Manipulation Under Anesthesia: For acute and chronic pain sufferers across south Florida, a simple and painless procedure is offering a level of relief never dreamed possible. Instead of allowing patients that failed to respond to conservative care slip into a cycle of drugs and surgery, Dr. Schwartz is giving them the opportunity to live pain free lives through a procedure known as Manipulation under Anesthesia (MUA). Manipulation of the spine with the patient sedated is one of the most gentle and most effective methods of alleviating chronic conditions. MUA provides adjustments and stretching of the spine and surrounding tissue in an atmosphere where the patient is more responsive and less apprehensive, therefore eliminating resistance and muscle contracture. Established and widely recognized in the manual medical arena for more than sixty years, MUA is a viable alternative for patients that do not respond to traditional care or invasive surgical procedures. The MUA procedure continues to gain widespread support and recognition in the medical community and is helping to bring much-needed relief to a greater patient base than ever before. This is a comprehensive guide to manipulation under sedation through the procedure of Manipulation Under Anesthesia. (MUA).

Manipulation under sedation involves a procedure called "Manipulation Under Anesthesia"

What is Manipulation Under Anesthesia?

Manipulation Under Anesthesia, otherwise known as MUA, is a non-invasive procedure increasingly offered for chronic conditions, including: neck pain, back pain, joint pain, muscle spasm, shortened muscles, fibrous adhesions and long term pain syndromes.

By sedating a patient, once painful adjustments and movements are accomplished quickly and pain free helping to greatly improve or even restore range of motion.

Manipulation Under Anesthesia is a viable alternative for those patients that are not responding to traditional conservative care of other invasive procedures such as surgery.

What is the history of Manipulation Under Anesthesia?

Manipulation Under Anesthesia is an established and widely recognized procedure that has been part of the manual medical arena for more than sixty years.

The practice of MUA can be traced back to the late 1930’s and its popularity has continued to grow in recent years as research has shown that MUA is not only safe, but also highly successful in treating acute and chronic musculoskeletal conditions.

Are there any studies that support Manipulation Under Anesthesia?

Bradford & Siehl reported on 723 MUA patients, the largest clinical trial conducted on MUA procedures, that 71% had good results, and that 25% had fair results and 4% ultimately required surgical intervention.[1]

Krumhansl and Nowacek reported on 171 patients who experienced constant intractable pain, of durations from several months to 18 years, and who underwent Manipulation Under Anesthesia. All patients had failed at previous conservative interventions. Results reported that post MUA, 25% had no pain at all and were “cured”, 50% were “much improved” with pain markedly reduced and ADLs essentially unaffected, 20% were “better but” pain continued to interfere with activities and finally 5% had minimal or no relief.[2]

West et al reported in a 1998 study of 177 patients that 68.6% of patients out of work returned to unrestricted work activities after a series of three consecutive MUA procedures at 6 months post MUA, that 58.4% of the MUA patients receiving medications prior to the procedure required no prescription medication post procedure and finally that 60.1% of patients with lumbar pain resolved post MUA series of procedures.[3]

[1] SIEHL D, BRADFORD W (1952). "Manipulation of the low back under general anesthesia". J Am Osteopath Assoc 52 (4): 239-42.

[2] Krumhansl BR, Nowacek CJ: Manipulation under anesthesia. In: modern manual therapy of the vertebral column. Edinburgh: Churchill Livingstone. 1986.

[3] West, D.C., C.C.R.D., Mathews, M.D., Miller, PA-C, Kent, M.D. "Effect of Management of Spinal Pain in 200 Patients Evaluated for Manipulation Under Anesthesia." J. Neurol Oethop Med Surg. (1998) 18: pp. 31-42.

Neuromuscular Re-education: In general, patients selected for Manipulation Under Anesthesia are those with certain neck, mid-back, low-back or other spinal conditions that have received conservative care for six to eight weeks with limited or no improvement in symptoms or findings.

MUA may also be appropriate for those patients that still experience pain after undergoing various invasive treatments such as surgery.

Common indications for Manipulation Under Anesthesia include but not limited to:

• Neck, middle and lower back pain
• Chronic muscle pain and inflammation including polymyalgia
• Chronic muscle spasm
• Chronic fibrositis including fibromyalgia
• Nerve entrapment
• Disk pathology including herniated disks and bulging disks
• Torticollis
• Failed back surgery
• Intractable pain from neuromusculoskeletal conditions
• Chronic re-injury
• Frozen shoulder
• Frozen elbow
• Frozen knee

Not all patients qualify for MUA as certain contraindications prevent some from undergoing the procedure. Dr. Schwartz will consult with you to
determine if you are a candidate for this procedure.

Who would be a candidate for Manipulation Under Anesthesia?
The Manipulation Under Anesthesia procedure involves three consecutive days of treatment. During these three days a patient is treated with spinal manipulative therapy and MUA stretches. Since the patient is lightly sedated during the MUA procedure, the usual resistance and pain associated with manipulation is eliminated. Through the use of “conscious sedation,” a patient is conscious and responsive, but relaxed, allowing the physician to administer adjustments similar to those received during regular chiropractic visits but more effectively.

What is Manipulation Under Anesthesia procedure like?

Post-Procedure care is a vital part of the MUA procedure. After the procedure, treatment continues as strengthening and stabilization programs are initiated over the next few weeks. Follow-up visits with Dr. Schwartz or with your chiropractor are important at this time as the stretches accomplished during the MUA procedure are built upon, helping the patient to regain strength and prevent future pain and discomfort.

Post-procedure care should begin soon after the MUA procedure is completed. You will return to Dr. Schwartz or your doctor's office where you will then begin rehabilitation for the next four to six weeks including cryo therapy and muscle stimulation early on followed by stretching, flexibility and strengthening exercises, plus regular adjustments as suggested by your doctor. A consistent program of post-MUA therapy will help you regain pre-injury strength and help prevent pain and disability in the future.

What happens following the MUA procedure?

The Manipulation Under Anesthesia procedure is performed at an Ambulatory Surgical Center. The center’s Dr. Schwartz enjoys privileges are of the highest standard and quality. Here patients receive the best in comprehensive, personalized care as well as the convenience and privacy of a same day surgical center.

All center’s facilities include fully-equipped, State Licensed and Medicare Certified operating rooms, Board Certified Anesthesiologists/ Anesthetists, monitored recovery rooms, spacious waiting areas for a patient’s family and friends, plenty of onsite parking, handicap accessibility and complimentary patient transportation if needed.

Where is the Manipulation Under Anesthesia procedure performed?
Those involved during the MUA procedure include Dr. Schwartz D.C., the Board Certified Anesthesiologist, and an MUA certified M.D. or D.O.

Who Performs the Manipulation Under Anesthesia procedure?
Sound vibrations to increase cell activity which cleans the tissue so the injured tissue heals faster and more completely.

What are the effects of Manipulation Under Anesthesia procedure?

The proposed effects of Manipulation Under Anesthesia therapy include the following:

• Breaking up scar tissue (adhesions) both in and around the spinal joints, commonly caused by multiple injuries or failed back surgery.
• A decreasing chronic muscle spasm
• Overcoming super-sensitivity of injured areas, making the patient unable to cooperate for effective treatment
• Stretching persistent shortened muscles, ligaments and tendons
• Relief from pain and radiating symptoms caused by damaged intervertebral discs.
• Most importantly however, Manipulation Under Anesthesia affords patients immediate relief and noticeable difference in their daily lives post-procedure.

These positive results only continue to improve with time and post-MUA therapy.

My doctor says I am a candidate for MUA…

Patients who have been selected for Manipulation Under Anesthesia Procedure by Dr. Schwartz or their doctor typically undergo a medical screening process to determine true MUA candidacy.

This screening process includes a medical history and physical examination and where indicated, CBC blood studies, chest X-Rays, EKG’s and other diagnostic tests such as MRI or CT’s.

Once a patient is cleared and medical necessity for MUA is determined, Schwartz Chiropractic Center along with the surgical center assists in pre-certification and scheduling the procedure dates and times. The surgical center will also handle the explanation of all pre and post-operative instructions, answer any questions the patient may have about the procedure and arrange transportation for the patient if necessary. At Schwartz Chiropractic Center, we pride ourselves on working with our patients to make their MUA experience as hassle free, comfortable and successful as possible!

What if I am already under care but my doctor does not perform the MUA procedure?
A patient can come in for a consultation with out a referral. If the patient qualifies as a candidate for the Manipulation Under Anesthesia procedure Dr. Schwartz can perform the procedure and refer you back to your chiropractor for the necessary post procedure care.

E-mail: spinedrdave@browardchiropractor.com