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Manipulation Under Anesthesia (MUA) is multidisciplinary manual therapy treatment
system which is used to improve articular and soft tissue movement using specifically
controlled release, myofascial manipulation, and mobilization techniques while the patient
is under moderate to deep IV sedation using monitorized anesthesia care (MAC)[1]
This procedure is used by specially trained chiropractors and orthopedic surgeons as a
means of breaking up scar tissue around a joint without complete range of motion. In
cases of post operative total knee replacement, for example, if a patient is having difficulty
achieving their flexibility after a 6-8 week period, the surgeon may elect to bring the patient
back to the operating room, place them under anesthesia and perform a manipulation
under anesthesia. The procedure takes a relatively short period of time (15- 20 min) and
the surgeon can gain improved range of motion for the patient. This can also be performed
for other orthopedic musculoskeletal limitations, as indicated. Knee manipulation under
anesthesia (MUA) is indicated for total knee arthroplasty (TKA) patients who have not
obtained at least 90º of flexion by the 6th postoperative week.
system which is used to improve articular and soft tissue movement using specifically
controlled release, myofascial manipulation, and mobilization techniques while the patient
is under moderate to deep IV sedation using monitorized anesthesia care (MAC)[1]
This procedure is used by specially trained chiropractors and orthopedic surgeons as a
means of breaking up scar tissue around a joint without complete range of motion. In
cases of post operative total knee replacement, for example, if a patient is having difficulty
achieving their flexibility after a 6-8 week period, the surgeon may elect to bring the patient
back to the operating room, place them under anesthesia and perform a manipulation
under anesthesia. The procedure takes a relatively short period of time (15- 20 min) and
the surgeon can gain improved range of motion for the patient. This can also be performed
for other orthopedic musculoskeletal limitations, as indicated. Knee manipulation under
anesthesia (MUA) is indicated for total knee arthroplasty (TKA) patients who have not
obtained at least 90º of flexion by the 6th postoperative week.
Training
Currently MUA certification courses offered through accredited chiropractic college post graduate departments are recognized by malpractice
carriers for inclusive coverage. It has been important to regulatory agencies, academic institutions, professional associations and organizations
and malpractice carriers to recognize appropriate training programs. Towards that end, specific criteria have been adopted to establish credible
certification course offerings. Standards and protocol establishing credible certification training programs are recognized by the National MUA
Academy of Physicians and the International Academy of MUA Physicians and are subscribed to by the accredited academic institutions offering
post graduate certification in Manipulation Under Anesthesia.
Evidence basis
* “In a first study by Siehl ad Bradford published in 1952, 33 percent of the patients … demonstrated good (symptom-free) results.” Page 294
* “Siehl’s followup study … 96 percent reported successful (good or fair) outcomes.”
* “In Chrisman’s study 83 percent of the subjects reported good or excellent result after a 3-year follow-up.” Page 294
* “In Morey’s 1973 review … treating physician reported excellent or good results in 85 percent of the cases.” Page 294
* “In a study published in 1986 by Krumhansel and Nowacek … outcomes were reported as 25 percent ‘cured’, 50 percent ‘much improved’, and
20 percent ‘better, but’. Page 294
* “In a 1990 article by Mennell … 30 percent with symptoms cured, 35 percent with marked improvement, 29 percent with moderate
improvement…” Page 294
* “In a recent case series by West et al … VAS scores improved 4.6 points for cervical pain and 4.31 points for lumbar pain. Decrease in time off
work and less use of prescription pain medication were also reported.” Page 294
* “We have been unable to find any report of complications using more modern osteopathic and chiropractic techniques or as a result of the use
of anesthesia.” Page 297 [3]
In addition, for over 30 years now, the collection of MUA procedures (including hip, pelvis, spine, and back among other body regions), has been
listed as a Category I CPT [4] code in the AMA Codebook of Reimbursable Procedures.[5]. The introduction of that book notes that in order to
qualify as a Category I code, "the clinical efficacy of the service/procedure is well established and documented in the United States per review
literature." This was later reaffirmed by the AMA, where they noted that simply by having a Category I code, a procedure, by definition is not
experimental and has a well established clinical efficacy.
History
MAM has been used since then 1930s, and MUA was practiced by osteopaths and orthopedic surgeons in the 1940s and 1950s. It was largely
abandoned due to complications from general anesthesia and due to the type of nonspecific manipulation procedures used. It was modified and
revived in the 1990s, primarily by chiropractors, and also by osteopaths; this was likely due to safer anesthesia used for conscious sedation,
along with increased interest in SM..
Currently MUA certification courses offered through accredited chiropractic college post graduate departments are recognized by malpractice
carriers for inclusive coverage. It has been important to regulatory agencies, academic institutions, professional associations and organizations
and malpractice carriers to recognize appropriate training programs. Towards that end, specific criteria have been adopted to establish credible
certification course offerings. Standards and protocol establishing credible certification training programs are recognized by the National MUA
Academy of Physicians and the International Academy of MUA Physicians and are subscribed to by the accredited academic institutions offering
post graduate certification in Manipulation Under Anesthesia.
Evidence basis
* “In a first study by Siehl ad Bradford published in 1952, 33 percent of the patients … demonstrated good (symptom-free) results.” Page 294
* “Siehl’s followup study … 96 percent reported successful (good or fair) outcomes.”
* “In Chrisman’s study 83 percent of the subjects reported good or excellent result after a 3-year follow-up.” Page 294
* “In Morey’s 1973 review … treating physician reported excellent or good results in 85 percent of the cases.” Page 294
* “In a study published in 1986 by Krumhansel and Nowacek … outcomes were reported as 25 percent ‘cured’, 50 percent ‘much improved’, and
20 percent ‘better, but’. Page 294
* “In a 1990 article by Mennell … 30 percent with symptoms cured, 35 percent with marked improvement, 29 percent with moderate
improvement…” Page 294
* “In a recent case series by West et al … VAS scores improved 4.6 points for cervical pain and 4.31 points for lumbar pain. Decrease in time off
work and less use of prescription pain medication were also reported.” Page 294
* “We have been unable to find any report of complications using more modern osteopathic and chiropractic techniques or as a result of the use
of anesthesia.” Page 297 [3]
In addition, for over 30 years now, the collection of MUA procedures (including hip, pelvis, spine, and back among other body regions), has been
listed as a Category I CPT [4] code in the AMA Codebook of Reimbursable Procedures.[5]. The introduction of that book notes that in order to
qualify as a Category I code, "the clinical efficacy of the service/procedure is well established and documented in the United States per review
literature." This was later reaffirmed by the AMA, where they noted that simply by having a Category I code, a procedure, by definition is not
experimental and has a well established clinical efficacy.
History
MAM has been used since then 1930s, and MUA was practiced by osteopaths and orthopedic surgeons in the 1940s and 1950s. It was largely
abandoned due to complications from general anesthesia and due to the type of nonspecific manipulation procedures used. It was modified and
revived in the 1990s, primarily by chiropractors, and also by osteopaths; this was likely due to safer anesthesia used for conscious sedation,
along with increased interest in SM..