Discovering The Value & Effectiveness of Manipulation Under Anesthesia

By DR. ALIREZA Mirshojae

Discover the intricate world of chiropractic care and Manipulation Under Anesthesia (MUA) with 'Manipulation Under Anesthesia and Chiropractic Care.' This comprehensive guide offers a thorough exploration of chiropractic principles, assessment procedures, and treatment

• Language: English
• Publisher: DR. Alireza Mirshojae
• Release date: Mar 19, 2024
• ISBN: 9798869263445

Book preview

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Discovering the Value and Effectiveness of Manipulation Under Anesthesia (MUA)

Based on Insights from a Chiropractor with Over 30 Years of Experience

Disclaimer

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This is a work of creative nonfiction. The guidelines are portrayed to the best of the authors' intuition and experience. While all the information in this book is true, some names and identifying details have been changed to protect the people's privacy.

This eBook has been written for information purposes only. Every effort has been made to make this eBook as complete and accurate as possible. However, there may be mistakes in typography or content. Also, this eBook provides information only up to the publishing date, so it may not include some information about the author's business experience.

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Contents

Introduction

What Is Manipulation Under Anesthesia (MUA)?

Defining MUA

The Acute Condition

The Chronic Condition

Who Is a Chiropractor and What Do They Do?

History of MUA

Basic Principles of Chiropractic Care

Chiropractic Education

Fundamental Principles, Terms, and Concepts of the Human Body

Mechanics and Biomechanics

Levers

Body Planes

Axis of Movement

Joint Motion

Synovial Joints

Bony Elements

The Joint Function

How Scar Tissues are Formed

Vitamins that Aid Muscle and Soft Tissue Recovery

Mechanical Forces Acting Targeted Toward Connective Tissue

Tension Forces

Torque Forces

Shear Forces

Compression Forces

Muscles

Joint Assessment Principles and Procedures

The Manipulable Lesion

Subluxation

Models of Spinal Dysfunction

Biomechanical Model

Neurophysiological Model

Psychosocial Model

When Do You Need Manipulation Under Anesthesia?

How Painful is Manipulation Under Anesthesia?

Is Manipulation Under Anesthesia Safe?

What Conditions Do Chiropractors Usually Treat?

What Conditions Demand MUA?

Top 10 Main Reasons Patient's Come to See Me:

What Methods Do Chiropractors Use?

Technique 1: Dietary Management/ Exercise

Technique 2: Chiropractic Adjustment/Spinal Manipulation

Technique 3: Heat and Ice Therapy

Technique 4: Spinal Mobilization

Technique 5: Ultrasound Therapy

Technique 6: Cervical Adjustment

Technique 7: Traction

Technique 8: Spinal Decompression

Technique 9: Activator Method

When Not to Use MUA?

What are the Goals of Chiropractic Care?

How Do You Know It’s Time to Visit a Chiropractor?

Importance of Chiropractic Care in Medical Science

What Education Should Your Chiropractor Have?

What are the Benefits of Chiropractic Care?

Eases Back Pain

Improves Posture

Improves Neck Pain

Alleviates Headache Symptoms

Lowers the Need for Opioid Pain Relievers

Reduces Scoliosis Symptoms

Potential Reduction of Osteoarthritis Symptoms

Highly Affordable Solution for Chronic Back Pain

High Satisfaction

Assist in Athletic Performance

The Availability of Chiropractors around the World

What to Expect From Your First Chiropractor Visit?

1. ​Disclosing Patient History and Symptoms

2. ​Chiropractic Examination

3. ​Chiropractic Diagnosis

Why is MUA so Successful?

What Type of Anesthesia is Used for the MUA Procedure?

Who Benefits from MUA?

What Is It Like to Undergo the MUA Procedure?

What Happens Right Before the MUA Treatment?

What to Expect from Your MUA Appointment?

What Happens After the MUA Procedure? What to Expect About the Results?

Can You Walk or Drive after Undergoing MUA?

What Type of Anesthesia is Used in MUA Procedure?

Why is Preparation Important When MUA is a Safe Therapy?

Should You Fast Before the MUA Procedure?

Should You Keep Taking Your Medications?

How Much Anesthesia is Injected in MUA?

Do You Need to Inform the Anesthesiologist of Any Preexisting Conditions?

What Precautions Should You Take After Receiving Anesthetic?

What are the Biggest Complications of General Anesthesia?

What’s the Biggest Threat to the MUA Practice?

What are the Risks of Chiropractic Treatment?

How Should You Choose a Chiropractor?

Who They Are

What Methods Do They Use?

Seek Recommendations

Conduct an Interview With Your Potential Chiropractor to Discuss Your Health Condition

Conduct Background Research

Understand the Treatment Costs

Red Flags About Shady Chiropractic Treatment

Absence of Treatment Plan

Short Visits (The Biggest Red Flag)

One Session Treatment

A Brief Exam Leading to a Long-Term Contract

Suggesting Spinal Manipulation Under Anesthesia Solely on the Basis of Posture

Beware of These Mistakes Made By Inexperienced Chiropractors

Medical / Legal & Insurance Companies

Legal, Ethical and Professional Considerations for Chiropractic Clinicians

Candidacy for Spinal Manipulation Under Anesthesia

OJM (Osseous joint Manipulation) vs. STM (Soft Tissue Manipulation)

STM/Soft Tissue Manipulation

OJM/Adjustment/Osseous Joint Manipulation.

Day 1: Initial Visit to the Clinic

Useful One page Pre- or Post-MUA Evaluation Form

Day 2: The Surgical Center- Inside the Exam Room

The Next Steps for Day 2

Propofol

Warnings for Propofol Use

The Procedure of Receiving Propofol

Side Effects of Propofol

The Principal Mechanism for Spinal Adhesions

MUA Case Study: Treating a Senior Female Patient Through MUA

My approach to Mr. X

Patient; ​Mr. Spine X

Pre- & Post-MUA evaluation.

Post-MUA complications

Stress/Anxiety

Ankylosis

Nerve Conduction Studies and Electromyography

Soft Tissue Inflammation and Obesity

Level of Risk with Spinal Manipulation Under Anesthesia

Chiropractic Care and Ear Infections

Chiropractic Care and Pregnancy Pain

Surgical Center Protocol

Is Chiropractic Care Worth It?

Conclusion

Introduction

Most of us enjoy the early youthful years, staying active and energetic at all times. But as we age, pain cripples our life all of a sudden, taking away even the simplest of joys. Frozen shoulder, for instance, is a common condition involving pain and a reduction in the range of motion (ROM), leading to disrupted sleep and disability to work. In some cases, the condition can persist for years, with the shoulder never regaining its full function. When living with a limited range of motion and chronic pain in a situation like this, it's easy to feel like nothing can help. When the pain becomes unbearable, you don't enjoy spending time with friends, having a cup of coffee, romance, or any recreational activity. The various therapeutic measures used to treat a frozen shoulder include physiotherapy, intra-articular steroid injection (ISI), acupuncture, pain killers, arthroscopic capsular release, and manipulation under anesthesia (MUA). Among these, MUA has proven to be most effective in providing relief, not only for frozen shoulders but also for other cases such as knee surgery.

As a Chiropractor, practicing for over 30 years, I have focused on manipulation of joints and spine through Manipulation Under Anesthesia (MUA) and Medically Assisted Manipulation (MAM) since 2003. This book is a summary of my entire professional life as a Chiropractor. Starting with the definition and history of the practice, I will walk you through how Manipulation Under Anesthesia (MUA) got linked into Chiropractic and how chiropractors became the leading doctors serving these patients, and then move on to educate you on what to expect from the entire practice. I truly hope the book makes a positive contribution to Chiropractors, other physicians, specialists, and the general public.

What Is Manipulation Under Anesthesia (MUA)?

Defining MUA

Manipulation under anesthesia (MUA) is a noninvasive technique aimed at treating mainly chronic and less likely acute conditions such as joint, spinal, and muscular pain, and improving the range of motion and the function of the joint or the spinal Unit. It’s another form of physiotherapy & chiropractic manipulative technique that involves stretching, decompressing, and mobilizing the joints and muscles, but with the patient receiving and being under anesthesia. In other words, the practice combines soft tissue work and manual manipulation of a spine or joint with an anesthetic. Patients who can't endure manipulations due to muscle contractures, pain, guarding, or spasms benefit from the impact of anesthesia right before the practice. Anesthetics can include injection of a drug to the affected area, mild sedation or general intravenous anesthesia, inhaled anesthetics, oral medication like muscle relaxants, or some other kind of anesthetic medical therapy. Under anesthesia, the protective reflex mechanism of the patient remains absent. This makes it remarkably easier to manipulate using a combination of specific postural and articular kinesthetic maneuvers, passive stretches, and specific short lever manipulations to break up scar tissue and fibrous adhesions around the tissue and the joint. Thanks to the effect of anesthesia, pain sensations diminish, and spastic muscles are known to relax, thereby making manipulation through a full range of motion incredibly easy.

When it comes to manipulation under anesthesia for the spine, it’s intended for use with two general categories of pain conditions that are as follows:

The Acute Condition

MUA may be performed on the spine when a patient's pain is so debilitating and intense that the implementation of standard Chiropractic and/or medication management is precluded. To return the patient to their pre-injury condition as soon as possible, immediate relief is desired. Chiropractic literature suggests that MUA is not normally applied in the case of acute trauma, but if performed, no more than a single dose would be needed to return the person to office-based care. Besides, when treating acute musculoskeletal conditions, the application of non-consecutive or intermittent MUA procedure doses may also be justified, in addition to the single procedure dose approach.

The Chronic Condition

When a patient's pain turns out to be of limited responsiveness to traditional office-based manipulative procedures, and if the condition has a measurable damaging impact upon functionality, MUA is indicated for a chronic condition. The MUA treatment, in this case, is targeted to eliminate the fibrotic adhesions known to have altered the person's ability to carry out routine activities compared to their pre-injury levels. When determining the degree to which physical helplessness may warrant MUA implementation, it has been found that condition intensity leads to impossible patient engagement in therapeutic exercise. When other conservative care methods have been exhausted, and the final scene of the patient decision of MUA versus surgery has been reached, that's when the MUA procedure is most appropriate.

Over the past decade, the recognition of spinal manipulation as a reasonable technique to treat patients with spinal pain has revived the interest and encouraged the use of these tactics performed in conjunction with commonly used procedures and medications. Manual therapy is widely being used along with analgesics,