Manipulation Under Anesthesia (MUA)

While considered a normal reaction to injury, scar tissue and similar fibrous growths sometimes contribute to back or neck pain. A non-invasive procedure that can remove these tissues is called manipulation under anesthesia (MUA). It’s a series of stretching, traction, and mobilization techniques performed while the patient is under either moderate sedation or general anesthesia. The purpose of MUA is to improve flexibility in the affected area by removing problematic scar tissue.

Why Consider Manipulation Under Anesthesia?

MUA is recommended to ease pain related to scar tissue that can occur as a result of acute and chronic pain conditions. Fibrous tissue may form in areas where muscle spasms frequently occur as a response to persistent inflammation and irritation. It can also affect areas of the spine around joints and individual vertebra, especially where there is disc herniation or nerve irritation. It may also be worth considering if you’re experiencing:

  • Frequent neck pain that’s not easing with other treatments
  • Recurring pain around knee and shoulder joints
  • Pain related to shortened muscles
  • Chronic or worsening pain around other joints (elbows, hips, fingers, ankles)
  • Persistent discomfort from long-term pain syndromes
Manipulation Under Anesthesia MUA Silicon Valley Medical Group 1 - Manipulation Under Anesthesia (MUA)
Manipulation Under Anesthesia MUA Silicon Valley Medical Group 2 - Manipulation Under Anesthesia (MUA)

How Does Manipulation Under Anesthesia Work?

Manipulation under anesthesia is a passive stretching technique. This means it’s something that’s done to the patient and does not require active participation to be effective. It’s an outpatient procedure that may be performed with mild sedation. Some patients prefer to have the manipulation done under general anesthesia. In some situations, an anesthetic solution is injected into specific tissues in the affected area of the spine.

Prior to the procedure, patients often undergo diagnostic testing that includes X-rays, CT scans, and MRIs. This is done so the specific area where scar tissue is located can be identified. Such tests will also determine whether or not there are other factors contributing to a patient’s pain. Nerve conduction velocity tests and musculoskeletal sonograms may also be performed to further identify potential pain sources.

During the procedure, joints are gently moved or manipulated. These gentle movements break up fibrous tissue or thick scar tissue. Patients may benefit from consecutive daily treatments if there is significant scar tissue around joints. Steroid injections are sometimes used at the same time. Such injections contain medication that eases inflammation around joints. Reducing inflammation sometimes makes it easier to perform manipulations. Muscles and tissues that aren’t inflamed may also respond better to MUA.

Who May Benefit from MUA?

Suitable candidates for manipulation under anesthesia are patients not experiencing significant relief from conservative (non-surgical) pain management techniques. Physical therapy alone and various pain and anti-inflammatory medications will not have any effect on joints where thick scar tissue has built up over time. Ideal candidates are patients who have:

  • Tried traditional remedies without significant success for 6-8 weeks or more
  • Experienced only temporary improvements with chiropractic care or the use of other therapeutic manipulations
  • Limited mobility around certain joints due to scar tissue buildup

What Are Possible Results from MUA?

Patients who are receptive to manipulation under anesthesia may experience relief as muscles relax in the affected area. MUA may also turn off the muscle spasm cycle and allow patients to get regular exercise or actively participate in physical therapy without disruptive discomfort. Sensitivity around joints may also be reduced as scar tissue breaks up and flexibility increases.

Is It Considered Safe?

The technique of manipulation under anesthesia is not new. It has been performed in one form or another for more than 50 years. It is an established and reliable medical procedure with positive results well-documented in various studies. MUA is performed in a way that does not stress muscles or other soft tissues. Because of the way the technique is done, it is generally considered a safe and effective pain management technique. It is widely used to treat pain affecting the lumbar, cervical (neck), and thoracic (upper- and middle-back) spine, and pelvic region.

Scar tissue can be beneficial since its meant to protect healing tissues. It becomes a problem when it becomes too thick and limits movements of the affected bone, muscle, tendon, or joint. Manipulation under anesthesia tends to be more effective for isolated joint conditions rather than widespread or non-specific pain. It’s sometimes used to treat fractures of the spine and dislocations, but the technique can be applied to most joints in the body. Continuing with physical therapy after MUA may further increase range of motion and ease pain as supporting muscles become stronger.

Manipulation Under Anesthesia MUA Silicon Valley Medical Group 3 - Manipulation Under Anesthesia (MUA)

What to Expect After a Trigger Point Injection

After you receive a trigger point injection from our doctors, pressure will be applied to the injection site for about two minutes. This allows your blood to flow through the area. The affected area will be palpated to check for any other painful trigger points. If our doctors find another trigger point in the same area, it can also be injected. After the two minutes of pressure, our doctors will show you how to gently stretch the muscle containing the trigger point. This stretching will facilitate the pain relief. You will move your muscle through its full range of motion about three times, with instructions given to you by our doctors. A simple bandage will be applied to each injection site. Pain relief should be nearly instantaneous. Avoid strenuous activities for three to four days after your injection.