Manipulation under anesthesia (MUA) is a noninvasive procedure to treat chronic pain unmanageable by other methods. MUA is designed not only to relieve pain, but also to break up excessive scar tissue. Scar tissue frequently builds up after orthopedic surgery, impeding movement of soft tissue and joints, so MUA is a valuable in re-establishing optimal range of motion. The patient normally goes through a series of examinations, including imaging tests and laboratory work, before undergoing MUA. These tests are necessary to precisely identify the targeted area and to ensure the patient’s ability to benefit from the procedure. MUA may be performed by a number of different types of medical professionals, but only those who have studied MUA and received certification in the technique.
Reasons For MUA
Though it may occasionally be used to alleviate acute pain, MUA is most often recommended for patients suffering from chronic musculoskeletal problems of the back, shoulder and knee. When more conservative treatments have not resolved the problem, MUA may be considered for the following conditions:
- Chronic musculoskeletal pain
- Spinal disc degeneration or herniation
- Myofascial pain syndrome
- Infant torticollis
- Chronic muscle spasms
- Frozen joints or restricted range of motion
- Ongoing pain or limited ROM after orthopedic surgery
- Nerve compression due to adhesion formation
- Chronic post-traumatic/whiplash syndrome
- Nerve entrapment
- Failed spinal surgery
The advantages of MUA involve the fact that the patient’s body is able to be manipulated therapeutically to a degree that would be too painful if the patient were not anesthetized.
The MUA Procedure
MUA is a multidisciplinary treatment, performed by at least two collaborating specialists in an outpatient surgical setting. Practitioners who participate, including orthopedic surgeons, chiropractors, osteopaths, and anesthesiologists, must have certification in MUA. MUA is administered to improve articular and soft tissue movement using controlled release, myofascial manipulation and mobilization techniques. All of this manipulation is done while the patient is sedated using monitorized anesthesia care (MAC). The patient may be under general anesthesia, local anesthesia administered by spinal injections, or may be sedated intravenously.
The MUA procedure varies in length depending on the number of areas of the body being treated. During the treatment, the patient’s joints are artificially articulated and put through their full ranges of motion and the limbs are stretched. Low intensity, repetitive stretching normally helps to break up internal scar tissue. In some cases, however, high impulse velocity thrusts may be performed to break barriers to movement. As scar tissue is broken down, joint restriction is reduced and muscle fibers are stretched, resulting in increased range of motion. In some cases, the patient undergoes the procedure again on another day. MUA may be repeated up to four times if necessary for maximum benefit.
Rehabilitation After MUA
Following the MUA procedure, the patient will experience an immediate increase in mobility, but will likely feel exhausted and sore. This is because during MUA the body undergoes a strenuous exercise session, even though the exercise is passive, performed by others. Rehabilitation should begin as soon as possible after MUA, typically within a week to 10 days, with a program of physical therapy appropriate to the individual patient. Rehabilitation programs usually include electrostimulation, ultrasound, heating and massage as well as physical therapy exercises. In many cases, rehabilitation will also include the use of a continuous passive motion machine (CPM) and cryotherapy treatment.
Contraindications For MUA
While MUA can be extremely beneficial, there are certain patients who should not receive this treatment. This includes patients who are of advanced age, who have had a stroke, and those who have:
- Bone or other cancer
- Uncontrolled diabetes
- Heart disease or uncontrolled hypertension
- Acute inflammatory arthritis
- Strep or staph infection
- Bone fracture
In the case of patients who have had previous compression fractures, the affected areas must be avoided during treatment.