palpation
Only a MUA certified physician can determine if you are a candidate for MUA.
Indications and contraindications:
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Indications (possible candidates) |
Contra indications (not candidates) |
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*Contraindications to anesthesia as determined by current medical literature and are the responsibility of the licensed medical co-manager (the anesthesiologist). |
Explanation of the MUA Procedure and Technique:
Manipulation under anesthesia is performed under conscious sedation with the consideration of the anesthesiologists. The patient is given anesthesia (conscious sedation) selected by the anesthesiologist that is most appropriate based on their personal medical history. Two properly trained and qualified physicians take the patient through specific and controlled passive stretching techniques (flexion, lateral, rotation). These stretches are intense, and the range of motion is taken beyond the point of consciously tolerable pain. Deep tissue pressure, traction and muscle stripping are performed. Similar in thought to spray and stretch but at a much more deep and intense level; beyond what would be possible without being sedated. Specific joint mobilization (manipulations) are then performed. This helps to increase the range of motion of the vertebral segments and helps to eliminate the deposited fibrosis with in the joints and stretches the shortened fibrosed connective tissue within the joint to help restore normal motion. The patient is injected with anti-inflammatory medication and then is awakened from the anesthesia and taken to recovery and monitored.
Goals:
1. Eliminate the scar tissue in and around the joints and in the muscles.
2. Decrease chronic muscle spasm.
3. Increase the resting muscle, ligament and tendon length.
4. Eliminate chronic pain and radiating symptoms caused by damaged and scarred soft tissue (disc, ligaments, nerves, muscles, tendons, joints).
Importance of anesthesia:
When the conservative treatment of chronic pain of the spine becomes intolerabe, the benefit of being under anesthesia becomes obvious. Anesthesia is also important for:
· Shutting off the muscle spasm cycle to allow spinal movement.
· Allow complete muscle relaxation to allow the patient’s shortened muscles to be stretched beyond the point of consciously tolerable pain to break up adhesions caused by scar tissue.
· Sedate pain-perceiving nerves in the joints and muscles that have been irritated due to the dysfunctional spine.
Explanation of Post MUA Rehabilitative Care:
Shortly after the procedure the patient usually experiences a dramatic increase in range of motion and decrease in pain. However, it is essential to complete a post MUA rehabilitation program to assure a permanent resolution of chronic pain. In an effort to minimize the re-formation of adhesions, a post operative care program is prescribed for six to eight weeks such as:
· physiotherapy
· passive manipulation
· active rehabilitation exercises
· spinal stability exercise
With patients that have been in chronic pain for years, they become severely de-conditioned. As a result they may require an additional 6 to 8 weeks of re-conditioning, work conditioning and strength training.
Goals:
1. Address any inflammation associated with the procedure
2. Assure free interrupted movements of the spinal joints and muscles
3. Allow for correct healing of the affected regions
4. Strengthen the affected muscles
5. Eliminate the re-formation of adhesions
Supporting Studies
There are several research studies about the effectiveness of manipulation under anesthesia, including:
1. 83% of 600 patients with EMG verified radiculopathies reported significant improvement - Robert Mensor, MD
2. Patients that had back pain for a minimum of 10 years reported an 87% recovery rate after MUA - 1987 with Ongly et al
3. 51% of patients with unrelieved symptoms after conservative care had been exhausted reported good to excellent results three years post MUA - Donald Chrisman, MD
4. 71% of 723 MUA patients had good results (return to normal activity relatively symptom free) and 25.3% had fair results (return to normal activity with slight residuals) and that flexibility, elasticity and range of motion can be restored following MUA - Bradford and Siehl
5. 83% of 517 patients treated with MUA responded well - Paul Kuo, MD professor of Orthopedic Surgery
6. Krumhansi and Nowacek reported on an MUA study done on 171 patients who experienced constant intractable pain for several months to 18 years. All of the patients of the study failed other conservative intervention. The results of the study showed that 25% of the patients had no pain, 50% were much improved with pain markedly decreased, 20% were better and could tolerate their pain but it interfered with work and recreation. Failures comprised 5% where there was minimal or no pain relief periods.
The medical literature demonstrates that for over forty years chronic neuromuscular skeletal conditions that have failed the conservative protocol may respond well to manipulation under anesthesia. Researchers have reported the overall effectiveness of spinal manipulation under anesthesia with success rates varying according to case selection criteria.
Diagnosis of herniated disc: MUA outcomes reported excellent to good results in:
· 60% of cases - PC Colonna and ZB Friendenberg: 1949
· 64% of cases - Merrill C Mensor, MD: 1949
· 60% of cases - Donald Sielh, DC: 1963
Diagnosis of myofibrositis (Chronic inflammation, spasms and scar tissue in the muscle: MUA outcomes reported excellent to good results in:
· 96.3%-Donald Siehl, OD: 1963
· 75%- BR Krumhansi and CJ Nowacek: 1988
MUA has demonstrated similar success rates in treating migraine headaches.
· 5000 patients diagnosed with migraine headaches were treated with MUA.
· On long-term follow-up 90% were headache free following a series of 3 days of MUA.
Source: International Journal of Headache: Vol 9, Supplement 10; 1989. Proceedings of the IV International Headache Congress. Oct 14-18, 1989 Sydney, Australia.
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