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What is Manipulation Under Anesthesia?

Chronic pain sufferers in the Parkland, Coral Springs, Boca Raton, Coconut Creek and Margate areas are discovering the tremendous benefits of a procedure called Manipulation Under Anesthesia, or MUA.

manipulation under anesthesiaMUA is a non-invasive, highly-specialized technique performed by specially trained chiropractic physicians. After medical clearance, the patient is sedated to achieve a state of relaxation. This state of relaxation allows the doctor to complete a series of adjustments and stretching movements without patient apprehension or muscle congestion. The results for properly selected patients are phenomenal.

For patients who are not finding relief through conservative treatment (chiropractic or physical therapy) or who may be facing (or recovering from) surgery, MUA could be an effective alternative. Studies prove that MUA eliminates or greatly reduces pain, and it also restores or greatly improves range of motion. Compared to surgery and other procedures, the return-to-work and return-to-activity rates for MUA patients are significantly faster and longer lasting.

The History of MUA

MUA has been practiced since the late 1930s and used by osteopathic physicians and orthopedic surgeons for many years as a proven form of treatment for many chronic pain conditions. During the past several years, the use of MUA has greatly increased thanks to tremendous advances in both the technique and in anesthesiology.

Today, MUA is a multi-disciplinary outpatient procedure that takes place in a medical setting. Case studies continue to show that MUA is safe and effective.

Who Can Benefit from MUA?

MUA can be an effective procedure for people with chronic neck, back and joint problems. It is also effective for people with conditions caused by long-term disabilities or accidents, and for injuries that have not been responsive to conventional treatment. Here are some of the conditions MUA helps:

  • Fibro-adhesion buildup
  • Chronic disc problems
  • Herniated disc without fragmentation
  • TMJ
  • Intractable pain from neuromusculoskeletal conditions
  • Torticollis
  • Chronic re-injury
  • Failed back surgery
  • Frozen shoulder

How Does MUA Work?


MUA achieves results because it allows your caregivers to adjust the bones and muscles – the therapy of choice – without the usual resistance. Light sedation allows you to be responsive but not apprehensive.

Adjustments are completed gently. Fibrotic adhesions, which limit range of motion and contribute to pain, are altered. Muscles are stretched; and collagen fibers are remodeled to eliminate or reduce restriction. The result – pain and discomfort are decreased or eliminated. It is especially helpful for patients with facet related issues, that are not corrected with conservative chiropractic care or physical therapy.

How Do I Begin an MUA Treatment Plan?

MUAGenerally speaking, any chronic pain patient who has reached a plateau using traditional therapy should consider MUA. However, careful selection of qualified patients is a key to success. Your doctor will help determine if MUA is an option for you.

Once you are approved for MUA, you will need to complete a medical screening process so you can be cleared for light sedation. Your doctor will also decide whether you need one or more MUA procedures.

Medical tests usually will include:

  • CBC blood studies
  • SMA 6
  • Chest X-ray and EKG, or electrocardiogram, for patients 50 and older
  • A pregnancy test for female MUA patients.

Your doctor may also order additional tests, such as MRI, as needed. After medical clearance, your MUA procedure will be scheduled.

What Happens After the Procedure?

MUAPost-procedure care is one of the most important parts of the MUA procedure. Post-procedure care should begin soon after the MUA procedure is completed.

Typically, you will visit your doctor’s office and move through a combination of stretching exercises, followed by cryo-therapy and electrical stimulation. You then return home to rest.

Following your final MUA procedure (if more than one) you can maximize results by following a consistent post care therapy program for the next seven to ten days in the doctor’s office. You will be taken through the same stretches accomplished during the MUA procedure.

You will then continue rehabilitation for the next four to six weeks with 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 Kind of Results Can I Expect?

Hundreds of case studies indicate that MUA has a 85% to 90% success rate with carefully selected patients. Following the MUA procedure and consistent post-procedural care, chronic pain patients enjoy restored mobility and restored range of motion, plus greatly reduced pain or no pain at all.

They are able to return to work quickly as well as resume the activities and daily pleasures they had been denied because of pain.

The key is careful selection of qualified patients. If you’re in the Parkland, Coral Springs, Boca Raton, Coconut Creek and Margate area please call us for a free consultation to see if MUA is right for you.

Indication For Manipulation Under Anesthesia

MUASpinal 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.


  1. Bulging, protruded, prolapsed or herniated discs without free fragment and are not surgical candidates
  2. Frozen or fixated articulations
  3. Failed low back surgery
  4. Compression syndromes with or without radiculopathies caused from adhesion formation, but not associated with osteophyic entrapment
  5. Restricted motion, which causes pain and apprehension from the patient
  6. Unresponsive to manipulation and adjustment when they are the therapy of choice
  7. Unresponsive pain, which interferes with the function of daily life and sleep patterns, but which falls within the parameters for manipulative treatment
  8. Unresponsive muscle contraction, which is preventing normal daily activities and function
  9. Post-traumatic syndrome injuries from acceleration/deceleration or deceleration/acceleration types of injuries, which result in painful exacerbation of chronic fixations
  10. Chronic recurrent neuromusculoskeletal dysfunction syndromes, which result in a regular periodic treatment series, that are always exacerbation of the same condition
  11. Neuromusculoskeletal conditions that are not surgical candidates but have reached MMI especially with occupational injuries


  1. Any form of malignancy
  2. Metastatic bone disease
  3. TB of bone
  4. Acute bone fractures
  5. Direct manipulation of old compression fractures
  6. Acute inflammatory arthritis
  7. Acute inflammatory gout
  8. Uncontrolled diabetic neuropathy
  9. Syphilitic articular or periarticular lesion
  10. Gonorrheal spinal arthritis
  11. Advanced osteoporosis
  12. Evidence of cord or caudal compression by tumor or disc herniation beyond 5mm
  13. Osteomyelitis
  14. Widespread staph/strep infection
  15. Sign/symptom of aneurysm
  16. Unstable apondylolysis

Patient Evaluation/Screening

In addition to the parameters of patient selection, appropriate pre-MUA conservative procedures are required. This includes traditional chiropractic/manual therapy for a minimum of 4-6 weeks (2-4 in acute cases), plain film radiographs and advanced imaging study such as MRI, CT when required by the condition. Neurological and/or orthopedic evaluation, in conjunction with EMG/NCV/SSEP studies, in many cases are also performed. This provides cross-disciplinary evaluations that support the concept that this is a team effort. Also, any other appropriately recommended treatment options/testing would be considered at this time. Any other recommended treatment options/testing would be made available to the patient prior to undergoing the MUA procedure.

Just prior to the MUA procedure, a medical history and physical examination is to be performed to assure that the patient is capable of undergoing the procedure with no additional medical complications. Included with this evaluation should be an ASA standard testing for conscious sedation such as chest x-ray, EKG (if the patient is over 50, or if their physical condition warrants it), and pregnancy testing for females. An anesthesia interview is then provided. This is to assure that the anesthesia, Diprivan (Propofol), Versed and sometimes Fentanyl would be appropriate for the patient and if there are any projected complications from the anesthesia that should be addressed.

Contact Parkside Health & Wellness now to schedule an appointment and begin care today.

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