Manipulation Under Anesthesia—What is it, and When is it Appropriate?

As the term describes, manipulation under anesthesia (MUA) is a procedure undertaken by a medical team in which a chiropractic manipulation is performed while the patient receives some sort of anesthetic, ranging from mild sedation to general anesthesia. It is commonly performed in cases of acute or chronic spinal pain, where the condition has not improved after six to eight weeks of conservative treatment.

MUA is a non-invasive way of breaking down the fibrous adhesions and scar tissue that may have accumulated around the spine and the tissues in the area surrounding it as a result of past or present injuries. In addition to helping relieve back and neck pain, it is often used to help stretch shortened muscles and alleviate chronic muscle spasms, joint pain and other long-term pain issues. It can also reduce the level of pain in areas that are super-sensitive, which keep the patient from being able to fully cooperate in his treatment.

Licensed physicians perform the procedure as a team in a hospital or medical center, and this team includes the anesthesiologist, the chiropractor or surgeon who performs the manipulation and an assistant who is also a chiropractor or physician who is certified to practice manipulation under anesthesia. The American Medical Association lists MUA as an established medical procedure, and it is a technique that has been used in conventional medical practice for over 60 years.

Patients who are selected to receive MUA must first have had non-invasive treatment for their condition that has proven to be ineffective for at least six weeks, and the patient must be made fully aware of both the risks and benefits of the procedure. Patients with one or more of the following conditions are considered to be candidates for MUA:

• Mid back and lower back pain

• Neck pain

• Chronic muscle pain and inflammation

• Nerve entrapment

• Acute and chronic muscle spasms

• Decrease in range of motion in the spine

• Fibromyalgia

• Chronic occipital or tension headaches

• Pseudo-sciatica

• Sciatica where disc bulges are less than 5 mm contained

• Unsuccessful back surgery

• Conditions where narcotic pain relievers have been ineffective

• Traumatic torticollis

• Reflex Sympathetic Dystrophy (RSD)

MUA may not be appropriate for patients with bone disorders, circulatory problems and neurological or cardiovascular disorders, such as fractures, arthritis, gout, malignancies with bone metastasis and diabetic neuropathy.

Studies have shown that many chronic pain problems that have not responded well to other conservative treatments respond well to MUA. If you feel you may be a good candidate for the procedure, contact your chiropractor, who will take your detailed medical history, evaluate any diagnostic testing that may have been performed (such as a CT scan, MRI or ultrasound), and perform a thorough physical examination to determine if MUA may be right for you.