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        Manipulation Under Anesthesia 
            Chiropractic Under Sedation
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Dr. Fishman is performing a
lateral flexion cervical MUA

   What is MUA?
Manipulation Under Anesthesia is exactly what it sounds like. After medical clearance, a patient is lightly anesthetized to achieve total relaxation, then adjustments and stretching movements - which would normally be too painful to even consider are easily, painlessly and quickly accomplished. MUA, combined with consistent, but simple post-procedure treatment and exercise, can eliminate or greatly reduce pain and restore or greatly improve range of motion. Plus, MUA procedures are cost-effective…thousands of dollars less than traditional surgery and other more invasive treatments - and usually qualify for insurance coverage. In addition, recovery is much faster, allowing MUA patients to get back to work, and the pleasure of living, much sooner than expected.





Is MUA new or experimental?
MUA is neither new nor experimental. It's actually been practiced since the late 1930s and used by osteopathic physicians and orthopedic surgeons for many years as a proven form of treatment. During the past eight years, interest in MUA has greatly increased thanks to tremendous advances in anesthesiology. Today, MUA is a multi-disciplinary outpatient procedure that takes place in a controlled hospital or ambulatory surgical setting, usually over the course of one to three days. Using specialized chiropractic techniques, supported by the expertise of MDs, RNs and anesthesiologists, MUA achieves maximum results for qualified patients. Countless recent case studies and medical research continue to show that MUA is widely regarded as safe and effective and is gaining acceptance by the medical community at large.

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: 

       Fibro adhesion buildup
       Chronic disc problems
       Herniated disc without fragmentation
       Chronic myofascitis
       Intractable pain from neuromusculoskeletal conditions
       Torticollis
       Chronic re-injury
       Failed back surgery
       TMJ (temporomandibular joint)

Dr. Fishman is performing a
cervical traction MUA

 MUA achieves results where other treatments fail because it allows your caregivers to adjust the bones and muscles - the therapy of choice - without the usual resistance. "Twilight" sedation allows you to be responsive, but not apprehensive. Manipulations are completed gently and without the patient's usual psychological resistance. Fibrotic adhesions, which limit range of motion and contribute to pain, are altered; muscles are stretched; collagen fibers are remodeled to eliminate or reduce restriction. Pain and discomfort are decreased. The adjustments received using MUA are the same as those the patient experiences during regular chiropractic visits, but require less force simply because of the relaxed state.

How do I begin an MUA treatment plan?
Using standards of care as described by the National Academy of MUA Physicians, the chiropractor selects patients. 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 and older
       A pregnancy test for female patients

Your chiropractor may also order additional tests, such as an MRI, or magnetic resonance imaging, CT (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's the MUA procedure like?

On the day of the MUA, the patient must be accompanied by a friend or family member to drive the patient home after the procedure. No patient will be allowed to drive following this procedure. The patient then confers with the anesthesiologist, is gowned and the sedative - usually Diprivan and/or Versed (and sometimes Fentanyl) - is administered to achieve the comfortable "twilight" sleep that makes treatment possible. If the full spinal procedure is performed, MUA begins with specialized techniques that first methodically start in the cervical spine with gentle axial traction, forward flexion and lateral flexion movements followed by adjustive procedures. The doctor then moves on to the thoracic spine, using mild stretching techniques and adjustment and finally into the lumbar spinal regions using flexion and traction techniques, plus stretching, targeted massage and knee-to-chest rolls, as well as lumbar adjustment.

Dr. Fishman is performing a
lumbar and gluteal MUA

What happens after the procedure?
After the procedure is completed, the patient is repositioned and awakened then taken to recovery, where he or she is carefully monitored by the O.R. nurse. Recovery time is generally 15-20 minutes. After recovery, the patient receives fluids and a light snack. The doctor and anesthesiologist also remain in attendance until the patient is discharged. To achieve results in most chronic cases, the MUA procedure is repeated. The doctor may adjust only the area of abnormality plus the adjacent area, the adjacent area only, or all three areas, depending on the doctor's assessment of the condition. Post-procedure care is one of the most important parts of the MUA procedure and makes it truly effective. The therapy begins immediately - the same day - after each MUA procedure is completed. At this time, the patient visits the chiropractor's office and undergoes a combination of stretching exercises, cryo-therapy and electrical stimulation to e liminate or reduce soreness. The patient then returns home to rest. Following the last MUA procedure, the patient should follow an intensive therapy program for 7 to 10 days. This post MUA therapy should be the same stretches accomplished during the MUA procedure and adjustments made in the doctor's office. This is followed by rehabilitation for the next two to three weeks, including stretching, flexibility and strengthening exercises, plus periodic adjustments as required by the doctor. A regimented program of post-MUA therapy will help the patient regain both pre-injury strength and help prevent future pain and disability.