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What is Manipulation under Anesthesia (MUA) and How Can It Help Me?

Documentation regarding the success and value of MUA has been recorded in the Osteopathic literature since 1948, when Clybourne reported in the Journal ofthe American Osteopathic Association a success rate of 80-90%. MUA, performed by Dr. Michael Shah, M.D., is a non-invasive procedure increasingly offered for acute and chronic neck pain, back pain, and extremity joint pain; along with attending limitations in ranges of motion and restrictions in daily activities. It is performed only on those patients that meet all of the requirements to be considered a candidate for the procedure.

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 of 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 joint mobilization and manipulation in conjunction with anesthesia to perform passive stretches, specific articular joint manipulations, and postural 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 can be directly responsible for the chronic pain, losses of motion, joint weakness, and difficulties in performing daily activities.

What Is The Cause of My Chronic Pain?

The basis of the symptoms associated with chronic pain often results from the natural healing and repair processes of the body. When damaged or injured, soft tissue (muscles, ligaments, tendons, and discs) heals with scar tissue, that tissue is not flexible and can limit or interrupt movement of the muscles and joints creating pain. This pain can become a common occurrence, or constant, and will vary in sensation (dull pain, ache, stiffness, burning, throbbing, radiating into arms or legs, and may causeheadaches, dizziness, nausea, blurred vision and even migraines). Fibrotic repaired tissue is oftentimes not only more sensitive, it is also weaker and less elastic than the original tissue. Studies show that untreated scar tissue (adhesions) may even cause and accelerate degenerative joint arthritis.

How Do You Know if You Need MUA?

After completion of a thorough examination, including MRI, X-ray and other diagnostic procedures, a specially trained doctor may determine that MUA can be implemented to help reduce or eliminate the condition.

How Does Anesthesia Help the Manipulation?

When movement is extremely and intolerably painful, the benefit of sedation is obvious, but the anesthesia performs other important functions, such as:

  • Shuts off the muscle spasm cycle to allow extremity joint andspinal movement.
  • Sedates the pain perceiving nerves that have been irritated in and around the painful joint region.
  • Allows for complete muscle relaxation to allow the doctor to stretch shortened muscle groups and to influence adhesions caused by scar tissue.


Who Can Benefit From MUA?

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:

  • Frozen Shoulder
  • Sciatica
  • Fibro-adhesion Buildup
  • Chronic disc problems or Bulging
  • Herniated disc without fragmentation
  • Chronic Myofascitis
  • Intractable Pain from Neuromusculoskeletal Conditions
  • Chronic Re-injury
  • Failed Back Surgery
  • Reduced Range of Motion

What Can I Expect with Manipulation Under Anesthesia?

Once a patient is selected by the physician, 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+
  • A Pregnancy Test for Female MUA Patients

Your physician may also order additional tests, such as MRI (Magnetic Resonance Imaging), CT or (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 Is the Procedure Like?

The evening before each procedure, the patient must not consume any food or liquids after midnight. On the day of the MUA, the patient must be accompanied by a friend or family member to drive the patient home afterwards. MUA is not an invasive surgery and the actual procedure is very gentle. An intravenous catheter is inserted into the patient’s arm and a small amount of anesthesia is administered by a qualified anesthesiologist. The procedure lasts approximately twenty (20) minutes. After the patient is gently sedated, the muscles and tissue affecting joint function are stretched and the fixated joints are mobilized to restore ranges of motion. The patient wakes up quickly thereafter and is monitored by qualified personnel, and must eat before the patient is ready to be discharged. Most MUA’s are performed over three (3) consecutive days to ease into the painful areas.

Post-Procedure Care

Post-procedure care is one of the most important parts of the MUA procedure and what can make it truly effective. After the last MUA procedure, the patient should follow an initial intensive therapy program for seven (7) to ten (10) days consisting of the same stretches and mobilization techniques accomplished during the procedure. A personally-designed rehabilitation program follows for the next four (4) to six (6) weeks and includes stretching, flexibility, and strengthening exercises. This regimented post-MUA therapy can help the patient regain pre-injury strength and help prevent future pain and disability. Statistics show that patients who do not follow their prescribed rehabilitation program have a recurrence of their initial problems in more than 50% of the cases.

What You Can Expect

Understandably, many patients experience varying degrees of soreness after having an MUA procedure. With post-procedure rehabilitation, most patients are able to resume activities that they were unable to participate in due to the constant pain they were living with. Their need for pain medication can be reduced and in many cases eliminated from their daily routine.


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